title: Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure.
abstract: OBJECTIVE
  Bowel lengthening may be beneficial for children with short bowel syndrome. However, current techniques require at least one intestinal anastomosis and place the mesenteric blood supply at risk. This study seeks to establish the technical principles of a new, simple, and potentially safer bowel lengthening procedure.
  
  
  METHODS
  Young pigs (n = 6) underwent interposition of a reversed intestinal segment to produce proximal small bowel dilation. Five weeks later the reversed segment was resected. Lengthening of the dilated bowel then was performed by serial transverse applications of a GIA stapler, from opposite directions, to create a zig zag channel. A distal segment of equal length served as an in situ morphometric control. Contrast radiologic studies were performed 6 weeks later, and the animals were killed. Statistical comparisons were made by paired t test with P less than.05 considered significant.
  
  
  RESULTS
  After bowel lengthening, all animals gained weight (66.7 +/- 3.0 [SD] kg v 42.5 +/- 3.5 kg; P <.001) and showed no clinical or radiologic evidence of intestinal obstruction. Intraoperatively, immediately after serial transverse enteroplasty, the intestine was substantially elongated (82.8 +/- 6.7 cm v 49.2 +/- 2 cm; P <.01). Six weeks after surgery, the lengthened intestinal segment became practically straight and, compared with the in situ control, remained significantly longer (80.7 +/- 13.1 cm v 57.2 +/- 10.4 cm; P <.01). There was no difference in diameter between these segments (4.3 +/- 0.7 cm v 3.8 +/- 0.4 cm; P value, not significant).
  
  
  CONCLUSIONS
  Serial transverse enteroplasty (STEP) significantly increases intestinal length without any evidence of obstruction. This procedure may be a safe and facile alternative for intestinal lengthening in children with short bowel syndrome.
authors.affiliation: Department of Surgery, Children's Hospital and Harvard Medical School, and Harvard Center for Minimally Invasive Surgery, Boston, Massachusetts 02115, USA.
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.forename: Dario
authors.initials: D
authors.lastname: Fauza
authors.forename: Jennifer
authors.initials: J
authors.lastname: Garza
authors.forename: Jung-Tak
authors.initials: JT
authors.lastname: Oh
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D004108:Dilatation, Pathologic / Q000601:surgery; D007583:Jejunum / Q000601:surgery*; D008643:Mesentery / Q000601:surgery; D023421:Models, Animal; D012778:Short Bowel Syndrome / Q000601:surgery*; D017792:Surgical Stapling; D013552:Swine