February 16, 2005

First-time surgery may save newborn from bowel transplant

The newborn baby of a Fort Campbell soldier family has become the first to receive a new type of surgery at the Monroe Carell Jr. Children‘s Hospital at Vanderbilt.

The newborn baby of a Fort Campbell soldier family has become the first to receive a new type of surgery at the Monroe Carell Jr. Children‘s Hospital at Vanderbilt. Colston Galloway, who is now 3 weeks old, is one of the first babies in the country to have a procedure called Serial Transverse Enteroplasty, or STEP. It is hoped the surgery will help babies born with Short Bowel Syndrome (SBS) avoid bowel and liver transplant.

Colston‘s parents, Noah and Brandi Galloway, were referred to Ed Yang, M.D., assistant professor of Pediatric Surgery, when their baby was born prematurely and then failed to have a bowel movement in the first days of life.

“They came into our room (at Jennie Stuart Medical Center in Hopkinsville, Ky.) and told us we were being transferred to Vanderbilt,” said Noah. “That was the first we knew anything was wrong.”

On Saturday, Jan. 29, Yang began what he thought would be a fairly routine procedure: to remove a small portion of obstructed or damaged intestine in Colston‘s belly, but once surgery was under way Yang discovered most of the baby‘s intestines had become twisted and had already died. He says this was probably why Colston was delivered prematurely. What remained of his intestine was backed up and stretched far beyond its normal shape and size. In the middle of the surgery, Yang called the family into a meeting to discuss the option of using STEP to preserve more of the baby‘s natural intestinal function. The family consented to the operation.

“I trained at the hospital in Boston where this surgery was developed,” said Yang. “While there have only been a handful of these operations in the country — perhaps less than 10 — I thought there was a significant chance the operation would help Colston.”

The damage was so severe; Colston didn‘t have enough intestine left to properly process food, the hallmark of SBS. With use of total parenteral nutrition (TPN), babies can survive by receiving most or all of their nutrition directly into the bloodstream, but for reasons that are not clear, TPN can also lead to liver failure. Depending on the severity of SBS, babies often end up needing a combined liver and intestinal transplant from an infant donor.

The purpose of the STEP procedure is to take the small section of intestine that is still living, but stretched too wide to be effective, and reshape it into a longer, narrower, more effective digestive tube.

Traditionally this has been done with a procedure known as the Bianchi, where one long incision splits the leftover section into a “V” shape but Yang says that procedure is technically difficult and is now considered to be less effective than a bowel transplant.

In the STEP procedure, the dilated section is cut several times down its length on alternating sides using a special stapler. This creates a “zigzag” or “accordion” appearance of the bowel.

“Without the surgery, Colston would not have bowel that would function well. He would certainly have malabsorption and stasis problems,” Yang said. “He would have been high risk for transplantation, but this surgery is simpler than the older procedure (the Bianchi)and we hope it will be more successful at avoiding bowel transplant and TPN-induced liver failure.”

The STEP is still considered to be experimental, but Yang is hoping to be able to include Colston in a national registry of patients who have had the STEP to find out if this should be the surgery of choice for many children with SBS.

In animal studies, researchers found the STEP procedure allowed animals with shortened intestine gain weight. In humans, it is hoped that the STEP may help babies come off TPN and prevent the need for a combined small bowel/liver transplant. But Yang stresses it will be six months before he‘ll know if STEP has worked for Colston and it will be years before it‘s clearly known if STEP can reduce the need for transplantation.

Brandi and Noah Galloway say Colston is doing very well. Noah is an Army Specialist in the 101st Airborne. He was deployed during the beginning of the war with Iraq and faces deployment again in the spring. The couple says their son‘s condition adds stress to their already tense situation, but they have complete confidence in Yang and expect Colston to do well. Brandi says the most important thing is that Colston is beginning to eat now, for the first time.

“The doctors say they will give him food very slowly to see how he‘ll handle it. It may take a couple of months before we can go home,” Noah said. “Right now I‘m enjoying this break in my job and spending time with my family.”

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Carole Bartoo