G. Dubrovsky1, N. Huynh2, A. Thomas2, S. Shekherdimian1, J. C. Dunn1,2 1University Of California – Los Angeles,Division Of Pediatric Surgery, Department Of Surgery, David Geffen School Of Medicine,Los Angeles, CA, USA 2Stanford University,Division Of Pediatric Surgery, Department Of Surgery, Stanford University School Of Medicine,Palo Alto, CA, USA
Introduction:
Spring-mediated distraction enterogenesis has been shown to increase the length of an intestinal segment in rat and pig models by as much as 3-fold, and therefore has potential as a new therapy for patients with short bowel syndrome. However, this method for intestinal growth has required the spring to be confined within a segment of intestine that has two closed ends and that has been defuctionalized. The goal of this study is to use suture plication to confine a spring within a functional intestinal segment while maintaining the luminal patency of the intestine and allowing for the normal flow of GI contents.
Methods:
Juvenile mini-Yucatan pigs underwent placement of a nitinol spring within a functional segment of jejunum in continuity. A 20 French catheter was passed temporarily, and sutures were used to plicate and narrow the intestinal lumen to the diameter of the catheter around the encapsulated spring on both sides (FIGURE). Pigs were maintained on a liquid diet post-operatively. The intestine was re-examined 3 weeks after spring placement for lengthening and for histological changes.
Results:
All pigs tolerated a liquid diet with appropriate weight gain. In the absence of plication, springs passed through the intestine within a week. Double plication allowed the spring to stay in place within the jejunum for 3 weeks. Compared to uncompressed springs that showed no change in the length of plicated segments, compressed springs caused a nearly 1.5-fold increase in the length of plicated segments. Histology showed a significant increase in both the thickness of the muscularis propria from 230 µm to 450 µm and in the crypt depth from 210 µm to 420 µm in lengthened segments compared to normal segments of intestine.
Conclusion:
Intestinal plication is an effective method to confine endoluminal springs. The confined springs are able to lengthen intestine while allowing for normal GI function and growth of animals, making this a clinically relevant model. We also see histological changes consistent with intestinal growth at the cellular level. This approach may be useful to lengthen intestine in patients with short bowel syndrome.
