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  • Title: The second STEP: the feasibility of repeat serial transverse enteroplasty.
    Author: Piper H, Modi BP, Kim HB, Fauza D, Glickman J, Jaksic T.
    Journal: J Pediatr Surg; 2006 Dec; 41(12):1951-6. PubMed ID: 17161180.
    Abstract:
    BACKGROUND: Serial transverse enteroplasty (STEP) lengthens and tapers dilated bowel. Redilation of the STEP segment occurs in some patients with intestinal failure. The feasibility of a repeat STEP procedure in a pig model is evaluated. METHODS: Six pigs underwent reversal of an intestinal segment distal to the ligament of Treitz. At 6-week intervals after reversal, each animal had 2 STEP procedures on the bowel proximal to the reversed segment. Necropsy was performed up to 6 weeks after repeat STEP. RESULTS: Bowel length increased by 11.3 +/- 3.9 cm and bowel diameter decreased from a mean of 5.3 +/- 0.8 to 1.8 +/- 0.4 cm (P < .0001) after the first STEP. After repeat STEP, bowel length increased by 16.7 +/- 13.3 cm (P < .01), and the bowel was tapered from a mean of 5.4 +/- 0.9 to 2.2 +/- 0.4 cm (P < .01). Five pigs did well after repeat STEP, and 1 pig had early necropsy for bowel obstruction. None had histologic evidence of bowel ischemia in the repeat STEP segment. CONCLUSIONS: A second STEP operation is feasible in a pig model and may be considered to optimize bowel length and function in select patients with intestinal failure.
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