The second STEP: the feasibility of repeat serial transverse enteroplasty.
BACKGROUND
Serial transverse enteroplasty (STEP) lengthens and tapers dilated bowel. Redilation of the STEP segment occurs in some patients with intestinal failure. The feasibility of a repeat STEP procedure in a pig model is evaluated.


METHODS
Six pigs underwent reversal of an intestinal segment distal to the ligament of Treitz. At 6-week intervals after reversal, each animal had 2 STEP procedures on the bowel proximal to the reversed segment. Necropsy was performed up to 6 weeks after repeat STEP.


RESULTS
Bowel length increased by 11.3 +/- 3.9 cm and bowel diameter decreased from a mean of 5.3 +/- 0.8 to 1.8 +/- 0.4 cm (P < .0001) after the first STEP. After repeat STEP, bowel length increased by 16.7 +/- 13.3 cm (P < .01), and the bowel was tapered from a mean of 5.4 +/- 0.9 to 2.2 +/- 0.4 cm (P < .01). Five pigs did well after repeat STEP, and 1 pig had early necropsy for bowel obstruction. None had histologic evidence of bowel ischemia in the repeat STEP segment.


CONCLUSIONS
A second STEP operation is feasible in a pig model and may be considered to optimize bowel length and function in select patients with intestinal failure.
Piper
Hannah
H
Department of Surgery, Children's Hospital Boston and the Harvard Center for Minimally Invasive Surgery, Harvard Medical School, Boston, MA 02115, USA.
Modi
Biren P
BP
Kim
Heung Bae
HB
Fauza
Dario
D
Glickman
John
J
Jaksic
Tom
T
D000818:Animals; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D007421:Intestine, Small / Q000601:surgery*; D008286:Malabsorption Syndromes / Q000601:surgery; D012086:Reoperation; D012778:Short Bowel Syndrome / Q000601:surgery*; D013552:Swine