Spring-mediated distraction enterogenesis in-continuity.
OBJECTIVE
Distraction enterogenesis has been investigated as a novel treatment for patients with short bowel syndrome (SBS) but has been limited by loss of intestinal length during restoration and need for multiple bowel surgeries. The feasibility of in-continuity, spring-mediated intestinal lengthening has yet to be demonstrated.


METHODS
Juvenile mini-Yucatan pigs underwent in-continuity placement of polycaprolactone (PCL) degradable springs within jejunum. Methods used to anchor the spring ends to the intestine included full-thickness sutures and a high-friction surface spring. Spring constant (k) was 6-15N/m. Bowel was examined for length and presence of spring at 1 to 4weeks.


RESULTS
Animals tolerated in-continuity lengthening without bowel obstruction for up to 29days. In-continuity jejunum with springs demonstrated intestinal lengthening by 1.47-fold ±0.11. Five springs had detached prematurely, and lengthening could not be assessed. Histologically, in-continuity jejunum showed significantly increased crypt depth and muscularis thickness in comparison to normal jejunum.


CONCLUSIONS
Self-expanding endoluminal springs placed in continuity could lengthen intestine without obstruction in a porcine model. This is the first study showing safety and efficacy of a self-expanding endoluminal device for distraction enterogenesis. This is proof-of-concept that in-continuity spring lengthening is feasible and demonstrates its therapeutic potential in SBS.


METHODS
Level 3.
Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Nhan
N
Huynh
Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Joshua D
JD
Rouch
Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Andrew
A
Scott
Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Elvin
E
Chiang
School of Engineering, Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Benjamin M
BM
Wu
Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Shant
S
Shekherdimian
Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA; School of Engineering, Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA. Electronic address: jdunn@mednet.ucla.edu.
James C Y
JC
Dunn
D020341:Absorbable Implants; D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D007583:Jejunum / Q000601:surgery*; D011091:Polyesters; D012778:Short Bowel Syndrome / Q000601:surgery*; D034421:Sus scrofa; D015626:Tissue Expansion / Q000295:instrumentation* / Q000379:methods; D015625:Tissue Expansion Devices
D011091:Polyesters; C016240:polycaprolactone
Biodegradable lengthening device; Bowel lengthening; Distraction enterogenesis; Mechanical enterogenesis; Short bowel syndrome; Spring lengthening device