Nontransplant operations. Currently, the most frequently used surgical techniques to treat SBS are intestinal lengthening, the creation of artificial valves, strictureplasty, and intestinal tapering procedures. These techniques are designed to prolong intestinal transit time, thus increasing absorption.The creation of intestinal valves or reversed bowel segments may also prolong transit time. The reversed segments increase water, nitrogen, and fat absorption. Strictureplasty is used to widen strictures (constricted sections) of intestine.

Transplantation. Small intestine transplantation is generally reserved for patients with severe SBS. Patients who are unlikely to ever be able to discontinue TPN are candidates for an intestinal transplant because of their risk of developing life-threatening complications. The most common life-threatening problem in this group of patients is TPN-induced liver disease. A smaller number of patients experience recurrent episodes of infection at the catheter site used for infusing TPN; or it may be difficult to find a suitable vein to provide the access needed to receive TPN or supplemental fluids. It is important to identify patients with persistent liver function abnormalities and consider them for possible intestinal transplantation before liver disease has progressed to cirrhosis. Other issues for these patients can include both the monetary and the psychological costs of TPN to the patients and their families. TPN is very expensive, with costs estimated at between $200 and $500 per day when administered at home, and $500 to $1500 per day when given in a hospital. Annual costs are estimated to be $50,000 to $200,000. Transplantation offers the possibility of a more normal lifestyle than is possible with TPN and its known complications.

Intestinal transplantation procedures can be divided into two groups: 1) those involving intestinal transplantation alone, and 2) those involving both intestinal and liver transplantation. Small intestine transplantation alone is used for patients who have developed life-threatening complications but who do not have irreversible liver disease. Small intestine and liver transplants are reserved for patients who have developed TPN-related liver disease combined with some type of intestinal failure. This is an extensive surgical procedure, and includes increased risks. All intestinal transplantation procedures carry a high degree of risk. The criteria for patient selection, operating procedures, immunosuppressive therapy, and postoperative care are continually evolving, and expertise in this area will continue to improve.