Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations

Giovanni Frongia, Ali Majlesara, Arash Saffari, Dezfouli Sepher Abbasi, Negin Gharabaghi, Jürgen Günther Okun, Christian Thiel, Patrick Günther, Rodrigo Vianna, Arianeb Mehrabi

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Transplantation
Citrulline
Ileus
Enterocytes
Transferrin
Nutritional Status
Pathologic Constriction
Swine
Body Weight
Tissue Donors
Hemorrhage
Transplants
Weights and Measures

Keywords

  • Children
  • Intestinal transplantation
  • Living donor
  • Size mismatch
  • STEP

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Frongia, G., Majlesara, A., Saffari, A., Abbasi, D. S., Gharabaghi, N., Okun, J. G., ... Mehrabi, A. (Accepted/In press). Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations. Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-018-3893-8

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 journalArticle

Frongia, G, Majlesara, A, Saffari, A, Abbasi, DS, Gharabaghi, N, Okun, JG, Thiel, C, Günther, P, Vianna, R & Mehrabi, A 2018, 'Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations', Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-018-3893-8
Frongia, Giovanni ; Majlesara, Ali ; Saffari, Arash ; Abbasi, Dezfouli Sepher ; Gharabaghi, Negin ; Okun, Jürgen Günther ; Thiel, Christian ; Günther, Patrick ; Vianna, Rodrigo ; Mehrabi, Arianeb. / Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations. In: Journal of Gastrointestinal Surgery. 2018.
@article{05a78555d0a648cc9ef8b48ad2923a73,
title = "Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations",
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.",
keywords = "Children, Intestinal transplantation, Living donor, Size mismatch, STEP",
author = "Giovanni Frongia and Ali Majlesara and Arash Saffari and Abbasi, {Dezfouli Sepher} and Negin Gharabaghi and Okun, {J{\"u}rgen G{\"u}nther} and Christian Thiel and Patrick G{\"u}nther and Rodrigo Vianna and Arianeb Mehrabi",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s11605-018-3893-8",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

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

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

ER -