Repeated lengthening using distraction enterogenesis: A porcine model.

Abstract

Spring-mediated distraction enterogenesis aims to use mechanical stretch to generate new functional intestinal tissue in patients with short bowel syndrome. Because of the incremental nature of spring-mediated distraction enterogenesis, patients may require multiple spring insertions to produce enough tissue to wean off parenteral nutrition. We aim to demonstrate the feasibility of repeated lengthening within the same intestinal segment. Juvenile Yucatan pigs underwent a laparotomy to introduce a gelatin-encapsulated nitinol spring into the jejunum. After 14-21 days, a second laparotomy was performed to remove the initial spring and insert a new compressed spring with a greater force constant into a portion of the previously lengthened jejunum. After 7 days, the pigs were killed, and samples were collected. Spring insertion produced a significant increase in jejunal length when compared to controls. Both the initial and the subsequent stronger springs produced an equivalent amount of lengthening. Crypt depth, mucosal thickness, muscularis thickness, and the outer serosal perimeter of the repeatedly lengthened jejunal segments all increased compared with control segments. Previously lengthened segments of jejunum were successfully relengthened using spring-mediated distraction enterogenesis in a porcine model. This suggests that patients with short bowel syndrome may be offered repeat distraction procedures to achieve a greater increase in bowel length than a single spring-mediated distraction enterogenesis procedure.