Optimization and standardization of the stages of surgical correction and conservative adaptation in children with short bowel syndrome

Abstract

Short bowel syndrome remains one of the most challenging conditions in pediatric gastroenterology and digestive surgery, representing the leading cause of intestinal failure in children. The management of this condition has undergone substantial transformation over recent decades, evolving from a primarily supportive approach to an integrated strategy that combines sophisticated surgical techniques with targeted medical therapy. This review examines current evidence for optimizing and standardizing the sequential phases of care in pediatric short bowel syndrome, encompassing the acute post-resection period, the adaptation phase, and the maintenance stage. Particular attention is devoted to autologous gastrointestinal reconstructive surgery, including serial transverse enteroplasty and longitudinal intestinal lengthening, as well as the emerging role of glucagon-like peptide-2 analogs in enhancing intestinal adaptation. The available evidence demonstrates that serial transverse enteroplasty achieves bowel lengthening of 50 to 70 percent with subsequent parenteral nutrition weaning in 42 to 73 percent of patients, while teduglutide therapy reduces parenteral nutrition requirements by approximately 30 to 67 percent over three years of treatment. Optimal outcomes depend critically upon the integration of surgical and medical interventions within multidisciplinary intestinal rehabilitation programs, standardized patient selection criteria, and objective monitoring of adaptation through biomarkers such as citrulline. This review proposes a framework for stage-specific standardization that may improve enteral autonomy rates and long-term quality of life in this complex patient population.