Intestinal lengthening experience in short-bowel swine

Traditional therapy for short-bowel syndrome is long-term, expensive and inconvenient; it is often associated with high morbidity and mortality. Thus, there has been increasing interest in the surgical management of this syndrome. Intestinal lengthening is attractive not only because of tapering of the dilated intestine, but also for preserving the intestine that is tapered. The purposes of this study were (a) to develop a reproducible surgical technique for intestinal lengthening and (b) to assess the response of the lengthened jejunum to a short-gut situation.

Fourteen pigs weighing 13-20 kg were chosen for the study. The animals were divided into three groups: Group I: two pigs received a 20 cm jejunum lengthening only; Group II: six pigs received an 80% bowel resection only; Group III: six pigs received an 80% bowel resection, followed by a 20 cm loop lengthening in the residual jejunum four to seven weeks later. All were observed for a period from 4 to 28 weeks.

All lengthened loops, of either primary lengthening (Group I) or delayed lengthening (Group III) functioned well and showed no clinical leakage. Three pigs in Group II (bowel resection only) died of malnutrition at the 5th, 10th and 19th postoperative week, respectively. Only one pig in Group III died, 67 days after bowel lengthening, from intestinal obstruction. During sacrificing laparatomy, two pigs in Group III were found to have side to side enteroenteral fistulae between the lengthened loops. The lengthened bowel was found to be normal histologically.

These results proved that intestinal lengthening is technically feasible, and may be useful for patients suffering from surgical short-bowel syndrome and who have not been completely weaned off parenteral feeding.