Growth of intestinal neomucosa on prosthetic materials

The short bowel syndrome is a potential complication of the surgical management of diseases of the large and small intestine. Recently methods have been examined for expanding the small bowel absorptive area using prosthetic materials. We investigated the feasibility of growing intestinal mucosa on prosthetic patches and tubes. Ileal defects were patched with a 2 X 5-cm patch of either Dacron (n = 15), polyglycolic acid mesh (PGA) (n = 9), or polytetrafluroethylene (PTFE) (n = 5) prosthesis in New Zealand white male rabbits. Gross and microscopic analysis at 2, 4, and 8 weeks revealed that the serosal surface was covered with neomucosa by 4 weeks. Dacron and PTFE grafts were either minimally attached or extruded and PGA grafts had dissolved. At 8 weeks, none of the patches were present but with all three materials the resultant area of neomucosa was only 15% of the original defect. The neomucosa was functional as determined by glucose uptake and disaccharidase activity. Three centimeter Dacron tubes were interposed in the distal ileum of 10 rabbits and in a bypassed ileal segment in 11 rabbits. There was an 80% mortality within 2 weeks, and no evidence of neomucosal growth. Although prosthetic patches support the growth of functional neomucosa, there is a minimal increase in the final surface area. The type of prosthesis did not influence the outcome. The use of Dacron tubes is associated with high mortality and no neomucosal growth. The use of prosthetic materials is not likely to be useful in the clinical management of the short bowel syndrome.