Short Bowel Syndrome in Adults: The Surgeon’s Review

The small intestine is essential for nutrient absorption. There are, however, various pathologies that can disrupt its physiology and require surgical resection, leading to short bowel syndrome (SBS). Advancements in our understanding of SBS have expanded treatment strategies for this life-altering condition. Unfortunately, fragmented healthcare systems and limited access to medical documentation across healthcare organizations have created challenges in evaluating small bowel anatomy in patients with unknown surgical histories. This review summarizes recent advancements in non-operative management, outlines contemporary methods for assessing the small bowel in patients with incomplete surgical records, and discusses emerging technologies shaping the future of SBS treatment. Management of SBS requires a multidisciplinary approach encompassing nutritional optimization, pharmacologic therapy, and surgical interventions. Operative options include longitudinal intestinal lengthening and tapering, spiral intestinal lengthening and tailoring, serial transverse enteroplasty, or small bowel transplantation. Emerging innovations, such as tissue-engineered bowel and gene-targeted therapies for colonic enterocyte reprogramming, may offer transformative alternatives to conventional surgical reconstruction and long-term parenteral nutrition, representing a paradigm shift in SBS care. SBS results in a wide range of nutritional, metabolic, and gastrointestinal complications, frequently accompanied by secondary biliary and renal sequalae. Optimal management of patients with SBS requires a coordinated multidisciplinary care team that integrates dietary and nutrient supplementation, tailored parental nutrition regimens, pharmacologic therapies to enhance absorption and intestinal adaptation, and consideration of surgical options, such as lengthening procedures and small bowel transplantation.