Background: Surgery plays a key role for the intestinal rehabilitation (IR) of children with short bowel syndrome or chronical intestinal failure. Whereas single procedures – especially for intestinal lengthening - are regularly being evaluated and described, the whole spectrum of surgical procedures within large IR programs in children is often difficult to assess. Our aim was to analyse the complete spectrum of major abdominal surgical procedures in a pediatric IR program.

Methods: We retrospectively analysed patients’ data from our pediatric IR program with special focus on all patients undergoing major abdominal surgery. Patients characteristics as well as surgical data were evaluated.

Results: The study period ranged from 2013 until 2018. During that period 184 patients were treated within our IR program. Of these children, 58 (31,5%) underwent major abdominal surgery. There were 35 male and 23 female patients. Diagnoses were anatomical short bowel syndrome (gastroschisis, atresia, volvulus on others) in 40 patients, hypoperistaltic conditions (aganglionosis, hypoganglionosis, MMIHS) in 17 patients and malabsorption (Microvillus Inclusion Disease) in one patient. Ten children originated from our own area, whereas 48 children were referred to us from different national or international regions. Mean number of operations prior to referral to us in those patients coming from other sites was 2.6 (0-7). In the 58 patients, 107 operations were performed (median 1.5, range 1-6). One operation was performed in 29 children, 19 children underwent 2 operations, 6 children underwent 3 operations, 2 children received 4 operations and 2 children underwent 6 operations. The types of surgical procedures were mostly reconstructive (n=100), while lengthening procedures were performed on 7 occasions (6.5%). Mean operating time was 145.2 minutes (range 31-1356). One child died in the early postoperative phase because of SIRS and two children died independently from the surgical procedure because of the central line sepsis.

Conclusion: The spectrum of surgical procedures in a pediatric IR program displays a wide variety of indications; reconstructive procedures are predominant. The procedures are complex and time consuming and require a comprehensive management including preoperative workup and indication, intraoperative surgical and anaesthesiological care as well as postoperative intensive care treatment.