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Salimi-Jazi F, Thomas AL, Rafeeqi TA, Wood LSY, Portelli K, Dunn JCY. Stem cell activation during distraction enterogenesis in the murine colon. Pediatr Surg Int 2023; 39:172. [PMID: 37031428 DOI: 10.1007/s00383-023-05455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Short bowel syndrome (SBS) is a devastating disease. We have proposed spring-mediated distraction enterogenesis for intestinal lengthening. Colonic lengthening is a potential treatment option for SBS to enhance fluid absorption capacity. We hypothesized that intraluminal spring-mediated colonic lengthening is associated with stem cell proliferation. METHODS C57BL/6 mice underwent placement of a gelatin-encapsulated compressed or uncompressed nitinol spring in a cecal segment. Animals were given clear liquid diet until postoperative day (POD) 7, followed by regular diet until POD 14. Cecal lengths were measured at euthanasia, and tissue was formalin fixed for histological processing. For Lgr5-GFP mice, immunohistochemistry against GFP was performed to localize Lgr5+ cells within crypts. RESULTS Significant cecal lengthening with compressed springs and shortening with uncompressed springs were observed on POD 7 and 14. Mucosa of the compressed spring group was significantly thicker on POD 14. The density of Lgr5+ cells within the crypts in the compressed spring groups was higher than that in the uncompressed spring groups on both POD 7 and 14. CONCLUSION Expandable springs can be used to lengthen the colon in the mouse model. Colonic lengthening was associated with gradual mucosal thickening and correlated with an increased density of stem cells within the crypts.
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Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, 453 Quarry Road, MC 5733, Palo Alto, CA, 94304, USA
| | - Anne-Laure Thomas
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, 453 Quarry Road, MC 5733, Palo Alto, CA, 94304, USA
| | - Talha A Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, 453 Quarry Road, MC 5733, Palo Alto, CA, 94304, USA
| | - Lauren S Y Wood
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, 453 Quarry Road, MC 5733, Palo Alto, CA, 94304, USA
| | - Katherine Portelli
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, 453 Quarry Road, MC 5733, Palo Alto, CA, 94304, USA
| | - James C Y Dunn
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, 453 Quarry Road, MC 5733, Palo Alto, CA, 94304, USA.
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
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The effect of spring diameter on porcine ileal distraction enterogenesis. Pediatr Surg Int 2022; 39:19. [PMID: 36449179 DOI: 10.1007/s00383-022-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Spring-mediated distraction enterogenesis has proven to be successful for intestinal lengthening. We aimed to evaluate the effect of spring diameter mismatch on intestinal adaptation. METHODS Juvenile mini-Yucatan pigs underwent placement of compressed nitinol springs with diameter of 10, 11, or 12 mm into the ileal lumen. Pigs were euthanized on postoperative day 7. The lengths, histology, total area of blood vessels, and enteric ganglia were evaluated. RESULTS All spring groups exhibited significant ileal lengthening. Across the different diameters, spring-expanded segments were similar in terms of ileal lengthening, crypt height, muscular thickness, blood vessels, and enteric ganglia area. CONCLUSION Spring-mediated distraction enterogenesis is successful in the porcine ileum. A smaller diameter spring is as effective as a larger diameter spring in lengthening the ileum. Springs of varying diameters result in comparable structural changes in the ileum.
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Liu S, Hu Q, Shao L, Lu X, Shen X, Ai S, Zeng P, Wang M, Guan W. Comparative short-term and long-term outcomes between internal and external intestinal plication in the management of small bowel obstruction. BMC Surg 2021; 21:309. [PMID: 34253214 PMCID: PMC8276395 DOI: 10.1186/s12893-021-01304-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/14/2021] [Indexed: 01/11/2023] Open
Abstract
Background Small bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO. Methods
All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well. Results Nine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery. Conclusions This study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01304-1.
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Affiliation(s)
- Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Qiongyuan Hu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Lihua Shao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Xiaofeng Lu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Nanjing Medical University, Nanjing, China
| | - Xiaofei Shen
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Shichao Ai
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Ping Zeng
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China. .,Medical School of Nanjing University, Nanjing, China.
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, 321 Zhongshan RD, Nanjing, China. .,Medical School of Nanjing University, Nanjing, China. .,Nanjing Medical University, Nanjing, China.
