Abstract
Background: Small bowel transplantation (SBTX) in children receiving larger grafts from adults can be challenging because of size mismatch. The aim of the present study was to assess whether a simultaneous serial transverse enteroplasty (STEP) can address the problem of size mismatch. Methods: Three different size ratio groups between donors and recipients were compared in a porcine model with a 14-day follow-up. The groups were size matched, size mismatched (1:3.8 weight ratio), and size mismatched + STEP (each n = 8). Results: It was technically feasible to simultaneously perform a STEP and SBTX of a mismatched intestinal segment. The postoperative clinical course was uneventful. No signs of bleeding, leakage, stenosis, or ileus were observed and the intestinal segment was well perfused at relaparotomy. Body weight decreased in all groups, but the percentage decrease was lowest in the mismatched + STEP group. Vital enterocyte masses were similar in all the groups (citrulline levels) and the nutritional status was best in the STEP group (transferrin levels, p = 0.04). Conclusions: We have demonstrated that a simultaneous STEP and SBTX procedure is technically feasible and clinically useful in overcoming the challenges associated with size mismatched SBTX. Our short-term findings justify further investigation in a larger series to elucidate the long-term outcomes of this procedure.
| Original language | English (US) |
|---|---|
| Journal | Journal of Gastrointestinal Surgery |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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Keywords
- Children
- Intestinal transplantation
- Living donor
- Size mismatch
- STEP
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations. / Frongia, Giovanni; Majlesara, Ali; Saffari, Arash; Abbasi, Dezfouli Sepher; Gharabaghi, Negin; Okun, Jürgen Günther; Thiel, Christian; Günther, Patrick; Vianna, Rodrigo; Mehrabi, Arianeb.
In: Journal of Gastrointestinal Surgery, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations
AU - Frongia, Giovanni
AU - Majlesara, Ali
AU - Saffari, Arash
AU - Abbasi, Dezfouli Sepher
AU - Gharabaghi, Negin
AU - Okun, Jürgen Günther
AU - Thiel, Christian
AU - Günther, Patrick
AU - Vianna, Rodrigo
AU - Mehrabi, Arianeb
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: Small bowel transplantation (SBTX) in children receiving larger grafts from adults can be challenging because of size mismatch. The aim of the present study was to assess whether a simultaneous serial transverse enteroplasty (STEP) can address the problem of size mismatch. Methods: Three different size ratio groups between donors and recipients were compared in a porcine model with a 14-day follow-up. The groups were size matched, size mismatched (1:3.8 weight ratio), and size mismatched + STEP (each n = 8). Results: It was technically feasible to simultaneously perform a STEP and SBTX of a mismatched intestinal segment. The postoperative clinical course was uneventful. No signs of bleeding, leakage, stenosis, or ileus were observed and the intestinal segment was well perfused at relaparotomy. Body weight decreased in all groups, but the percentage decrease was lowest in the mismatched + STEP group. Vital enterocyte masses were similar in all the groups (citrulline levels) and the nutritional status was best in the STEP group (transferrin levels, p = 0.04). Conclusions: We have demonstrated that a simultaneous STEP and SBTX procedure is technically feasible and clinically useful in overcoming the challenges associated with size mismatched SBTX. Our short-term findings justify further investigation in a larger series to elucidate the long-term outcomes of this procedure.
AB - Background: Small bowel transplantation (SBTX) in children receiving larger grafts from adults can be challenging because of size mismatch. The aim of the present study was to assess whether a simultaneous serial transverse enteroplasty (STEP) can address the problem of size mismatch. Methods: Three different size ratio groups between donors and recipients were compared in a porcine model with a 14-day follow-up. The groups were size matched, size mismatched (1:3.8 weight ratio), and size mismatched + STEP (each n = 8). Results: It was technically feasible to simultaneously perform a STEP and SBTX of a mismatched intestinal segment. The postoperative clinical course was uneventful. No signs of bleeding, leakage, stenosis, or ileus were observed and the intestinal segment was well perfused at relaparotomy. Body weight decreased in all groups, but the percentage decrease was lowest in the mismatched + STEP group. Vital enterocyte masses were similar in all the groups (citrulline levels) and the nutritional status was best in the STEP group (transferrin levels, p = 0.04). Conclusions: We have demonstrated that a simultaneous STEP and SBTX procedure is technically feasible and clinically useful in overcoming the challenges associated with size mismatched SBTX. Our short-term findings justify further investigation in a larger series to elucidate the long-term outcomes of this procedure.
KW - Children
KW - Intestinal transplantation
KW - Living donor
KW - Size mismatch
KW - STEP
UR - http://www.scopus.com/inward/record.url?scp=85051486578&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051486578&partnerID=8YFLogxK
U2 - 10.1007/s11605-018-3893-8
DO - 10.1007/s11605-018-3893-8
M3 - Article
C2 - 30091037
AN - SCOPUS:85051486578
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
ER -