Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplantation. Oct 22, 2018; 8(6): 198-202
Published online Oct 22, 2018. doi: 10.5500/wjt.v8.i6.198
Surgeon’s perspective on short bowel syndrome: Where are we?
Ignazio R Marino, Augusto Lauro
Ignazio R Marino, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA 19107, United States
Augusto Lauro, Liver and Multiorgan Transplant Unit, St. Orsola-Malpighi University Hospital, Bologna 40138, Italy
Author contributions: Marino IR and Lauro A conceived the study and drafted the manuscript; both authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Augusto Lauro, MD, PhD, Surgeon, Liver and Multiorgan Transplant Unit, St. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy. augustola@yahoo.com
Telephone: +39-051-6363721
Received: July 4, 2018
Peer-review started: July 4, 2018
First decision: August 20, 2018
Revised: August 25, 2018
Accepted: October 8, 2018
Article in press: October 8, 2018
Published online: October 22, 2018
Abstract

Short bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented by the residual length of the small bowel where ileum has shown increased adaptive function than jejunum, but colon should be considered because of its importance in the digestive process. These concepts have been translated also in intestinal transplantation, where a colonic graft is nowadays widely used and the terminal ileum is the selected segment for a living-related donation. The whole replacement by a bowel or multivisceral transplant is still affected by poor long term outcome and must be reserved to a select population of SBS patients, affected by intestinal failure associated with irreversible complications of parenteral nutrition.

Keywords: Parenteral nutrition, Bowel rehabilitation, Surgical rescue, Intestinal transplantation, Short bowel syndrome

Core tip: Short bowel syndrome represents a surgical dilemma: parenteral nutrition is considered the gold standard of care and any surgical attempt must be limited by the universal principle “first do not harm.” The surgical rehabilitation should be pursued when there are enough residual intestines to obtain a better bowel function: lengthening the intestine or reversing a loop of it with different techniques should have the only aim of slowing the transit while increasing the absorptive surface. When intestinal failure is associated to life-threating parenteral nutrition complications, bowel transplantation should be considered as an option.