title: The second STEP: the feasibility of repeat serial transverse enteroplasty.
abstract: 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.
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: Hannah
authors.initials: H
authors.lastname: Piper
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.forename: Dario
authors.initials: D
authors.lastname: Fauza
authors.forename: John
authors.initials: J
authors.lastname: Glickman
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: 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