WOFAPS 2025 8th World Congress of Pediatric Surgery

Dionisiy Petrov ¹, Aleksey Butuzov ², Ekaterina Frolova ¹, Aleksander Razumovsky ¹

¹ Pirogov Russian National Research Medical University, Moscow, Russia
² Russian Children’s Clinical Hospital, Moscow, Russia

Purpose:

To evaluate the effects of distraction enterogenesis (DE) on intestinal adaptation following small bowel resection (SBR) and determine whether timing impacts outcomes.

Methods:

Eight Vietnamese pot-bellied mini pigs were divided into two groups:

1. Healthy group (n=4): Three compressed biodegradable springs were implanted in the proximal jejunum via laparotomy, secured by reducing lumen diameter by 50% with absorbable sutures. Animals were euthanized on POD 7, 10, 20, and 30.

2. Short bowel syndrome (SBS) group (n=4): A 90% SBR was performed, followed by spring placement (4 per animal) 30 days later. Springs were upsized to accommodate post-resection dilatation. Animals were euthanized 2 months post-DE.

Intestinal segments were analyzed for:

- Morphometry: Villus height, crypt depth, and muscular thickness.

- Proliferation/adaptation: Ki67+ (cellular proliferation), SMA (muscular hypertrophy), and CD34/ERG+ (angiogenesis).

Results:

Both groups demonstrated an average 2.5-fold increase in each intestinal segment length. Histology revealed significant villus elongation, muscular hypertrophy, neoangiogenesis, and transmural proliferation. In SBS animals, ERG+ expression confirmed progressive neovascularization, while Ki67+ spiked post-resection (indicating adaptive proliferation) before declining as adaptation plateaued.

Conclusions:

Distraction enterogenesis effectively lengthened intestinal segments in both intact and resected bowel. The SBS group’s robust proliferative response suggests that post-resection adaptation may promote the bowel's enhanced enterogenesis. Early intervention during peak adaptation could maximize growth potential, offering a strategic window for clinical translation.