A. Scott1, J. D. Rouch1, N. Huynh1, E. Chiang1, S. L. Lee1, B. M. Wu2, J. C. Dunn1,2, S. Shekherdimian1 1University Of California – Los Angeles,Department Of Surgery, Division Of Pediatric Surgery,Los Angeles, CA, USA 2University Of California – Los Angeles,Department Of Bioengineering,Los Angeles, CA, USA
Introduction: Currently, models used for mechanical intestinal lengthening achieve lengthening within the intra-abdominal cavity. Here we show that spring-mediated lengthening can be achieved outside the intra-abdominal cavity through a stoma.
Methods: Using Sprague-Dawley rats, the defunctionalized limb of a Roux-en-y jejunojejunostomy was exteriorized from the peritoneal cavity through a defect created in the anterior abdominal wall (n=8). An encapsulated polycaprolactone spring was placed into the extra-abdominal segment. The stoma containing the spring was secured under the skin to protect it from desiccation and destruction. After 4 weeks, segments were retrieved for histological analyses. Animals who had blank capsules placed in the extra-peritoneal de-functionalized limb served as controls (n=3).
Results: Stomal segments were successfully lengthened from 1.0 cm to 2.5 ± 0.4 cm, whereas control segments were lengthened from 1.0 cm to 1.5 ± 0.1 cm (p<0.05). After lengthening, the exteriorized bowel remained viable and patent. Lengthened segments had increased smooth muscle thickness and crypt depth when compared to normal jejunal mucosa.
Conclusion: Spring-mediated mechanical lengthening is not limited to the abdominal cavity. Extra-peritoneal lengthening yields greater than a 2-fold increase in intestinal length. Lengthening through a stoma removes the need to enter the abdomen for subsequent re-lengthening of intestinal segments.
