EFFECT OF INTESTINAL TAPERING AND LENGTHENING ON INTESTINAL STRUCTUREAND FUNCTION

BACKGROUND: Intestinal lengthening (TL) is increasingly performed for the short bowel syndrome. Our aim was to evaluate the effect of TL on canine intestinal structure and function. METHODS: Two groups of 5 dog s had 75% distal intestinal resection, Twelve weeks later, serosal ele ctrodes were placed in one group (RO) and tapering and lengthening of 10 to 15 cm distal intestine and electrode placement was performed in the other group (TL), Nutritional status and intestinal absorption, mo tility, and hormone release were assessed every 4 weeks for 12 weeks a fter tbe second procedure. RESULTS: The animals with the lengthening h ad diminished body weight (75% +/- 2% versus 81% +/- 4% P < 0.05) and albumin levels (2.4 +/- 0.2 g/dL versus 2.9 +/- 0.5 g/dL, P < 0.05) an d impaired absorption (stool fat 18% +/- 6% versus 10% +/- 3%, P < 0.0 5) compared with those that had undergone resection alone, The intesti nal adaptive response was blunted in the TL group (villus height 328 /- 90 mu m versus 410 +/- 36 mu m, P < 0.05), Transit time was prolong ed 4 and 8 weeks (19 +/- 6 min and 18 +/- 5 min, respectively, versus 11 +/- 3 min, P < 0.05) after TL. Myoelectrical recordings showed a dr op in slow wave frequency and impaired migration of Phase III of the m igrating motor complex within the tapered and lengthened segments (P < 0.05), Both fasting and postprandial serum gastrin levels were two ti mes greater in the TL group (P < 0.05), Enteroglucagon levels were inc reased after resection alone; this increase was attenuated by more tha n 50% in the TL group (P < 0.05). The somatostatin response to feeding was substantially greater in the TL animals. CONCLUSIONS: TL impairs nutritional status and intestinal absorption and adaptation following massive resection. The changes in absorption and transit may be relate d, in part, to motor disruption and hypergastrinemia, The impaired ada ptation is possibly related to decreased enteroglucagon and increased somatostatin levels.