title: The next step? Use of tissue fusion technology to perform the serial transverse enteroplasty--proof of principle.
abstract: BACKGROUND
  Serial transverse enteroplasty (STEP) is an established procedure for intestinal lengthening and tapering. A gastrointestinal linear stapler is used to taper the bowel sequentially. We report preliminary experience with tissue fusion technology to perform STEP in a porcine model.
  
  
  METHODS
  Four weaned male pigs (mean age, 4 ± 0 weeks; mean weight, 6.8 ± 0.1 kg) first underwent a 60-cm reversed intestinal segment followed by a STEP 4 to 6 weeks later. The LigaSure Impact (Covidien, Valleylab, Tyco Healthcare Group LP, Boulder, CO) was used to perform the procedure. Animals were fed on postoperative day 2 and terminated 1 week later. Morphometric data were collected, and intestinal tissue was obtained for histology.
  
  
  RESULTS
  Mean bowel caliber of 5.1 ± 0.5 cm was tapered to 1.8 ± 0.3 cm post-STEP with a mean increase in the length of the dilated segment of 82% ± 20%. All animals tolerated enteral feeding, and all survived to termination on day 7. Histologic evaluation revealed the zone of tissue fusion to be 7.1 ± 1.5 mm. Masson trichrome, hematoxylin and eosin, and polarized picrosirius red stains demonstrated that the fusion zone was well healed with overlying granulation tissue.
  
  
  CONCLUSIONS
  This is the first report of the successful application of radiofrequency energy to perform the STEP procedure in animals. Although further evaluation is required, tissue fusion devices may eventually provide an alternative to the linear stapler for the STEP procedure.
authors.affiliation: Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Megha
authors.initials: M
authors.lastname: Suri
authors.forename: Bryan
authors.initials: B
authors.lastname: Dicken
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Nation
authors.forename: Pamela
authors.initials: P
authors.lastname: Wizzard
authors.forename: Justine M
authors.initials: JM
authors.lastname: Turner
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004564:Electrocoagulation / Q000295:instrumentation*; D005240:Feasibility Studies; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D012778:Short Bowel Syndrome / Q000601:surgery*; D013552:Swine; D016896:Treatment Outcome