Creation of the avascular bowel segment and evaluation of the peristaltic function

Abstract

KBS da tedavi sorunu hala guncelligini korumakta ve i;:ozum aray1§lar1 surmektedir. Son y1llarda TPB 'nin uygulamaya girmesiyle, artan say1da KBS 'lu hastalann ya§amas1 sonucu, cerrahi tedaviler on plana i;:1km1§ ve degi§ik cerrahi yontemler deneysel ve kliniksel olarak gundeme getirilmi§tir. Son ylllarda tanimlanan Iowa modelinde izole bir barsak segmentinin olu§turulmas1 ve bu segmentte emilim oldugunun gosterilmesi olduki;:a ilgi gormu§ ve bu konuda pek i;:ok i;:al1§ma yapllm1§t1r. Fakat bu i;:al1§malarda kai;: santim uzunlugundaki bir iBS 'nin canl1l1g1n1 koruyabilecegi ve obstruksiyon olu§turmaks1z1n iletiyi saglayabilecegi konusu ayd1nlat1lamam1§t1r. Bu konuyu ayd1nlatmak amac1yla bu deneysel i;:al1§ma planland1.Cal1§mada kullan1lan otuz adet rat; kontrol grubu (grup I}, laparotomi grubu (grup II), 5 cm grubu (grup Ill}, 9 cm grubu (grup IV) ve 13 cm grubu olmak uzere her biri alt1§ar rat ii;:eren be§ gruba aynld1. Grup 11, Ill ve IV teki ratlarda Treitz ligamentinin on santim distalinden ba§lamak uzere be§, dokuz ve on ui;: santimlik jejunal segmentlere omentoenteropeksi ve/veya miyoenteropeksi uyguland1 ve be§ hafta sonra bu .segmentlerin mezenterik kan ak1m1 kesilerek, canl1llgin1 koruyabildigi gosterildi. Histopatolojik olarak, iskemi ve nekroz tespit edilmedi ve olu§an yeni damarlar gosterildi. Deneyin bundan sonraki a§amas1nda, gruplar aras1nda barsak kapsam1n1 iletme ve iTZ' ni degerlendirme ai;:1s1ndan skopik inceleme yap1ld1. Bu inceleme . ii;:in ratlar ketamin anestezisi ile uyutuldu ve nazogastrik sonda tak1ld1. Bu sondadan verilen baryumun barsaklardan gei;:i§i skopik olarak izlendi ve iTZ 'n1 her gruptaki rat ii;:in ayn ayr1 kaydedildi. Eide edilen sonui;:lar istatistiksel olarak degerlendirildi. iTZ 'nin on ui;: santimlik grupta tum gruplara gore uzad1g1 tesbit edildi ve fark istatistiksel olarak anlaml1 bulundu.Sonui;: olarak bu deneysel i;:al1§mada ratlarda omentoenteropeksi ve miyoenteropeksi yontemleri kullanilarak 13 cm uzunlugunda iBS elde edildi. Bu uzunlukta iBS 'nin makroskopik ve mikroskopik incelenmesinde normal ince barsak yap1s1n1 korudugu tespit edildi. Aynca 13 cm 'lik iBS 'nin obstruksiyon olu§turmaks1zin iTZ 'nin uzamas1na yol ai;:t1g1 gozlendi. Eide edilen bu sonui;:lann KBS 'da olumlu katk1s1 olacag1n1 du§unmekteyiz.

Treatment of small bowel syndrome is still have importance and new treatment strategies are being developed. With the recent advances in total parenteral nutrition, patients survivals increased and different experimental and clinical surgical techniques are developed. At recent years Iowa model has been developed an isolated bowel segment which has absorbtion. After this intresting model, a lot of experiments on this subject have been made. But the length of the isolated bowel segment which would not cause necrosis and obstruction had not been described yet The aim of this study is to find the optimal length of the bowel segment which will be used in isolated bowel segment 30 rats were divided in five groups containing 6 rats in each. Group I control group, group II laparotomy group, group Ill 5 cm group, group IV 9 cm group, groupV 13 cm groupIn group Ill, a 5 cm jejunal segment omentoenteropeksi and/or myoenteropeksi was performed on 10 cm distal to the ligament of Treitz. In groups IV and V the length of the jejunal segment were 9 and 13 cm respectively. 5 weeks later mesenteric bood flow of the jejunal segments divided and it was seen that segments were alive.In the hystopathological examination angioneogenesis was shown. There was not ischemia and necrosis. After that stage of the experiment, scopic examinationsof the groups made for comparing the transmissionof the bowelcontentsandintestinaltransittime. Ratswereanesthetizedby intramuscular injection of ketamin HCL and nasogastric tubes were inserted. Barium which was given through the nasogastric tube, was observed under fluoroscopy and intestinal transit time was recorded for each rat. Results wereanalysedstatistically. It wasfoundthatintestinaltransittimewas longer at 13 cm group than the other groups and this wasstatistically significant. In conclusion, in thisexperimentalstudy13 cmlongisolated bowel segment wasachieved with omentoenteropexyand myoenteropexy The structure of this 13 cm long isolated bowel segment was like normal smallintestinehystopathologically. Atthesametimethisisolatedbowel segmentprolongedtheintestinaltransittimewithoutcausingany obstruction.The results of this study showed that this procedure is useful in short bowel syndrome.