2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.42 - Experimental model of acute short bowel syndrome with gastric tube transposition in pigs

Presenter: Andreas, Koszka, , Brazil
Authors: Andreas J M Koszka¹, Eduardo Pompeu¹, Andreza Moraes¹, Alessandro R de C Martins¹, Thiago A Martins¹, Pamela Tung¹, Andre I David¹, Eleazar Chaib¹

Experimental model of acute short bowel syndrome with gastric tube transposition in pigs

Andreas J M Koszka¹, Eduardo Pompeu¹, Andreza Moraes¹, Alessandro R de C Martins¹, Thiago A Martins¹, Pamela Tung¹, Andre I David¹, Eleazar Chaib¹

¹Gastroenterology/Abdominal organ transplantation - LIM37, Universidade de Sao Paulo, Sao Paulo, Brazil

Introduction

The short bowel syndrome is characterized by a state of malabsorption due to extensive intestinal resections. This condition results in a massive reduction in capacity to absorb nutrients, requiring parenteral nutrition for the survival of the affected patient. [1,2]

Surgical procedures intend to improve the intestinal absorption of fluid and nutrients by reducing the speed of intestinal transit and increasing the absorptive surface. [3,4]

Aim

We developed an experimental model in pigs to promote intestinal lengthening with the transposition of a gastric tube interposed between the jejunum and terminal ileum after massive extensive enterectomy. [5,6]

Methodology

We perform a laparotomy and splenectomy for the ligation of the short gastric vessels. The small intestine is removed after ligation of the mesenteric vessels.

The initial portion of the jejunum and the last portion of the ileum before the ileocecal valve are preserved. A linear stapler was used to cut along the greater gastric curvature in order to make the gastric tube. Four stapler shots were done to set the size of the tube and a suture over the staple line was made. The right gastroepiploic artery is preserved to assure blood supply to the gastric flap. {figure1} Double layer gastroenteric anastomoses were performed to place the tube between the jejunum and the ileum.

Results

Three animals were operated. Survival days varied from 5 to 20. The average weight lost was 20% of the initial weight.

Laboratorial tests were collected before the procedure and during the postoperative follow up every 7 days. Markers of nutritional status such as albumin, cholesterol, triglycerides, creatinine, bilirubin and hemoglobin showed no alterations. Increased white blood count was noted associated to lymphopenia. Platelet count also showed elevation after the first week and decreased slowly in the following days.

All animals were submitted to necropsy. Ischemia of the flap wasn’t observed in any cases.

Conclusion

This Model initially shows viability. In the future, gastric tube can be used to delay intestinal transplant. Continuity of this study whit more animals and longer follow up will be necessary.

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