Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome

Visa fullständig post



Permalänk

http://hdl.handle.net/10138/297801

Citation

Hukkinen , M , Kivisaari , R , Koivusalo , A & Pakarinen , M P 2017 , ' Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome ' , Journal of Pediatric Surgery , vol. 52 , no. 7 , pp. 1121-1127 . https://doi.org/10.1016/j.jpedsurg.2017.01.052

Titel: Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome
Författare: Hukkinen, Maria; Kivisaari, Reetta; Koivusalo, Antti; Pakarinen, Mikko P.
Upphovmannens organisation: Children's Hospital
University of Helsinki
Clinicum
Lastenkirurgian yksikkö
HUS Children and Adolescents
HUS Medical Imaging Center
Department of Diagnostics and Therapeutics
Datum: 2017-07
Språk: eng
Sidantal: 7
Tillhör serie: Journal of Pediatric Surgery
ISSN: 0022-3468
DOI: https://doi.org/10.1016/j.jpedsurg.2017.01.052
Permanenta länken (URI): http://hdl.handle.net/10138/297801
Abstrakt: Background: In remains unclear why in some short bowel syndrome (SBS) patients, the remaining small bowel (SB) dilates excessively leading to requirement of tapering surgery. Methods: Among SBS children, we retrospectively analyzed risk factors for tapering surgery with logistic regression and compared the outcome of operated patients (n = 16) to those managed conservatively (n = 44) with Cox proportional hazards regression. Results: SBS was caused by necrotizing enterocolitis (NEC) (n = 31), SB atresia (SBA) (n = 13), midgut volvulus (n = 12), or gastroschisis (n = 4). Patients with spontaneous symptomatic SB dilatation unable to wean parenteral nutrition (PN) underwent tapering surgery at median age of 1.04 (interquartile range 0.70-3.27) years. Missing ICV was related to an 8-fold (p = 0.003) increased risk while SBA diagnosis was related to a 13-fold risk of tapering surgery (p <0.001). Increasing SB length and NEC diagnosis were protective of tapering (p = 0.027-0.004). Of operated patients, 75% reached enteral autonomy during follow-up and their postoperative adjusted PN weaning rate was similar to nonoperated children (p = 0.842). Conclusion: SBS children with short remaining SB, missing ICV, and SBA etiology are more likely while NEC patients are less likely than others to necessitate tapering surgery. Postoperative PN weaning rates were comparable to patients who initially had more favorable intestinal anatomy and adapted without surgery. (C) 2017 Elsevier Inc. All rights reserved.
Subject: Short bowel syndrome
Intestinal failure
Tapering surgery
Serial transverse enteroplasty
Longitudinal intestinal lengthening and tapering
SERIAL TRANSVERSE ENTEROPLASTY
BACTERIAL OVERGROWTH
RECONSTRUCTION SURGERY
PARENTERAL-NUTRITION
SMOOTH-MUSCLE
ENTERAL AUTONOMY
DATA REGISTRY
CHILDREN
FAILURE
GASTROSCHISIS
3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
Referentgranskad: Ja
Användningsbegränsning: openAccess
Parallelpublicerad version: publishedVersion


Filer under denna titel

Totalt antal nerladdningar: Laddar...

Filer Storlek Format Granska
1_s2.0_S0022346817300854_main.pdf 405.1Kb PDF Granska/Öppna

Detta dokument registreras i samling:

Visa fullständig post