The contribution of Serial Transverse Enteroplasty (STEP) to the Treatment of Short Bowel Syndrome: Review of the Literature

Serial Transverse Enteroplasty (STEP) is an autologous reconstructive surgical technique performed in patients affected by short bowel syndrome (SBS). SBS implies anatomical and functional loss of a large segment of intestine and according to the algorithm which has recently been proposed, is appropriate in patients with dilated bowel (> 4cm) and short bowel length (60-90cm) or on parenteral nutrition (PN) dependency. In some cases, creation of a newvalve is proposed as a first step and a bowel lengthening operation follows subsequently. In many reports observed that the number of patients listed for transplantation, the patient mortality on the waiting list and the overall mortality were significantly reduced after STEP. There were significant benefits for patients as STEP allowed weaning off PN and improved their liver function. Compared with Bianchi procedure (LILT), recorded lower complication rates, is easier to perform, fewer patients underwent transplantation and there is no limit to the required length of dilation in order to be performed. A prognostic factor affecting the outcome of the operation is the preoperative length of the intestine, as being longer have many more chances of success. STEP should be performed in specialized centers and the long-term results will give a new aspect to the surgical strategy and treatment of SBS.