Comparison of techniques for growing small bowel neomucosa

Abstract

Small bowel neomucosa has been grown on a variety of surfaces. The purpose of this study was to compare the rate of growth and function of neomucosa on colon serosa (CS) and abdominal wall muscle (AM) in New Zealand white rabbits. The terminal ileum was incised for 5 cm and patched with either adjacent CS (23 animals) or AM (19 animals) to create a 2 × 5-cm defect. Gross and histologic examinations of the specimens at 1, 2, 4, and 8 weeks revealed that the rate of growth was similar in both groups. There was minimal lateral ingrowth at 2 weeks, nearly complete coverage of the defects at 4 weeks, and complete coverage of the defect at 8 weeks in more than 85% of animals with mature villi and muscularis mucosae. The ileal diameter at the site of patching increased in both groups from 11.9 ± 2.6 to 16.3 ± 3.2 mm in the CS group and 11.3 ± 2.5 to 15.1 ± 1.8 mm in the AM group ( P < 0.01). Glucose uptake was similar in both groups being 65.4 ± 24.1% of control in the CS group and 73.9 ± 29.8% in the AM group. Brush border enzyme activity of sucrase, maltase, and lactase was similar to controls in the AM group but in the CS group activity of sucrase and maltase were significantly less than controls ( P < 0.01). Average body weight was increased postoperatively in both groups. There was one anastomotic leak in each group and two cases of partial intestinal obstruction in the abdominal wall group. Both colon serosa and abdominal wall musculature will support the growth of functioning neomucosa with a similar rate of growth and quality of the neomucosa. The use of either in clinical situations should be determined by availability and technical considerations.