Interposition of a reversed jejunal segment enhances intestinal adaptation in short bowel syndrome: an experimental study on pigs.
BACKGROUND
Interposition of a reversed intestinal segment as a factor facilitating intestinal adaptation has been experimentally investigated. Controversy exists about its efficacy in terms of body weight improvement, direction of luminal changes, and underlying mechanisms. This study aims to provide a comprehensive approach.


METHODS
The pigs were randomly allocated to two groups: (1) short bowel (SB) group (n=8) and (2) short bowel reverse jejunal segment (SB-RS) group (n=8). On postoperative d 3, 30, and 60, intestinal transit time was measured; body weight and serum albumin were measured on baseline, as well as on postoperative d 30 and 60. After sacrifice, histopathologic and immunohistochemical (PCNA, activated caspase-3) evaluation followed.


RESULTS
Transit time was numerically longer in SB-RS group at all time points; the difference reached statistical significance on d 60. No statistically significant differences were observed concerning body weight or serum albumin. In the SB-RS group, a statistically significant increase in muscle thickness, crypt depth, villus height, and PCNA immunostaining, and a decrease in caspase-3 positive (+) cell count were documented both at the jejunal and ileal level.


CONCLUSIONS
The reversed jejunal segment seemed able to enhance intestinal adaptation at a histopathologic level, as well as to favorably modify transit time. These putatively beneficial actions were not reflected upon body weight. The decrease in apoptosis was caspase-3-dependent.
Digalakis
Michail
M
1st Department of General Surgery, Asklipieio Voulas General Hospital, and Department of Pathology, Medical School, University of Athens, Athens, Greece.
Papamichail
Michail
M
Glava
Chryssoula
C
Grammatoglou
Xanthippi
X
Sergentanis
Theodoros N
TN
Papalois
Apostolos
A
Bramis
John
J
D000222:Adaptation, Physiological / Q000502:physiology*; D000818:Animals; D017209:Apoptosis / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D053148:Caspase 3 / Q000378:metabolism; D002455:Cell Division / Q000502:physiology; D004195:Disease Models, Animal; D005769:Gastrointestinal Motility / Q000502:physiology; D007085:Ilium / Q000473:pathology / Q000502:physiology; D007413:Intestinal Mucosa / Q000473:pathology / Q000502:physiology; D007583:Jejunum / Q000473:pathology / Q000502:physiology* / Q000601:surgery*; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism; D012778:Short Bowel Syndrome / Q000473:pathology / Q000503:physiopathology*; D034421:Sus scrofa
D018809:Proliferating Cell Nuclear Antigen; D012709:Serum Albumin; D053148:Caspase 3