Collection
Short Bowel Syndrome Management
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Among patients with limited gut, necrotizing enterocolitis patients do best because they have been fed before, have established GI motility, and the maturation phase has already been initiated. — Michael Helmrath, Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1 · 8:40
Surgical Techniques5 items
Surgical Management and Intestinal Rehabilitation in Short Bowel Syndrome
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In this episode, Drs. Jason Silverman and Jennifer Lee talk to Dr. Paul Wales all about the surgical management of short bowel syndrome, including decision-making based on initial presentation and important considerations for any autologous
podcast1:11:10 · Nov 2026
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
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We're back with a new topic, discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
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video19:07 · Oct 2022
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
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We're back with a new topic, discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
Resources:
Bianchi A.
podcast19:07 · Oct 2022
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 2
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We're back with the second part of discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
Don't forget to lik
podcast12:24 · Oct 2022
The evolution of the serial transverse enteroplasty for pediatric short bowel syndrome at a single institution
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Purpose: The serial transverse enteroplasty (STEP) tapers and lengthens the gut to improve adaptation. Mortality has decreased with multidisciplinary intestinal rehabilitation programs (IRP) allowing more time to reach adaptive potential. W
article · Nov 2026
Massive Bowel Resection2 items
Characteristics and clinical outcomes of pediatric patients following massive bowel resection: A retrospective cohort study
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Background: Massive bowel resection (MBR), defined as residual small bowel < 25 % of expected length-for-age based on established norms, is a rare entity. Traditionally, children who have undergone MBR have higher mortality and less probabi
article · Nov 2026
Massive bowel resection for children with non-short bowel syndrome intestinal failure
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Introduction: Pediatric patients with chronic intestinal pseudo-obstruction (CIPO) and congenital diarrheas and enteropathies (CODE) are unique intestinal failure (IF) patient populations. Intestinal transplantation is often considered due
article · Nov 2026
Ultrashort Bowel Syndrome2 items
Contemporary challenges and outcomes in children with ultrashort bowel syndrome: A descriptive cohort study
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Objectives: Ultra-short bowel syndrome (USBS) constitutes the most severe form of short bowel syndrome (SBS). Contemporary outcome data are scarce. The aim was to describe the experience of managing children with USBS and assess outcomes. M
article · Nov 2026
Multidisciplinary Management in Pediatric Ultrashort Bowel Syndrome
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Pediatric intestinal failure (IF) remains a complex and devastating condition resulting in the inability of the gastrointestinal tract to absorb adequate fluids and nutrients to sustain life. The goal in the management of IF is to achieve e
article · Nov 2026
Management of pediatric intestinal failure related to short bowel syndrome
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Intestinal failure (IF) secondary to short bowel syndrome is a challenging and complex medical condition with significant risk for surgical and medical complications. Significant advancements in the care of this patient population have led
article · Nov 2026
Predictors of Autonomy3 items
Early Predictors of Enteral Autonomy in Pediatric Intestinal Failure Resulting From Short Bowel Syndrome: Development of a Disease Severity Scoring Tool
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Introduction: Patients with short bowel syndrome (SBS) are dependent on parenteral nutrition (PN) while their bowel attempts to compensate. Our objective was to create an SBS disease severity score to predict the probability of achieving en
article · Nov 2026
Predicting Intestinal Adaptation in Pediatric Intestinal Failure: A Retrospective Cohort Study
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Objective: The primary goal in intestinal failure (IF) is adaptation and enteral autonomy (EA). Our goals were to determine the proportion of patients treated for IF by an established intestinal rehabilitation program who achieved EA and to
article · Nov 2026
Small and large bowel anatomy is associated with enteral autonomy in infants with short bowel syndrome: A retrospective cohort study
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Background: Achievement of enteral autonomy (EA) is the ultimate treatment goal in pediatric intestinal failure (IF). We aimed to assess predictors of EA in pediatric short bowel syndrome (SBS) and explore the impact of residual small bowel
article · Nov 2026
Role of Colon1 item
Does the colon play a role in intestinal adaptation in infants with short bowel syndrome? A multiple variable analysis
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Purpose: We sought to examine in a multiple variable model the impact of residual colonic length on time to intestinal adaptation in a cohort of infants with short bowel syndrome. Method: Infants with a surgical diagnosis of short bowel syn
article · Nov 2026
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Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
Adrian Bianchi first reported the longitudinal intestinal lengthening procedure (Bianchi procedure) that divides bowel along its two leaves and tubularizes it.
clinicalMichael Helmrath1:23 ↗
In the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols.
Host summaryEllen Encisco summarizing the discussion — not the host's own clinical position1:50 ↗
Rising direct bilirubin was recognized as a sign that children with intestinal failure would not do well.
clinicalMichael Helmrath2:13 ↗
The first 4 months of life is when care for intestinal failure patients is most uncoordinated, and surgical decisions made during this period have the most profound effect on long-term outcome.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position2:29 ↗
The gut doubles in length during the last trimester and the first year of life, and this maturation process occurs when the baby is fed.
clinicalMichael Helmrath2:55 ↗
Healthy growth of the intestine requires nutrition; anything that disrupts this affects maturation of both absorptive/digestive capacity and peristalsis.
clinicalMichael Helmrath3:03 ↗
Absorptive surface area comes from the waves of peristalsis moving over the villi, not from the exposed length of bowel.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position3:32 ↗
Lengthening bowel that doesn't have peristalsis does not increase absorption; very short bowel children can sometimes come off TPN because their motility is good.
clinicalMichael Helmrath3:46 ↗
The majority of pediatric short bowel syndrome cases present at birth due to neonatal causes: congenital GI anomalies or acquired conditions like necrotizing enterocolitis.
epidemiologicalPaul Wales4:18 ↗
When reestablishing bowel continuity, size discrepancy between bowel ends must be addressed or a functional obstruction will result even if the anastomosis is patent.
clinicalPaul Wales5:42 ↗
Size discrepancy can be managed by resection to a more appropriate caliber, tapering enteroplasty, or serial transverse enteroplasty (STEP) depending on available bowel length.
clinicalPaul Wales6:02 ↗
Gastroschisis patients tend to not do as well with STEP procedures regardless of whether atresia is present; among STEP procedures performed over the years, gastroschisis cases consistently had worse outcomes.
epidemiologicalPaul Wales7:08 ↗
Gastroschisis patients have inherent dysmotility.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position7:21 ↗
The enteric nervous system in gastroschisis is damaged from exposure to amniotic fluid and requires a healing and recovery phase; this regeneration is attenuated by dysmotility and stasis, not enhanced.
clinicalMichael Helmrath7:32 ↗
In atresia without gastroschisis, the bowel may have good peristalsis from working against an obstruction, and when done correctly with proper orientation, a longitudinal lengthening procedure may benefit the child.
opinionMichael Helmrath7:55 ↗
Children who undergo STEP procedures in their first year of life sometimes never progress and are labeled as poor motility patients unable to tolerate enteral feeds.
clinicalMichael Helmrath8:19 ↗
Among patients with limited gut, necrotizing enterocolitis patients do best because they have been fed before, have established GI motility, and the maturation phase has already been initiated.
opinionMichael Helmrath8:40 ↗
STEP procedure is not usually performed unless bowel is at least 5 centimeters dilated to make it worthwhile.
clinicalPaul Wales9:09 ↗
At birth, neonatal bowel is usually not dilated enough to apply the STEP procedure.
Host summaryEllen Encisco summarizing the discussion — not the host's own clinical position9:36 ↗
In scenarios where bowel is not adequately dilated, options include resecting bulbs with tapering enteroplasty, establishing continuity if possible, or leaving bowel disconnected with distal feeding tube access to grow the distal bowel before reconnection.
clinicalPaul Wales9:41 ↗
The STEP procedure was originally described by HP Kim and Tom Jackson.
clinicalPaul Wales10:45 ↗
For STEP, a transverse supraumbilical abdominal incision is used, all adhesions are lysed, and the entire intestinal tract is laid out from top to bottom to understand anatomy and maximize mobility.
clinicalPaul Wales11:02 ↗
The anti-mesenteric surface of the bowel is marked with surgical pen after drying with a lap sponge; maintaining this alignment prevents longitudinal twisting of the bowel during stapling.
clinicalPaul Wales11:29 ↗
Bowel length is measured before the procedure using 30 silk dipped in mineral oil; caliber and length of the dilated segment to be stepped are also recorded.
clinicalPaul Wales11:58 ↗
An endo-GIA stapler is preferred over an open GIA stapler because the smaller cartridge head is more amenable in smaller patients.
opinionPaul Wales12:20 ↗
Staple lines are applied perpendicular to the mesentery at 90° and 270° (3 o'clock and 9 o'clock positions if mesenteric vessels are at 0°).
clinicalPaul Wales12:34 ↗
A vascular (white) cartridge with 2.5 mm staples that crimp to 1 mm is used; this is more appropriate for younger patients' bowel thickness and prevents leaks that occurred with classic blue loads in early experience.
clinicalPaul Wales12:58 ↗
Target caliber for STEP is 1.5 cm in babies and 2 to 2.5 cm in older infants or children; making it too narrow risks obstruction, especially in patients with borderline motility.
clinicalPaul Wales13:23 ↗
Before firing the stapler, measurements are taken to both the end of the bowel and to the side to ensure proper caliber is maintained throughout the length.
clinicalPaul Wales14:09 ↗
A U-stitch with 4-0 PDS is placed in the crotch of each staple line to prevent potential leaks at that point.
clinicalPaul Wales14:28 ↗
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