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Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: use of reconstructive tissue matrix

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Abstract

Background

Distraction-induced intestinal growth may be a novel treatment for short bowel syndrome. Longitudinal, distractive tension created by the application of force creates a significant challenge: to produce adequate force, yet not cause perforation at the fixation points. This paper describes our development of a coupling strategy to allow for successful bowel lengthening.

Methods

A curvilinear hydraulic device was implanted in an isolated Roux limb of small bowel in young Yorkshire pigs. Bowel was lengthened over a 2-week period. Study groups included: Group 1: Twelve silk transmural anchoring sutures into an engineered-coupling ring at the ends of each device. Group 2: Addition of felt pledgets to the coupling rings on the serosal surface of the small bowel. Group 3: Extraluminal use of either thin AlloDerm®, thick AlloDerm®, or Strattice™ mesh to anchor the device.

Results

Group 1 (suture-only) resulted in a gradual pulling through the suture with increasing tension and no lengthening. Felt pledgets eroded in a similar fashion, causing abdominal sepsis. Thin AlloDerm® failed to prevent erosion; however, it protected against gross contamination. Animals in which either thick AlloDerm® or Strattice™ mesh was used survived complication free to the study endpoint. Both thick AlloDerm® and Strattice™ prevented erosion and perforation allowing for an average of 10.85 cm expansion.

Conclusion

This study demonstrates the use of either thick AlloDerm® or Strattice™ reconstructive tissue matrix which allows for safe and effective coupling. Further, we suggest this approach could be an adjunct to esophageal lengthening procedures.

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Acknowledgments

This study was supported by Hartwell Biomedical Research Award, FDA P50 Pediatric Device Consortia Grant 2-P50-FD-003787-03 and NIH 2R44DK085765-02.

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Authors and Affiliations

  1. Section of Pediatric Surgery, Department of Surgery and the C.S, Mott Children’s Hospital, University of Michigan, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, 48109-4211, MI, USA

    Matthew W. Ralls, Ryo Sueyoshi, Richard Herman & Daniel H. Teitelbaum

  2. Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA

    Brent Utter, Isabel Czarnocki, Jonathan Luntz & Diann Brei

Authors
  1. Matthew W. Ralls
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  2. Ryo Sueyoshi
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  3. Richard Herman
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  4. Brent Utter
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  5. Isabel Czarnocki
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  6. Jonathan Luntz
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  7. Diann Brei
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  8. Daniel H. Teitelbaum
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Corresponding author

Correspondence to Daniel H. Teitelbaum.

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Ralls, M.W., Sueyoshi, R., Herman, R. et al. Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: use of reconstructive tissue matrix. Pediatr Surg Int 29, 151–156 (2013). https://doi.org/10.1007/s00383-012-3198-z

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  • DOI: https://doi.org/10.1007/s00383-012-3198-z

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