Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations

  • Giovanni Frongia
  • Ali Majlesara
  • Arash Saffari
  • Dezfouli Sepher Abbasi
  • Negin Gharabaghi
  • Jürgen Günther Okun
  • Christian Thiel
  • Patrick Günther
  • Rodrigo Vianna
  • Arianeb Mehrabi
Original Article



Small bowel transplantation (SBTX) in children receiving larger grafts from adults can be challenging because of size mismatch. The aim of the present study was to assess whether a simultaneous serial transverse enteroplasty (STEP) can address the problem of size mismatch.


Three different size ratio groups between donors and recipients were compared in a porcine model with a 14-day follow-up. The groups were size matched, size mismatched (1:3.8 weight ratio), and size mismatched + STEP (each n = 8).


It was technically feasible to simultaneously perform a STEP and SBTX of a mismatched intestinal segment. The postoperative clinical course was uneventful. No signs of bleeding, leakage, stenosis, or ileus were observed and the intestinal segment was well perfused at relaparotomy. Body weight decreased in all groups, but the percentage decrease was lowest in the mismatched + STEP group. Vital enterocyte masses were similar in all the groups (citrulline levels) and the nutritional status was best in the STEP group (transferrin levels, p = 0.04).


We have demonstrated that a simultaneous STEP and SBTX procedure is technically feasible and clinically useful in overcoming the challenges associated with size mismatched SBTX. Our short-term findings justify further investigation in a larger series to elucidate the long-term outcomes of this procedure.


Intestinal transplantation STEP Living donor Size mismatch Children 


Author’s Contributions

Study conception and design: Frongia G; Mehrabi A.

Data collection: Frongia G; Majlesara A; Saffari A; Abbasi Dezfouli S; Gharabaghi N; Okun JG; Thiel C.

Analysis and data interpretation: Frongia G.

Drafting of the manuscript: Frongia G.

Critical revision: Günther P; Vianna R; Mehrabi A.

Compliance with Ethical Standards

Animal Ethics

This study was performed in accordance with the National Research Council’s principles for the care and use of laboratory animals. The Animal Ethics Review Committee of the Regional Commission (Karlsruhe, Germany) approved the study protocol. This study was performed in accordance with the National Research Council’s guidelines and the EU Directive 2010/63/EU for animal experiments. Animals received humane care in compliance with institutional guidelines.

Conflict of Interest

The authors declare that they have no conflicts of interest. No funding was received.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Giovanni Frongia
    • 1
  • Ali Majlesara
    • 2
  • Arash Saffari
    • 2
  • Dezfouli Sepher Abbasi
    • 2
  • Negin Gharabaghi
    • 2
  • Jürgen Günther Okun
    • 3
  • Christian Thiel
    • 3
  • Patrick Günther
    • 1
  • Rodrigo Vianna
    • 4
  • Arianeb Mehrabi
    • 2
  1. 1.Division of Pediatric Surgery, Department of General, Visceral, and Transplantation SurgeryUniversity Hospital of HeidelbergHeidelbergGermany
  2. 2.Department of General, Visceral, and Transplantation SurgeryUniversity Hospital of HeidelbergHeidelbergGermany
  3. 3.Department of Pediatrics, Pediatric Metabolic LaboratoryUniversity Hospital of HeidelbergHeidelbergGermany
  4. 4.Division of Liver/Gastrointestinal Transplantation, Miami Transplant Institute, University of Miami Miller School of MedicineJackson Memorial HospitalMiamiUSA

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