Pediatric Bowel Lengthening Surgery: Bianchi and STEP

Children in our Intestinal Rehabilitation Program receive the full spectrum of care from our dedicated staff. We may recommend bowel lengthening surgery for children who do not respond to medical therapy or do not experience sufficient relief from symptoms. Features of our surgical care include:

• Expertise. Our team includes nationally renowned experts in intestinal failure, including pediatric surgeons and a pediatric anesthesiologist, available 24/7 for your child’s needs. Read more about anesthesia at Children’s National.
• Personalized care. We have the experience and expertise in all types of bowel lengthening procedures, including the Bianchi and STEP procedures. We don’t practice cookie-cutter care — we believe in choosing the approach that works best for your child.
• Advanced operating rooms. Our 17 sophisticated operating rooms are equipped with advanced monitoring technology, allowing us to perform precise, effective surgery. We perform laparoscopic and traditional open surgery, depending what offers your child the optimal results.

Although the primary management of SBS is medical, there are many circumstances in which surgical intervention may offer great therapeutic benefits. Patients with SBS may develop high ostomy outputs, anastomotic strictures and/or severe bowel dilation and regularly have problems with recurrent emesis, dysmotility, bacterial overgrowth and severe diarrhea. Proadaptive surgery, such as stoma closure, stricturoplasty, enteroplasty, ostomy in continuity and tapering or lengthening procedures may produce dramatic clinical improvement. The main indications for surgical intervention in the IRP for children with SBS are failure to progress in enteral feedings, a decrease in the previous level of enteral tolerance, life-threatening complications such as liver disease intestinal failure–associated and recurrent septic episodes with enteric bacteria in a child with a dilated bowel.

We offer several procedures, with their own advantages and risks. We will discuss the procedures with you in detail and choose the most appropriate approach for your child.

• Bianchi procedure. During this procedure, your child’s surgeon divides the bowel in half and sews one end to the other. The goal is to convert the intestine from one short tube with a large diameter to a longer tube with a smaller diameter. This allows more time for food to travel and be absorbed into the body.
• Serial transverse enteroplasty procedure (STEP). Your child’s surgeon divides the bowel and staples it in a zigzag pattern. The accordion-like pattern allows food to spend more time in the intestine where it can be absorbed naturally.
• Ostomy in continuity. In children with short bowel and severely impaired motility, we construct an “ostomy in continuity” which enables proximal intestinal decompression and allows the distal bowel (colon) to enlarge, improving the feeding tolerance and absorption of nutrients.