Serial transverse enteroplasty

Serial Transverse Enteroplasty (STEP) is a surgical procedure used to lengthen and taper the small intestine in patients with Short Bowel Syndrome (SBS). This condition often results from the surgical removal of a large portion of the intestine, which can lead to difficulties in nutrient absorption and digestion. The STEP procedure aims to increase the absorptive surface area of the remaining intestine, thereby improving the patient's nutritional status and reducing dependence on parenteral nutrition.

Indications

Serial Transverse Enteroplasty is indicated for patients with Short Bowel Syndrome who are experiencing significant nutritional and metabolic complications despite optimal medical and nutritional management. Candidates for STEP typically have less than 100 cm of small intestine remaining, with or without the presence of the ileocecal valve.

Procedure

The STEP procedure involves making sequential, alternating transverse and longitudinal cuts along the dilated segment of the small intestine and then stapling these cuts together. This process creates a longer and narrower segment of intestine, which can improve peristalsis and nutrient absorption. The surgery is performed under general anesthesia and can be done using either open or laparoscopic techniques.

Benefits

The primary benefit of the STEP procedure is the potential for increased intestinal absorptive capacity, which can lead to improved nutritional status and growth in children and adults with SBS. Additionally, patients may experience a reduction in the need for parenteral nutrition, which is associated with significant complications such as liver disease and central venous catheter infections.

Risks and Complications

As with any surgical procedure, the STEP procedure carries risks, including infection, bleeding, and anastomotic leak. Long-term complications may include bowel obstruction and the development of strictures at the site of the stapled intestine. Close postoperative monitoring and follow-up care are essential to identify and manage any complications.

Outcomes

Studies have shown that the STEP procedure can lead to significant improvements in intestinal function and nutritional status in many patients with SBS. However, outcomes can vary based on the length of the remaining intestine, the presence of the ileocecal valve, and the patient's overall health status. Long-term nutritional support and monitoring by a multidisciplinary team are crucial to optimize outcomes.

Conclusion

Serial Transverse Enteroplasty offers a surgical option for patients with severe Short Bowel Syndrome, aiming to enhance their quality of life by improving nutrient absorption and reducing dependence on parenteral nutrition. While promising, the procedure requires careful patient selection and a comprehensive approach to postoperative care to achieve the best possible outcomes.