Treatment OptionsNutritional TherapiesAll patients will undergo a complete nutritional analysis. Our physicians and dietitians work closely to determine recommendations regarding optimal Total Parenteral Nutrition (TPN) management, fluid and electrolyte management and special diet designed to meet the patient's specific needs. These recommendations are provided to the patient and referring physician to help achieve desired outcomes. Goals are to increase weight, decrease stool output, improve hydrations status and improve nutrient deficiencies. What is TPN?Total Parenteral Nutrition (TPN) is a method of feeding a person through an intravenous (IV) catheter. Physicians often order this method of feeding when a person is unable to absorb enough nutrition from the food they consume. TPN contains nutrients such as carbohydrates, lipids, proteins, vitamins, minerals, and water. What is Enteral Feeding?Enteral Feeding is a method of delivering liquid feedings though a tube and is used in instances where the gastrointestinal tract is functional, but the person cannot consume enough food to meet nutritional requirements. Surgical OptionsSurgical options include a number of methods to taper the intestine in hopes of improving intestinal motility and preventing the development of bacterial overgrowth. Additionally, a number of other surgical methods to lengthen the intestine have also been introduced. These include the Bianchi method and the more recent STEP procedure. All of these options may be considered in patients with SBS, however, they are used only after it is clear that medical management is not effective in weaning the child off TPN. A surgeon is available for consultation at the clinic and will make recommendations specific to the individual need and clinical presentation. Surgical procedures performed at Mott Children's Hospital include bowel lengthening either by a standard Bianchi or STEP procedure and bowel tapering. Additionally, routine gastrointestinal surgeries, including feeding tube placement and management, and antireflux procedures are provided. The Bianchi MethodFigure 13 below shows a bowel lengthening procedure via the Bianchi method. Note that the bowel is split longitudinally by separating the mesentery to either one side of the intestine or the other. A stapling device then splits the bowel longitudinally. The bowel is then placed into continuity, with correct peristaltic direction.
Figure 13
The STEP ProcedureFigure 14 below shows the current STEP procedure for intestinal lengthening. Note that the absolute length of bowel can be adjusted by altering the interval of creating linear staplings, and the luminal diameter can be corrected by the length of each stapling. Figure adapted from K. Georgenson. J Pediatr Surg. 2003, 38(6):881-5, and originally described by Bae and Jaksic, J Pediatr Surg. 2003 Jun;38(6):881-5
Figure 14
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