Intestinal Adaptation and Functional Recovery After Extensive Bowel Resection: Advances in Nutritional Rehabilitation, Pharmacological Therapy, and Surgical Reconstruction

Short bowel syndrome (SBS) represents a complex consequence of extensive intestinal resection, characterized by impaired nutrient absorption, fluid and electrolyte disturbances, and variable degrees of intestinal failure requiring prolonged nutritional support. This narrative review aimed to analyze the physiological mechanisms of gastrointestinal adaptation and evaluate the clinical relevance of nutritional rehabilitation, pharmacological treatment, and surgical reconstruction in patients with SBS, incorporating international evidence and Latin American clinical experience. A descriptive and analytical synthesis of 20 scientific publications, including international guidelines, randomized controlled trials, systematic reviews, and observational studies published between 2014 and 2024, was conducted. The findings identified residual intestinal anatomy, preservation of ileal and colonic continuity, and adaptive capacity as major determinants of functional recovery. Nutritional rehabilitation emerged as the foundation of treatment, integrating parenteral support with progressive enteral stimulation and individualized dietary strategies. Pharmacological therapy with teduglutide demonstrated significant benefits, with 63% of treated patients achieving a predefined reduction in parenteral support requirements compared with 30% receiving placebo. Surgical reconstruction through serial transverse enteroplasty (STEP) and longitudinal intestinal lengthening and tailoring (LILT) was associated with reported parenteral nutrition independence rates of 46% and 52%, respectively, although methodological heterogeneity prevented definitive comparisons. Latin American evidence, particularly the RESTORE Registry, documented differences in rehabilitation outcomes between adult and pediatric populations, emphasizing the complexity of regional clinical management. Overall, the evidence indicates that intestinal rehabilitation requires individualized multidisciplinary strategies integrating gastrointestinal physiology, nutritional support, pharmacological interventions, and reconstructive surgery when appropriate. Further prospective multicenter investigations are necessary to standardize clinical outcomes, identify predictors of nutritional autonomy, and improve long-term functional recovery and quality of life.