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The second STEP: the feasibility of repeat serial transverse enteroplasty
Hannah Piper1, Biren P Modi, Heung Bae Kim
1Department of Surgery, Children's Hospital Boston and the Harvard Center for Minimally Invasive Surgery, Harvard Medical School, Boston, MA 02115, USA.
Journal of Pediatric Surgery
|December 13, 2006
Summary
Repeat serial transverse enteroplasty (STEP) is feasible in pigs, effectively lengthening and tapering bowel segments. This suggests a potential option for patients with intestinal failure experiencing bowel redilation after initial STEP.
Area of Science:
- Surgical innovation in pediatric surgery
- Gastrointestinal surgery research
- Animal models for surgical procedures
Background:
- Serial transverse enteroplasty (STEP) is a surgical technique to lengthen and taper dilated bowel.
- Some patients undergoing STEP for intestinal failure experience segment redilation.
- Evaluating the feasibility of repeat STEP is crucial for managing recurrent intestinal issues.
Purpose of the Study:
- To assess the feasibility and outcomes of a repeat serial transverse enteroplasty (STEP) procedure.
- To determine if repeat STEP can effectively re-lengthen and re-taper previously operated bowel segments.
- To evaluate the safety and histologic effects of repeat STEP in a preclinical model.
Main Methods:
- Six pigs underwent intestinal segment reversal followed by two serial transverse enteroplasty (STEP) procedures at 6-week intervals.
- Bowel length and diameter were measured before and after each STEP procedure.
- Necropsy was performed up to 6 weeks post-repeat STEP to assess outcomes and histology.
Main Results:
- The first STEP increased bowel length by 11.3 cm and decreased diameter significantly (P < .0001).
- Repeat STEP further increased length (16.7 cm, P < .01) and tapered diameter (P < .01).
- Five pigs tolerated repeat STEP well; one experienced obstruction, and no histologic ischemia was observed.
Conclusions:
- A second serial transverse enteroplasty (STEP) operation is technically feasible in a porcine model.
- Repeat STEP can successfully re-lengthen and re-taper previously treated bowel segments.
- This procedure may offer a viable option for select patients with intestinal failure and recurrent dilation.