Modified Paul-Mikulicz ileostomy in a Swine model of isolated small bowel transplantation.
BACKGROUND
Intestinal transplantation (ITx) is a life-saving procedure for patients with intestinal failure. The poorer outcome of ITx than of other organ transplantation, however, warrants more clinical and basic research on ITx. Herein, we developed a modified Paul-Mikulicz ileostomy procedure in a swine model of ITx, and investigated its feasibility for obtaining intestinal samples of both the graft and the recipient.


METHODS
We performed ITx in 10 pairs of piglets, each weighing 15-20 kg. Procurement included an isolated segment of the small bowel, constituting a model of a living, related donor surgery. The recipient procedures included end-to-end anastomosis of vascular stumps, a proximal jejuno-jejunal anastomosis, and a distal modified Paul-Mikulicz ileostomy. The procedure differed from the classic Paul-Mikulicz ileostomy in that a common channel was created in a side-to-side fashion.


RESULTS
Vascular thrombosis occurred in three pigs, resulting in immediate loss of the graft. All other pigs underwent ITx successfully and survived for at least 1 wk (7-180 d). No pig experienced anastomotic leaks, ileus, or stoma-related complications. Moreover, this technique enabled us to obtain tissue samples of both the graft and the native ileum without disturbing the natural bowel conduit.


CONCLUSIONS
The modified Paul-Mikulicz ileostomy was feasible in a swine model of ITx. It facilitated the collection of intestinal samples of both the graft and the recipient.
Tsai
Ming-Shian
MS
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Lin
Wen-Hsi
WH
Hsu
Wen-Ming
WM
Lai
Hong-Shiee
HS
Yeh
Chi-Chuan
CC
Huang
John
J
Tai
Hao-Chih
HC
Lee
Po-Huang
PH
Chen
Wei-Jao
WJ
D000818:Animals; D001835:Body Weight; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007410:Intestinal Diseases / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery / Q000637:transplantation*; D019520:Living Donors; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery / Q000637:transplantation; D008642:Mesenteric Veins / Q000601:surgery; D010288:Parenteral Nutrition / Q000379:methods; D011184:Postoperative Period; D015424:Reperfusion / Q000379:methods; D013552:Swine; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous / Q000276:immunology
D007166:Immunosuppressive Agents; D016559:Tacrolimus