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Extraluminal Helicoidal Stretch (Helixtretch): A Novel Method of Intestinal Lengthening
Beatrice Dionigi, MD; Joseph Brazzo III, BS; John Patrick Connors, BS; Azra Ahmed, BS; Jeremy Fisher, MD; David Zurakowski, PhD; Dario O Fauza, MD,PhD
Boston Children's Hospital, Department of Surgery, Boston, MA

Background: The ideal method of intestinal lengthening remains to be described. Common limitations of the techniques reported to date include the need to violate the intestinal wall and/or the placement of unwieldy intraluminal devices. We sought to test a novel method that circumvents these limitations.

Methods:Forty-five Sprague-Dawley rats underwent isolation of a size-matched bowel segment via Roux-en-Y reconstruction, so as to allow for ad libitum feeding during manipulation of the isolated segment. Group-1 (n=14) had no further manipulations. In isolated segments of Groups-2 (n=12) and 3 (n=19), a length-matched cylindrical device was introduced in a zig-zag fashion through multiple avascular mesenteric windows, so that bowel would wrapped around it in a helicoidal fashion. The device consisted in a plain IV line in Group-2 vs. an expandible hygroscopic hydrogel rod which gradually expands from 4mm to 10-12.5mm in Goup-3. Euthanasia was performed at 8-21 days. Statistical analysis was by two-way ANOVA (2-tailed P0.50). There were no significant differences in total DNA/protein ratios across the groups (P=0.65). Histologically, there was an apparent increase in goblet cells density in Group-3.

Conclusions: Measured extraluminal helicoidal stretch (helixtretch) is tolerated by the intestine and induces bowel lengthening in a rodent model. Further analysis of this novel, minimally invasive alternative for intestinal augmentation is warranted.

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