Duodenal lengthening in short bowel with dilated duodenum

Although duodenal dilatation occurs in children with short bowel syndrome (SBS) facilitating dismotility and bacterial overgrowth, the duodenum has been an untouchable intestinal segment for lengthening procedures owing to its close relationship with bilio-pancreatic structures and blood supply shared with the pancreas. Three children (age range, 0.5-7 years) with SBS and dilated duodenum underwent a novel surgical procedure of duodenal lengthening combined with a technical modification of serial transverse enteroplasty (STEP). Pre-STEP, jejunum length was 5, 35 and 45 cm, respectively. Duodenal lengthening was performed with sequential transverse applications of an endoscopic stapler on the anterior and posterior wall of the duodenum to avoid bilio-pancreatic structure injury. Two patients underwent 3 duodenal firings (stapler of 35 mm) and the third 5 firings (stapler of 45 mm). Duodenal firings were 17%, 21% and 83% of the total firings. Results: No surgical complications occurred. One patient developed transient episodes of D-lactic acidosis. Two patients (5 and 45 cm) were weaned off parenteral nutrition at 12 months post-surgery and the remaining patient's (35 cm) parenteral calorie requirements have decreased by 60%. Conclusion: Duodenal lengthening is effective since it tailors and increases the absorptive surface of the duodenum, even in cases of extreme SBS. (C) 2015 Elsevier Inc. All rights reserved.