EARLY IMPROVEMENT IN INTESTINAL FUNCTION AFTER ISOPERISTALTIC BOWEL LENGTHENING

Isoperistaltic bowel lengthening (the Bianchi procedure) has been used increasingly in the management of infants and children with short bow el syndrome. Although clinical improvement is observed frequently, few studies document the early effects of the Bianchi procedure on nutrie nt absorption and transit time. Five infants and children (aged 3 mont hs to 4 years) with profound short bowel syndrome (<50 cm of small bow el) underwent isoperistaltic bower lengthening(10 to 40 cm) when their bowel was greater than 3 cm in diameter. One to 2 weeks preoperativel y, the following were obtained for each patient: 24-hour stool counts, transit time (charcoal), intestinal clearance of barium, and nutrient absorption (fat balance and D-xylose). The studies were repeated 1 an d 6 months postoperatively. The mean stool count per 24 hours decrease d from eight preoperatively to four and three at 1 and 6 months postop eratively. Transit time increased from 52 minutes to 135 and 205 minut es, and clearance of barium improved from 4.5 hours to 2.4 and 2.6 hou rs, respectively. Results of D-xylose absorption and dietary fat balan ce studies, both abnormal preoperatively, also normalized at 1 and 6 m onths. These data show that the Bianchi procedure provides short- and intermediate-term improvement in intestinal and nutrient absorption, w hich should allow more rapid weaning from parenteral nutrition. Copyri ght (C) 1996 by W.B. Saunders Company