SHORT COMMUNICATION Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome Lara Lourenço & Miguel Campos & Joaquim Monteiro & Eunice Trindade & Jorge Amil Dias & António Guerra & Paula Guerra & Jorge Correia-Pinto & José Estevão-Costa Received: 23 January 2012 / Accepted: 20 March 2012 / Published online: 4 April 2012 # Springer-Verlag 2012 Abstract Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the recent description of serial transverse enteroplasty (STEP). We reviewed the patients who underwent the STEP operation for short bowel syndrome in our hospital in order to evaluate medium-term outcome. Between April 2006 and December 2008, three children were submitted to STEP without postop- erative complications directly related to the procedure. In two cases the autonomy for oral/enteric feeding was obtained within 3 and 7 months after surgery with sustained growth, persisting at 5 years of follow-up after STEP. One child remained dependent of parenteral nutrition and was submitted to intestinal transplantation 30 months after STEP. However, since STEP until transplantation, it was possible to increase enteric volume and decrease intestinal dilation and the fre- quency of occlusive episodes. STEP is an effective and safe technique for intestinal lengthening that may allow increased tolerance to oral/enteric feeding or at least alleviate some complications of short bowel syndrome. Keywords Serial transverse enteroplasty . Short bowel syndrome . Gastroschisis . Intestinal atresia Introduction Intestinal failure is defined as the inability to absorb enough nutrients to maintain body weight or normal growth and development. Short bowel syndrome is the most common cause of intestinal failure in children [17] and can result from congenital anomalies (e.g., intestinal atresia) or acquired con- ditions (e.g., necrotizing enterocolitis). It affects 24.5 per 100,000 live births and is higher in preterm infants (353.7 per 100,000) [16]. Treatment is based on a multidisciplinary approach involving the intervention of pediatricians, pediatric surgeons, and nutritionists, trying to optimize the adaptation of the remaining intestine with a conservative attitude in order to obtain full enteral tolerance. The extent and type of the remaining intestine (e.g., presence of ileocecal valve), as well as the underlying disease are factors that significantly influ- ence the achievement of full enteral tolerance. When weaning of parenteral nutrition is not possible, in- testinal lengthening surgery, if indicated, can stop the vicious cycle of infection of central venous catheter (CVC), develop- ment of liver disease, and malnutrition. This type of procedure has regained interest with the recent description in 2003 of serial transverse enteroplasty [9, 10], a simpler technique than those previously used (Bianchi, Kimura, and Soper) and with promising results. Serial transverse enteroplasty (STEP) is a surgical technique of autologous bowel reconstruction which consists of applying a linear stapler, perpendicular to the longitudinal axis of the intestine and midway between the L. Lourenço : E. Trindade : J. A. Dias : A. Guerra : P. Guerra Department of Pediatrics, Hospital S. João, Oporto, Portugal M. Campos : J. Monteiro : J. Correia-Pinto : J. Estevão-Costa Department of Pediatric Surgery, Hospital S. João, Oporto, Portugal M. Campos : A. Guerra : J. Estevão-Costa Faculty of Medicine of University of Porto, Oporto, Portugal L. Lourenço (*) Serviço de Pediatria, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Oporto, Portugal e-mail: larapslourenco@gmail.com Eur J Pediatr (2012) 171:1265–1268 DOI 10.1007/s00431-012-1728-2