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Portelli KI, Park JB, Taylor JS, Thomas AL, Stelzner M, Martin MG, Dunn JC. Intestinal adaptation following spring insertion into a roux limb in mice. J Pediatr Surg 2021; 56:346-351. [PMID: 32709529 PMCID: PMC7772252 DOI: 10.1016/j.jpedsurg.2020.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE Intraluminal springs have recently been shown to lengthen segments of intestine in a process known as distraction enterogenesis. We hypothesized that biocompatible springs could be used to lengthen defunctionalized murine small intestine and would lead to identifiable intestinal adaptations at the molecular level. METHODS Age and weight matched C57BL/6 mice underwent surgical insertion of nitinol spring-loaded capsules into a Roux limb of jejunum. Segment lengths were measured at initial spring placement and at euthanasia after 14 and 21 days. Histology and gene expression of the Roux limb were evaluated at scarification and compared to untreated control segments. RESULTS Intestinal segments loaded with compressed springs lengthened an average of 240%, which was significantly longer than control segments loaded with either empty capsules or uncompressed springs. Muscularis thickening was greater in spring-treated mice compared to controls without springs. Crypt depth and Lgr5+ expression was greater in mice that received compressed spring treatments when compared to control groups. CONCLUSIONS Insertion of a compressed nitinol spring into a Roux limb results in significant intestinal lengthening, smooth muscle thickening, and Lgr5+ expression in a mouse model. The ability to increase small bowel length in a defunctionalized murine model may be used to understand the mechanism of distraction enterogenesis.
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Affiliation(s)
| | - Jun-Beom Park
- Department of Surgery, Stanford University, Stanford, CA
| | | | | | | | - Martin G. Martin
- Department of Pediatrics, University of California, Los Angeles, CA
| | - James C.Y. Dunn
- Department of Surgery, Stanford University, Stanford, CA,Division of Bioengineering, Stanford University, Stanford, CA,Correspondence to: James Dunn, Division of Pediatric Surgery, Stanford University, 300 Pasteur Drive, Alway Building M116, Stanford, CA 94305; Telephone: (650) 723-6439; Fax (650) 725-5577;
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Biomechanical Force Prediction for Lengthening of Small Intestine during Distraction Enterogenesis. Bioengineering (Basel) 2020; 7:bioengineering7040140. [PMID: 33171760 PMCID: PMC7711478 DOI: 10.3390/bioengineering7040140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/04/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
Distraction enterogenesis has been extensively studied as a potential treatment for short bowel syndrome, which is the most common form of intestinal failure. Different strategies including parenteral nutrition and surgical lengthening to manage patients with short bowel syndrome are associated with high complication rates. More recently, self-expanding springs have been used to lengthen the small intestine using an intraluminal axial mechanical force, where this biomechanical force stimulates the growth and elongation of the small intestine. Differences in physical characteristics of patients with short bowel syndrome would require a different mechanical force—this is crucial in order to achieve an efficient and safe lengthening outcome. In this study, we aimed to predict the required mechanical force for each potential intestinal size. Based on our previous experimental observations and computational findings, we integrated our experimental measurements of patient biometrics along with mechanical characterization of the soft tissue into our numerical simulations to develop a series of computational models. These computational models can predict the required mechanical force for any potential patient where this can be advantageous in predicting an individual’s tissue response to spring-mediated distraction enterogenesis and can be used toward a safe delivery of the mechanical force.
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Hosseini HS, Wood LS, Taylor JS, Dubrovsky G, Portelli KI, Thomas AL, Dunn JC. Biomechanical signaling and collagen fiber reorientation during distraction enterogenesis. J Mech Behav Biomed Mater 2020; 101:103425. [DOI: 10.1016/j.jmbbm.2019.103425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/16/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
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Optimization of In-Continuity Spring-Mediated Intestinal Lengthening. J Pediatr Surg 2020; 55:158-163. [PMID: 31676077 DOI: 10.1016/j.jpedsurg.2019.09.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/29/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spring-mediated intestinal lengthening has been studied in numerous animal models to effectively achieve up to a 3-fold increase in length. In this study we are interested in optimizing this method of spring lengthening. METHODS Juvenile mini-Yucatan pigs underwent laparotomy for spring implantation. Springs were secured by plicating the intestine around the springs. In one set of experiments, varying degrees of plication were compared to determine the necessary narrowing needed to confine the spring. In another set of experiments, dissolvable sutures were used for the plication to allow for spontaneous spring passage postoperatively. Intestinal segments were retrieved and evaluated for lengthening and histological changes. RESULTS Pigs tolerated their diet advancement to a regular diet postoperatively. 10% plication resulted in a 1.3-fold increase in length, while 50% plication resulted in a 2.7-fold increase in length (p<0.05). At two months postoperatively, the majority of springs had safely passed out of the intestine. All lengthened intestine showed significant growth histologically. CONCLUSIONS A 50% reduction in lumen diameter achieves optimal spring-mediated intestinal lengthening. Springs can safely pass out of the intestine, thus avoiding a second operation for spring removal. These results may be important in developing future therapies for short bowel syndrome. LEVEL OF EVIDENCE Level I experimental study.
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