Restorative Surgery in Adult Short Bowel Syndrome: Outcomes from a Single-Center Experience with an Illustrative Complex Case

Background: Short bowel syndrome (SBS) is a severe form of intestinal failure often associated with high output jejunostomy, fluid and electrolyte imbalance, and long-term dependence on parenteral nutrition (PN). In patients with type I SBS, restorative surgery may reduce PN dependence and enable conversion to type II or III SBS through restoration of intestinal continuity. Methods: We report our single-center experience. Between 2018 and 2025, nine adult patients with chronic type I SBS and high output jejunostomy underwent restorative surgery within a multidisciplinary intestinal rehabilitation program. All patients were PN-dependent preoperatively, and two had intestinal failure-associated liver disease (IFALD). Surgical strategies were individualized according to residual anatomy and focused on restoration of intestinal continuity, without bowel lengthening procedures. Clinical outcomes were descriptively analyzed. Results: Intestinal continuity was successfully restored in all patients, resulting in conversion from type I to type II or III SBS. A clinically relevant improvement in intestinal function was observed in all cases. Complete enteral autonomy was achieved in three patients, while the remaining patients experienced a meaningful reduction in PN requirements, including partial or nocturnal supplementation. Five of nine patients developed postoperative complications: one required reoperation and one endoscopic treatment for anastomotic bleeding. No perioperative mortality was recorded. Conclusions: In adult patients with type I SBS, restorative surgery enables anatomical and functional conversion to type II or III SBS. When performed within specialized multidisciplinary programs and guided by careful management of hostile abdomen, this approach may result in significant functional improvement and reduced PN dependence.