Short bowel syndrome (SBS) is defined as loss of bowel mass from surgical removal, congenital anomaly or disease. A small number of long-gap OA/TOF patients fall into this definition as a result of the jejunal and colonic interpositions undertaken to repair the OA, in particular those where complications meant that more than one such procedure was undertaken. It is estimated that having less than 200cm of functional intestine is needed to develop SBS and less than 35cm for intestinal failure (where oral feeding plus supplements are not sufficient to meet nutritional needs and parenteral nutrition is necessary). (195)
Whilst any adults with OA/TOF will have had loss of bowel since childhood and some adaptation will have occurred over this time, some may present with ongoing symptoms in adulthood, particularly if any further surgery to the bowel has occurred, and some may have worsening problems due to gastrointestinal infection or may be debilitated by the symptoms they have lived with for many years.