title: Serial transverse enteroplasty enhances intestinal function in a model of short bowel syndrome.
abstract: OBJECTIVE/SUMMARY BACKGROUND DATA: Serial transverse enteroplasty (STEP) is a new intestinal lengthening procedure that has been shown to clinically increase bowel length. This study examined the impact of the STEP procedure upon intestinal function in a model of short bowel syndrome.
  
  
  METHODS
  Young pigs (n=10) had a reversed segment of bowel interposed to induce bowel dilatation. Five pigs underwent a 90% bowel resection with a STEP procedure on the remaining dilated bowel while 5 served as controls and had a 90% bowel resection without a STEP procedure. Determinations of nutritional status, absorptive capacity, and bacterial overgrowth were conducted 6 weeks after resection. Statistical comparisons were made by 2-sample t test (significance at P<0.05).
  
  
  RESULTS
  The STEP procedure lengthened the bowel from 105.2+/-7.7 cm to 152.2+/-8.3 cm (P<0.01). The STEP animals showed improved weight retention compared with controls (mean, -0.5%+/-1.8% body weight versus -17.6%+/-1.5%, P<0.001). Intestinal carbohydrate absorption, as measured by d-Xylose absorption and fat absorptive capacity as measured by serum vitamin D and triglyceride levels, were increased in the STEP group versus controls. Serum citrulline, a marker of intestinal mucosal mass, was significantly elevated in the STEP pigs compared with controls. None of the STEP animals but 4 of 5 control animals were noted to have gram-negative bacterial overgrowth in the proximal bowel.
  
  
  CONCLUSIONS
  STEP improves weight retention, nutritional status, intestinal absorptive capacity, and serum citrulline levels in a porcine short bowel model. A salutary effect upon bacterial overgrowth was also noted. These data support the use of this operation in short bowel syndrome.
authors.affiliation: Department of Surgery, Children's Hospital Boston and the Harvard Center for Minimally Invasive Surgery, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Chang
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Javid
authors.forename: Jung-Tak
authors.initials: JT
authors.lastname: Oh
authors.forename: Steven
authors.initials: S
authors.lastname: Andreoli
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.forename: Dario
authors.initials: D
authors.lastname: Fauza
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D004108:Dilatation, Pathologic; D004195:Disease Models, Animal; D007422:Intestines / Q000382:microbiology; D012778:Short Bowel Syndrome / Q000601:surgery*; D017792:Surgical Stapling; D013552:Swine