Surgical Options for SBS
The main goal of surgery for SBS is to increase the capacity for absorption by the existing bowel. Surgery is considered in patients who are dependent long-term on parenteral nutrition when medications have failed and where the goal is to try to avoid intestinal transplantation.
Several different surgical procedures are available depending on the existing bowel length and function. The goal of these procedures is to improve function of the existing bowel by slowing transit or increasing surface area. Different methods include reconnecting the remaining small bowel to the colon when continuity has been lost, attempting to increase transit time by reversing a segment of bowel, and intestinal lengthening procedures.
Intestinal transplantation becomes a necessary option when required life-long parenteral nutrition begins to fail. When this happens, the patient may experience any of the following:
- Significant evidence of liver injury
- The inability to maintain central venous access. Central venous access is used for parenteral nutrition (a long thin and hollow plastic tube called a ‘catheter’ or ‘line’ is placed in a vein to provide nutrition, medications and fluids).
- Frequent bloodstream infections with the line used for central venous access, which are becoming life threatening.
- Inability to keep up with excessive fluid loss (dehydration).
Isolated intestinal transplants are the preferred procedure in patients who have adequate liver function. However, a combined liver and intestinal transplant is required for those with liver failure. Management strategies for intestinal transplantation, both before and after the operation, require careful consideration.
Learn more about management and treatment of short bowel syndrome
Adapted from IFFGD publication #294 “Managing and Treating SBS” Contributors: Evelin Eichler RD LD, Clinical Dietitian, University Medical Center Texas Tech University; Richard McCallum MD, Professor of Medicine and Founding Chair and Chief of Gastroenterology, Texas Tech University; Harold J. Boutté Jr. MD, Assistant Professor of Medicine, Northwestern University Feinberg School of Medicine