Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery.
BACKGROUND
Resection of lesions of the root of the mesentery with established techniques is difficult and at times impossible because of their proximity to the blood supply of the intestine. Damage of the superior mesenteric vessels necessitates resection of the intestine, resulting in short bowel syndrome and intestinal failure.


METHODS
We describe a surgical technique drawn from our experience in intestinal transplantation in which the root of the mesentery (including the lesion) and the head or the entire pancreas, duodenum, small intestine, and part of the colon are excised en bloc and preserved in a cold solution. Resection of the lesion is performed in a bloodless field ex vivo, and the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients, two adult and two pediatric, who had extensive neoplasms of the root of the mesentery. Their underlying diseases were mesenteric fibroma, vascular dysplasia of the root of the mesentery, pancreatic cancer, and desmoid tumor.


RESULTS
Local control of the lesions was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the operation and live on enteral nutrition 6 to 49.5 months after the procedure.


CONCLUSIONS
The procedure of partial abdominal exenteration, ex vivo resection, and autotransplantation is an extension of our experience with intestinal transplantation. In selected cases, this technique may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.
Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Miami, FL, USA.
Andreas G
AG
Tzakis
Panagiotis
P
Tryphonopoulos
Werviston
W
De Faria
Tomoaki
T
Kato
Seigo
S
Nishida
David M
DM
Levi
Juan
J
Madariaga
Debbie
D
Weppler
Naveen
N
Mittal
Phillip
P
Ruiz
Jose R
JR
Nevy
John F
JF
Thompson
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D016470:Bacteremia / Q000209:etiology; D002675:Child, Preschool; D015925:Cryopreservation / Q000379:methods; D005260:Female; D005350:Fibroma / Q000601:surgery; D018222:Desmoid Tumors / Q000601:surgery; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D045823:Ileus / Q000209:etiology; D007422:Intestines / Q000601:surgery*; D008026:Ligation / Q000379:methods; D008297:Male; D008643:Mesentery / Q000002:abnormalities / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001261:Pulmonary Atelectasis / Q000209:etiology; D012092:Replantation / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome