Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP procedures.

ABSTRACT

BACKGROUND: It has been thirty years since Bianchi introduced the technique that made intestinal lengthening possible. The last three decades have seen lengthening procedures established as vital components of intestinal rehabilitation programs. The goal of the present study was to use a systematic literature review to determine patient outcomes for the two most commonly used lengthening procedures, the Bianchi procedure and the serial transverse enteroplasty procedure (STEP). METHODS: Pubmed and Embase were searched using the terms "intestinal lengthening" and "bowel lengthening." Patient outcomes were extracted from each relevant journal article on the basis of a set proforma. The results were combined to create overall mean outcomes. Mean outcomes were also calculated separately for the Bianchi procedure and STEP. Significance was tested with the independent t-test. RESULTS: Overall survival for the last thirty years is 83%. However, survival for the last fifteen years has been 89%, with no significant difference between the two procedures. The Bianchi procedure has a higher rate of weaning patients who were static on parenteral nutrition with conservative measures: 55% versus 48%. In addition, the Bianchi procedure was associated with a higher rate of patients receiving transplants 10% versus 6%. The STEP has a higher rate of complication. Length of follow-up is significantly longer for the Bianchi procedure 76 versus 22 months. The impact that this differential could have had on our results must be considered. CONCLUSIONS: Outcomes for intestinal lengthening procedures are very good, and increasingly so. However, further analysis is required in order to fully understand the relative strengths and weaknesses of each procedure.