What is the name of the procedure where the small intestine is cut to match the size of a larger intestine?

Intestinal Lengthening Procedures for Size Matching

The procedure you're describing is most likely tapering enteroplasty when the goal is simply to reduce the diameter of a dilated small intestine to match a larger (wider) intestine downstream, or alternatively, one of the bowel lengthening procedures (LILT or STEP) when the goal is to preserve surface area while reducing diameter.

Simple Tapering Enteroplasty

When bowel length is adequate and loss of absorptive surface is acceptable, a simple tapering enteroplasty is performed by removing a strip of bowel along the anti-mesenteric border to restore normal caliber and match the size of the downstream intestine. 1

• This straightforward procedure addresses segmental bowel dilatation with poor peristalsis, which commonly causes small bowel bacterial overgrowth 1
• The technique involves excising redundant bowel tissue to narrow the lumen without complex reconstruction 1, 2
• This is the simplest option when the patient clearly does not have short bowel syndrome and bowel length preservation is not critical 1

Lengthening Procedures When Surface Area Must Be Preserved

When bowel length is critical (as in short bowel syndrome), two main procedures accomplish tapering without losing absorptive surface area:

Longitudinal Intestinal Lengthening and Tailoring (LILT/Bianchi Procedure)

• The Bianchi procedure splits dilated bowel longitudinally along the antimesenteric border, creating two hemi-loops that are reconnected end-to-end, resulting in bowel that is twice the original length and half the original diameter. 1
• This technique was first described by Adrian Bianchi and relies on the bifurcated mesenteric blood supply 1, 3
• Each half receives essentially half the original blood supply and the segments are anastomosed in isoperistaltic fashion 1

Serial Transverse Enteroplasty (STEP)

• The STEP procedure narrows the intestinal lumen by firing staples perpendicular to the bowel's long axis in a zig-zag pattern, preserving blood supply while achieving tapering. 1
• Described by Kim et al. in 2003, this is technically simpler than the Bianchi procedure 1
• The choice between LILT and STEP remains somewhat unclear and often relates to surgeon preference, as there are no critical differences in outcomes 1

Clinical Context and Outcomes

• These procedures are primarily used in short bowel syndrome patients with dilated intestinal segments who remain dependent on parenteral nutrition 1
• Overall, 50-60% of patients who undergo autologous gastrointestinal reconstructive surgery may eventually wean off parenteral nutrition. 1
• The procedures should be employed within a comprehensive multidisciplinary approach, as no single operation offers a cure for short bowel syndrome 1

Key Decision Points

Use simple tapering enteroplasty when:

• Bowel length is clearly adequate 1
• Loss of absorptive surface area is an acceptable tradeoff for improved peristalsis 1
• The patient does not have short bowel syndrome 1

Use LILT or STEP when:

• Bowel length is critical and the patient has short bowel syndrome 1
• Preservation of absorptive surface area is essential 1
• The patient has dilated bowel segments with poor motility while on parenteral nutrition 1