title: Development of an endoluminal intestinal attachment for a clinically applicable distraction enterogenesis device.
abstract: OBJECTIVE
  Previous methods of distraction enterogenesis have relied upon blind-ending intestinal segments or transmural device fixation, requiring multiple operations and potential bowel injury. We hypothesized that using a novel attachment would allow reversible device coupling to the luminal bowel surface, achieving effective endoluminal distraction.
  
  
  METHODS
  A telescopic hydraulic device was designed with latex balloon attachments covered with high-friction mesh and a dilating fenestrated elastic mask (DFM attachment), allowing mesh-to-mucosa contact only with inflation. Yorkshire pigs underwent jejunal Roux-en-Y limb creation and device placement via jejunostomy. Devices underwent 3 cycles of balloon inflation and hydraulic extension/retraction per day for 7 days and then explanted and studied for efficacy.
  
  
  RESULTS
  DFM attachment allowed reversible, high-strength endoluminal coupling without tissue injury or reduction in bowel perfusion. After 7 day implant, distracted bowel achieved a 44 ± 2% increase in length vs. fed, nondistracted bowel, corresponding to a gain of 7.1 ± 0.3 cm. Distracted bowel demonstrated increased epithelial cell proliferation vs. control bowel. Attachment sites demonstrated villus flattening, increased crypt depth, thicker muscularis mucosa, and unchanged muscularis propria thickness vs.
  
  
  CONCLUSIONS
  Novel high-strength, reversible attachments enabled fully endoluminal distraction enterogenesis, achieving length gains comparable to open surgical techniques. This approach may allow development of clinically applicable technology for SBS treatment.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: Farokh R
authors.initials: FR
authors.lastname: Demehri
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Utter
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Freeman
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Fukatsu
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Luntz
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA.
authors.forename: Diann
authors.initials: D
authors.lastname: Brei
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA. Electronic address: dttlbm@umich.edu.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D000818:Animals; D005260:Female; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery*; D012778:Short Bowel Syndrome / Q000601:surgery*; D013552:Swine; D015626:Tissue Expansion / Q000295:instrumentation* / Q000379:methods; D015625:Tissue Expansion Devices
keywords: Distraction enterogenesis; Mechanotransduction; Pediatric device; Short bowel syndrome