Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery

Andreas G. Tzakis, Panagiotis Tryphonopoulos, Werviston De Faria, Tomoaki Kato, Seigo Nishida, David M. Levi, Juan Madariaga, Debbie Weppler, Naveen Mittal, Phillip Ruiz, Jose R. Nery, John F. Thompson

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

BACKGROUND: Resection of lesions of the root of the mesentery with established techniques is difficult and at times impossible because of their proximity to the blood supply of the intestine. Damage of the superior mesenteric vessels necessitates resection of the intestine, resulting in short bowel syndrome and intestinal failure. STUDY DESIGN: We describe a surgical technique drawn from our experience in intestinal transplantation in which the root of the mesentery (including the lesion) and the head or the entire pancreas, duodenum, small intestine, and part of the colon are excised en bloc and preserved in a cold solution. Resection of the lesion is performed in a bloodless field ex vivo, and the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients, two adult and two pediatric, who had extensive neoplasms of the root of the mesentery. Their underlying diseases were mesenteric fibroma, vascular dysplasia of the root of the mesentery, pancreatic cancer, and desmoid tumor. RESULTS: Local control of the lesions was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the operation and live on enteral nutrition 6 to 49.5 months after the procedure. CONCLUSIONS: The procedure of partial abdominal exenteration, ex vivo resection, and autotransplantation is an extension of our experience with intestinal transplantation. In selected cases, this technique may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.

Original languageEnglish
Pages (from-to)770-776
Number of pages7
JournalJournal of the American College of Surgeons
Volume197
Issue number5
DOIs
StatePublished - Nov 1 2003

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Mesentery
Autologous Transplantation
Intestines
Short Bowel Syndrome
Small Intestine
Transplantation
Aggressive Fibromatosis
Therapeutics
Fibroma
Abdominal Cavity
Enteral Nutrition
Pancreatic Neoplasms
Duodenum
Blood Vessels
Pancreas
Neoplasms
Colon
Head
Pediatrics

ASJC Scopus subject areas

  • Surgery

Cite this

Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery. / Tzakis, Andreas G.; Tryphonopoulos, Panagiotis; De Faria, Werviston; Kato, Tomoaki; Nishida, Seigo; Levi, David M.; Madariaga, Juan; Weppler, Debbie; Mittal, Naveen; Ruiz, Phillip; Nery, Jose R.; Thompson, John F.

In: Journal of the American College of Surgeons, Vol. 197, No. 5, 01.11.2003, p. 770-776.

Research output: Contribution to journalArticle

Tzakis, AG, Tryphonopoulos, P, De Faria, W, Kato, T, Nishida, S, Levi, DM, Madariaga, J, Weppler, D, Mittal, N, Ruiz, P, Nery, JR & Thompson, JF 2003, 'Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery', Journal of the American College of Surgeons, vol. 197, no. 5, pp. 770-776. https://doi.org/10.1016/S1072-7515(03)00756-7
Tzakis, Andreas G. ; Tryphonopoulos, Panagiotis ; De Faria, Werviston ; Kato, Tomoaki ; Nishida, Seigo ; Levi, David M. ; Madariaga, Juan ; Weppler, Debbie ; Mittal, Naveen ; Ruiz, Phillip ; Nery, Jose R. ; Thompson, John F. / Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery. In: Journal of the American College of Surgeons. 2003 ; Vol. 197, No. 5. pp. 770-776.
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abstract = "BACKGROUND: Resection of lesions of the root of the mesentery with established techniques is difficult and at times impossible because of their proximity to the blood supply of the intestine. Damage of the superior mesenteric vessels necessitates resection of the intestine, resulting in short bowel syndrome and intestinal failure. STUDY DESIGN: We describe a surgical technique drawn from our experience in intestinal transplantation in which the root of the mesentery (including the lesion) and the head or the entire pancreas, duodenum, small intestine, and part of the colon are excised en bloc and preserved in a cold solution. Resection of the lesion is performed in a bloodless field ex vivo, and the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients, two adult and two pediatric, who had extensive neoplasms of the root of the mesentery. Their underlying diseases were mesenteric fibroma, vascular dysplasia of the root of the mesentery, pancreatic cancer, and desmoid tumor. RESULTS: Local control of the lesions was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the operation and live on enteral nutrition 6 to 49.5 months after the procedure. CONCLUSIONS: The procedure of partial abdominal exenteration, ex vivo resection, and autotransplantation is an extension of our experience with intestinal transplantation. In selected cases, this technique may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.",
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AU - Tzakis, Andreas G.

AU - Tryphonopoulos, Panagiotis

AU - De Faria, Werviston

AU - Kato, Tomoaki

AU - Nishida, Seigo

AU - Levi, David M.

AU - Madariaga, Juan

AU - Weppler, Debbie

AU - Mittal, Naveen

AU - Ruiz, Phillip

AU - Nery, Jose R.

AU - Thompson, John F.

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N2 - BACKGROUND: Resection of lesions of the root of the mesentery with established techniques is difficult and at times impossible because of their proximity to the blood supply of the intestine. Damage of the superior mesenteric vessels necessitates resection of the intestine, resulting in short bowel syndrome and intestinal failure. STUDY DESIGN: We describe a surgical technique drawn from our experience in intestinal transplantation in which the root of the mesentery (including the lesion) and the head or the entire pancreas, duodenum, small intestine, and part of the colon are excised en bloc and preserved in a cold solution. Resection of the lesion is performed in a bloodless field ex vivo, and the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients, two adult and two pediatric, who had extensive neoplasms of the root of the mesentery. Their underlying diseases were mesenteric fibroma, vascular dysplasia of the root of the mesentery, pancreatic cancer, and desmoid tumor. RESULTS: Local control of the lesions was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the operation and live on enteral nutrition 6 to 49.5 months after the procedure. CONCLUSIONS: The procedure of partial abdominal exenteration, ex vivo resection, and autotransplantation is an extension of our experience with intestinal transplantation. In selected cases, this technique may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.

AB - BACKGROUND: Resection of lesions of the root of the mesentery with established techniques is difficult and at times impossible because of their proximity to the blood supply of the intestine. Damage of the superior mesenteric vessels necessitates resection of the intestine, resulting in short bowel syndrome and intestinal failure. STUDY DESIGN: We describe a surgical technique drawn from our experience in intestinal transplantation in which the root of the mesentery (including the lesion) and the head or the entire pancreas, duodenum, small intestine, and part of the colon are excised en bloc and preserved in a cold solution. Resection of the lesion is performed in a bloodless field ex vivo, and the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients, two adult and two pediatric, who had extensive neoplasms of the root of the mesentery. Their underlying diseases were mesenteric fibroma, vascular dysplasia of the root of the mesentery, pancreatic cancer, and desmoid tumor. RESULTS: Local control of the lesions was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the operation and live on enteral nutrition 6 to 49.5 months after the procedure. CONCLUSIONS: The procedure of partial abdominal exenteration, ex vivo resection, and autotransplantation is an extension of our experience with intestinal transplantation. In selected cases, this technique may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.

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