title: The use of bi-planar tissue expanders to augment abdominal domain in a pediatric intestinal transplant recipient.
abstract: Intestinal transplantation is a well-accepted treatment for SBS. However, patients with SBS often have decreased abdominal capacity, which makes size-matching of donor organs more difficult, thus decreasing organ availability. Reported approaches for addressing this problem include surgically reducing the graft size, leaving an open abdomen for a prolonged period, and cotransplanting rectus fascia as a non-vascularized allograft. Each approach has significant disadvantages. There has been one previous report of tissue expanders used intra-abdominally and two reports of subcutaneous use to increase intra-abdominal capacity prior to transplantation. We report the first use of bi-planar expander placement for this purpose. In our case, a two-yr-old male child with SBS due to malrotation was treated with tissue expanders 10 months prior to intestinal transplantation, thus allowing transplantation of a larger graft with the ability to close the abdomen safely. There were no complications, and the patient is now doing well and tolerating diet off PN. The use of tissue expanders prior to intestinal transplantation is a promising approach for such patients and avoids the morbidity associated with other approaches. This approach requires a multidisciplinary effort by gastroenterology, transplant surgery, and plastic surgery teams.
authors.affiliation: Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Weiner
authors.forename: June
authors.initials: J
authors.lastname: Wu
authors.forename: Mercedes
authors.initials: M
authors.lastname: Martinez
authors.forename: Steven
authors.initials: S
authors.lastname: Lobritto
authors.forename: Nadia
authors.initials: N
authors.lastname: Ovchinsky
authors.forename: Christine
authors.initials: C
authors.lastname: Rohde
authors.forename: Adam
authors.initials: A
authors.lastname: Griesemer
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D002675:Child, Preschool; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000637:transplantation*; D059325:Intra-Abdominal Hypertension / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012778:Short Bowel Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D015625:Tissue Expansion Devices; D014180:Transplantation / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: abdominal compartment syndrome; intestinal transplantation; pediatric transplantation; tissue expander