Mechanical lengthening in multiple intestinal segments in-series

J Pediatr Surg. 2016 Jun;51(6):957-9. doi: 10.1016/j.jpedsurg.2016.02.058. Epub 2016 Mar 2.

Abstract

Purpose: Current models of mechanical intestinal lengthening employ a single device in an isolated segment. Here we demonstrate that polycaprolactone (PCL) springs can be deployed in-series to lengthen multiple intestinal segments simultaneously to further increase overall intestinal length.

Methods: A Roux-en-y jejunojejunostomy with a blind Roux limb was created in the proximal jejunum of rats. Two encapsulated 10-mm PCL springs were placed in-series into the Roux limb and were secured with clips. After 4weeks, the lengthened segments were retrieved for histological analyses.

Results: Lengthening two intestinal segments simultaneously was achieved by placing two PCL springs in-series. The total combined length of the lengthened segments in-series was 45±4mm. The two jejunal segments with PCL springs (25±2 and 20±2mm) were significantly longer than control segments without the spring (14±1mm, p<0.05).

Conclusion: Spring-mediated lengthening can be achieved using multiple springs placed sequentially. The use of the Roux-en-y surgical model allowed easy insertion of springs in a blind Roux limb and arrange them in-series. Combined with relengthening techniques, we can use these methods to increase the length of small intestine to reach clinical significance.

Level of evidence: 1 Experimental.

Keywords: Biodegradable lengthening device; Bowel lengthening; Distraction enterogenesis; Mechanical enterogenesis; Short bowel syndrome; Spring lengthening device.

MeSH terms

  • Anastomosis, Roux-en-Y
  • Animals
  • Female
  • Jejunum / surgery*
  • Models, Animal
  • Polyesters
  • Rats
  • Rats, Sprague-Dawley
  • Short Bowel Syndrome / surgery*
  • Tissue Expansion / instrumentation
  • Tissue Expansion / methods*
  • Tissue Expansion Devices

Substances

  • Polyesters
  • polycaprolactone