Table 1.

Different operative approaches for SBS including advantages and limitations of the different techniques

	AGIR procedure
	antiperistaltic segments	colon interposition: iso- or antiperistaltic	Bianchi LILT	STEP lengthening	others: intestinal valves, tapering, and plication
Indications	adequate small bowel length with or without remnant colon but with rapid transit and diarrhea or increased ileostomy output due to absence of ileocecal valve	i) rapid transit time with any length of remnant small bowel but with adequate colon length ii) USBS	i) dilated small bowel >3 cm in diameter, >20 cm in length, with length of residual small bowel >40 cm ii) preferred initial lengthening option	i) dilated remnant small bowel >3–4 cm in diameter ii) presence of foreshortened mesentery (duodenum) iii) with prior abdominal surgeries without preservation of both leaves of the mesentery iv) dilated segments shorter than 20 cm v) when re-dilatation occurs	valves: i) non-dilated, short remnant native small bowel length (with/without remnant colon), with rapid transit ii) to create dilatation in short bowel segment for subsequent AGIR tapering and plication: dilated bowel with malabsorption in presence of adequate intestinal length
Advantages	slows the transit and enhances nutrient absorption by: i) partial mechanical obstruction ii) delay of distal segment myoelectric activity	i) no use/loss of precious small bowel length	i) doubles length of the original small bowel segment ii) can be applied to the colon as well	i) simpler technique than LILT ii) can be applied to asymmetrical bowel dilatation, over shorter or longer lengths iii) can be repeated post STEP or LILT iv) can be applied to previously operated bowel	valves: increased transit time + improved enteral absorption tapering: optimizes bowel caliber and effective peristalsis return plication: optimizes bowel caliber without long suture line and preserves mucosal mass
PN weaning	Panis/Thompson 75%	Glick 50%	Bianchi 75%, Weber 100%, Thompson 53%	Sudan 58%, STEP Registry 48%	unclear due to non-uniform outcomes
Disadvantages	i) risk of obstruction with longer reversed segments ii) cannot be used when remnant bowel length is <25 cm iii) loss of bowel length if unsuccessful	i) fatal/nonfatal obstruction ii) enterocolitis in the transposed segment iii) colonic dilatation iv) unpredictability	i) needs uniformly dilated bowel segment ii) one-time surgery, cannot be duplicated on the same bowel loop following re-dilatation iii) risk of necrosis with mesenteric damage iv) morbidity 15% v) mortality: Bianchi 45%, Hosie 10–20%	i) needs dilated bowel segment (non-uniform) ii) staple line perforations or leaks iii) re-dilatation with failure to increase absorption iv) morbidity 18.4% v) mortality 7.9% both Sudan et al. & Modi et al.	valves: i) intussuception ii) obstruction and bacterial overgrowth iii) sacrifice of valuable bowel length if unsuccessful tapering: i) loss of significant mucosal absorptive surface ii) long suture line with risk of leak plication: i) obstruction ii) re-dilatation due to unraveling from suture breakdown

AGIR = Autologous gastrointestinal reconstruction; STEP = serial transverse enteroplasty; LILT = longitudinal intestinal lengthening and tailoring; USBS = ultra-short bowel syndrome; PN = parenteral nutrition.