Ramírez-Arbeláez Jaime A, Orjuela Robinson, Ramirez Ana, Giraldo Henry, Ardila Carlos M
Transplant, Hospital San Vicente Fundación, Rionegro, COL.
Surgery, Intestinal Rehabilitation Center, Hospital San Vicente Fundación, Medellin, COL.
Cureus. 2025 Apr 28;17(4):e83145. doi: 10.7759/cureus.83145. eCollection 2025 Apr.
Intestinal failure is defined as a reduction in function below the minimum required for adequate absorption of water, electrolytes, and nutrients, necessitating intravenous support. One of the most common etiologies is short bowel syndrome (SBS). For many years, intestinal transplantation was the only surgical option to achieve reduced dependence on parenteral nutrition (PN). However, intestinal lengthening surgery, such as serial transverse enteroplasty (STEP), has proven to be a safe and effective option for select patients with SBS, including those with ultra-short bowel syndrome (USBS) or PN-dependent SBS. Nevertheless, reported cases of STEP in adults are isolated due to the high complexity of the procedure. We present a case series of three patients with USBS and type III intestinal failure, in whom STEP was performed as part of intestinal rehabilitation. At the time of writing, one patient achieved enteral autonomy, while the other two have significantly reduced their PN requirements (by 33% and 20%, respectively) and improved oral tolerance. Autologous gastrointestinal reconstruction plays a key role in the treatment of intestinal failure secondary to SBS. Among the surgical options, STEP has been successfully used in children, though adult reports remain scarce, particularly for duodenal lengthening (with ≤ two cases reported globally). Postoperative outcomes are favorable, with low morbidity and mortality, offering the possibility of reducing PN dependence and, in select cases, avoiding intestinal transplantation. STEP is a complex but safe and effective procedure for adult patients with SBS, including USBS. It may enable reduced PN dependence, though further studies are needed to define its role in avoiding transplantation.
肠衰竭的定义是肠道功能下降至低于充分吸收水、电解质和营养物质所需的最低水平，从而需要静脉支持。最常见的病因之一是短肠综合征（SBS）。多年来，肠道移植是减少对肠外营养（PN）依赖的唯一手术选择。然而，肠道延长手术，如连续横向肠成形术（STEP），已被证明是适合某些SBS患者的安全有效的选择，包括那些患有超短肠综合征（USBS）或依赖PN的SBS患者。尽管如此，由于该手术的高度复杂性，成人STEP的报道病例较为孤立。我们报告了一组3例USBS和III型肠衰竭患者的病例系列，其中STEP作为肠道康复的一部分进行。在撰写本文时，1例患者实现了肠内自主，而另外2例患者的PN需求显著降低（分别降低了33%和20%），且口服耐受性有所改善。自体胃肠重建在SBS继发的肠衰竭治疗中起着关键作用。在手术选择中，STEP已成功应用于儿童，但成人报道仍然很少，特别是十二指肠延长术（全球报道≤2例）。术后结果良好，发病率和死亡率较低，有可能降低PN依赖，在某些情况下避免肠道移植。对于包括USBS在内的成人SBS患者，STEP是一种复杂但安全有效的手术。它可能会降低PN依赖，不过还需要进一步研究来确定其在避免移植方面的作用。
