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Serial Transverse Enteroplasty Bowel Lengthening & Tapering

On Monday, April 3, at 10:30 am EDT (14:30 UTC), surgeons at Children's Hospital Boston will perform a serial transverse enteroplasty (STEP) bowel lengthening and tapering procedure on a six-year-old pediatric patient with short bowel syndrome (SBS) during a live Webcast. The Webcast is part of Children's ongoing effort to bring its pioneering care and technology to specialists and referring physicians around the world and allow consumers to see the latest and most innovative medical treatments available.

Tom Jaksic, MD, PhD, Surgical Director of the Short Bowel Syndrome Program and Senior Associate in Surgery at Children's Hospital Boston and Associate Professor at Harvard Medical School, will perform the surgery. Dr. Jaksic is Board Certified in Pediatric Surgery as well as Surgical Critical Care and has a special interest in the care of patients with short bowel syndrome. Heung Bae Kim, MD, and Dr. Jaksic developed the STEP operation five years ago and it has garnered increasing international acceptance.

Moderating the live broadcast will be Robert C. Shamberger, MD, Chief of the Department of Surgery at Children's and Robert E. Gross Professor of Surgery at Harvard Medical School, and Heung Bae Kim, MD, Surgical Director of the Liver, Intestine & Multivisceral Transplantation Center at Children's and Assistant Professor at Harvard Medical School. Christopher Duggan, MD, MPH, Medical Director of the Short Bowel Syndrome Program and Associate Professor of Pediatrics at Harvard Medical School will provide commentary on the medical and nutritional needs of patients with SBS. The doctors will answer e-mail questions from viewers during the live broadcast.

SBS is a potentially deadly disorder caused by the loss of part of the small bowel as a result of certain diseases. The most common diseases are: necrotizing enterocolitis, an acquired disease of usually premature newborns, intestinal atresia, a failure of development of a portion of the intestine, and intestinal volvulus, which occurs when the bowel gets twisted and the blood supply is impaired.

Regardless of the cause, the result is that the remaining bowel tends to grow wider, thereby creating more surface area to absorb whatever nutrients it can. This can also result in a slowing down of food digestion and the overgrowth of bacteria in the intestine with potentially life-threatening infections. In addition, most patients with SBS must get their nutrients delivered intravenously. This parenteral nutrition is life-saving, but for unclear reasons prolonged use can lead to severe liver disease, sometimes necessitating liver and small bowel transplantation.

A surgery called the Bianchi Procedure, in which the bowel is cut in half and one end is sewn to the other, has been used to treat SBS, but is technically more difficult and can be used effectively only in regions of symmetric bowel dilatation.

The STEP procedure that Drs. Kim and Jaksic evolved is based on the idea that stapling and dividing the bowel transversely on alternating sides across the mesentery of the bowel will decrease its width and increase its length. Subsequent dilatation of the lengthened bowel may further enhance intestinal absorptive area.

"I thought it would work because it fulfills all of the requirements of an ideal bowel lengthening procedure: it lengthens the bowel, tapers the dilated portions of the bowel and doesn't require removal of any bowel," says Kim. "It's also a simple concept, and simplicity of design is important in surgery."

Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit:



Tom Jaksic

Tom Jaksic, MD, PhD

Dario Fauza

Dario Fauza, MD

Heung Kim

Heung Kim, MD

Christopher Duggan

Christopher Duggan, MD, MPH