Autologous gastro-intestinal reconstruction: the composite ileo-colic loop

Abstract

A reproducible technique was developed experimentally in pigs for construction of a 'composite bowel tube' (CBT) made up of ileal mucosa that was grafted to a mucosally denuded colonic muscle surface vascularised by the colonic mesentery. Macroscopic and microscopic studies at terminal laparotomy revealed a viable, mucosally lined, patent peristaltic loop of bowel in six of the eight animals. Two animals died after sloughing the grafted mucosa. In vivo absorption studies, using l-alanine as an index of amino acid absorption, showed a transport pattern through the grafted mucosa of the composite ileo-colic loop appropriate to ileum when compared with controls. The CBT constitutes another autologous gastro-intestinal reconstructive technique for redistribution of available absorptive mucosa over a longer intestinal length, and may therefore be of benefit in the management of the short-bowel syndrome.

The Bianchi procedure: a 20-year single institution experience

“…The optimal timing for the performance of the Bianchi procedure and/or referral for intestinal transplantation is unknown [9][10][11]. Long-term survival for children who develop SBS while neonates is largely determined by their liver status.…”

Functional liver recovery parallels autologous gut salvage in short bowel syndrome

“…Autologous gastrointestinal reconstruction (AGIR) refers loosely to a group of nontransplant surgical approaches that are adopted in efforts to improve intestinal function in the patient with intestinal failure. 5 In its simplest form, it may simply refer to recruitment of unused intestine by taking down stomas and restoring intestinal continuity but more often refers to specific procedures such as the longitudinal intestinal lengthening and tapering (LILT) procedure first described by Adrian Bianchi. 6 Unfortunately, it is believed that patients with more than the mildest forms of PN-associated liver disease may not be candidates for such medical or surgical strategies, but rather be candidates for intestinal transplantation, in isolation or combined with a liver graft.…”

Indications for pediatric intestinal transplantation: A position paper of the American Society of Transplantation

“…Intestinal pseudo‐obstruction and congenital enterocyte abnormalities, such as microvillus inclusion disease, are also forms of intestinal failure, because no curative treatment for these life‐threatening diseases has been described (1). In addition to the requirement for parenteral nutrition, the child with intestinal failure may benefit from other established medical and surgical interventions intended to improve function of the remaining gut (2). However, some children develop complications whilst receiving standard therapy for intestinal failure and will be considered for intestinal Tx.…”