Segmental reversal of distal small intestine in short bowel syndrome: a study on the influence on postoperative weight and intestinal topography in piglets

Abstract

Reversal of a 20-cm distal segment showed no effect on weight gain, but there were some significant histological changes of unknown clinical significance.

Segmental reversal of the distal small intestine in a short bowel syndrome model in piglets showed detrimental effect on weight gain

“…This study showed, that reversal of a 25 cm long segment of the distal small intestine in our SBS model with excision of 70% of the distal small intestine had a negative effect on weight gain compared to control at a 28 days follow-up. Our results are in concordance to some studies [ 21 – 25 ] and different from others [ 26 ].…”

“…In a similar short bowel model with excision of 60% of the distal small intestine length and reversal of 20 cm of the distal small intestine, the weight gain in the group with a reversed segment was 2.31 kg at one month follow-up compared to 2.03 kg in the control group. The difference was not significant [ 21 ]. In another model, small intestine from 150 cm distal to the ligament of Treitz and 150 cm proximal from the ileocecal valve was excised.…”

“…Furthermore, there is an ethical limit for the percentage of bowel that can be excised. Thus, most studies regarding segmental reversal report removal of 60-80% of the small intestine [21][22][23][24]26], which was enough to induce SBS in some studies, but insufficient in others. In our study, the removal of 70% of the small intestine and reversal of a 25 cm distal jejunal segment showed a significant difference in weight.…”

“…This length of the reversed segment was chosen from the available literature [21][22][23]. In the study by Grave et al [21] 20 cm of distal small intestine was reversed without any significant differences in weight gain.…”

Autologous Intestinal Reconstruction Surgery in Short Bowel Syndrome: Which, When, and Why

“…First experiments on RS in animals were reported by Mall ( 23 ), but the use of this technique on experimental models of SBS was introduced in the 1950s and 1960s. Many experimental studies with an RS have demonstrated prolongation of transit time, improved absorption, better nutritional status, weight gain, and prolonged survival ( 24 – 27 ), but other reports have shown no beneficial effects ( 28 – 30 ). Structural changes like dilatation of the bowel proximal to the RS and increase in muscle thickness, crypt depth, and villus height were described ( 24 , 31 ).…”