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

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dc.contributor.author Hukkinen, Maria
dc.contributor.author Kivisaari, Reetta
dc.contributor.author Koivusalo, Antti
dc.contributor.author Pakarinen, Mikko P.
dc.date.accessioned 2019-01-23T22:34:07Z
dc.date.available 2021-12-17T22:02:49Z
dc.date.issued 2017-07
dc.identifier.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
dc.identifier.other PURE: 87621125
dc.identifier.other PURE UUID: 45370fe6-353f-4927-bffe-0a52a197ddd9
dc.identifier.other WOS: 000405362500009
dc.identifier.other Scopus: 85011586021
dc.identifier.uri http://hdl.handle.net/10138/297801
dc.description.abstract 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. en
dc.format.extent 7
dc.language.iso eng
dc.relation.ispartof Journal of Pediatric Surgery
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject Short bowel syndrome
dc.subject Intestinal failure
dc.subject Tapering surgery
dc.subject Serial transverse enteroplasty
dc.subject Longitudinal intestinal lengthening and tapering
dc.subject SERIAL TRANSVERSE ENTEROPLASTY
dc.subject BACTERIAL OVERGROWTH
dc.subject RECONSTRUCTION SURGERY
dc.subject PARENTERAL-NUTRITION
dc.subject SMOOTH-MUSCLE
dc.subject ENTERAL AUTONOMY
dc.subject DATA REGISTRY
dc.subject CHILDREN
dc.subject FAILURE
dc.subject GASTROSCHISIS
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.subject 3123 Gynaecology and paediatrics
dc.title Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome en
dc.type Article
dc.contributor.organization Children's Hospital
dc.contributor.organization University of Helsinki
dc.contributor.organization Clinicum
dc.contributor.organization Lastenkirurgian yksikkö
dc.contributor.organization HUS Children and Adolescents
dc.contributor.organization HUS Medical Imaging Center
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1016/j.jpedsurg.2017.01.052
dc.relation.issn 0022-3468
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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