A SURGICAL MODEL TO INCREASE THE INTESTINAL ABSORPTIVE SURFACE - INTESTINAL LENGTHENING AND GROWING NEOMUCOSA IN THE SAME APPROACH

Despite numerous investigations short bowel syndrome (SBS) is still an unsolved clinical problem. The purpose of this study was to develop a new surgical approach that combines both intestinal lengthening and g rowing neomucosa. The operative principle is based on a longitudinal d ivision of an intestinal segment antimesenterically and a formation of two intestinal tubes out of bowel halves anastomosing one cutting edg e to the incised mucosal midline and the other to the antimesenteric s ide of the constructed first intestinal tube, so that a common wall be tween the two hemiloops was created which leads to grow neomucosa. Thi s procedure was applied to 11 rabbits. The hemiloops and neomucosa wer e investigated for its feasibility and morphologic characteristics. Gr oss and microscopic examinations at 8 weeks revealed that all the inte stinal tubes were viable and patent. No anastomotic leakage was presen t, In all animals, the serosal surfaces of the common walls were cover ed with neomucosa that resembles the mucosa of the existing intestine morphologically; there was no significant difference in villus height, villus width at base, crypt depth, number of villi per unit serosal l ength, villus surface, and villus surface per unit serosa, The growth of neomucosa was completely a result of epithelialization without any evidence of contraction. The quantity and rate of neomucosal growth se ems uneffected by intestinal segment length. Finally a two times incre ase in intestinal length, whereas the diameter halved and a statistica lly significant increase (P < 0.001) in total villus surface via growi ng neomucosa was obtained, This model might be useful in the managemen t of SBS when supported by clinical and functional investigations. (C) 1996 Academic Press, Inc.