Serosal patching impairs intestinal adaptation following enterectomy

Increasing intestinal absorptive surface by mucosal regeneration on serosal patched intestinal defects is a potential surgical treatment for the short bowel syndrome. We previously found in long-term studies that serosal patching in dogs undergoing 75% enterectomy was deleterious to intestinal adaptation and absorption. Our aim was to evaluate the effect of serosal patching on the early morphologic and functional changes in postresectional adaptation and to examine the role of polyamine metabolic pathways in this process. Five unoperated New Zealand white rabbits (GP I) served as controls. Twelve other rabbits underwent either 50% distal enterectomy alone (GP II) or simultaneously had two 2 × 5-cm full-thickness ileal defects patched with adjacent cecal serosa (GP III). Animals in GP II gained an average of 7.2 ± 5.3% body weight, whereas GP III animals lost 5.6 ± 9.0% body weight (P < 0.05). Intestinal remnant length was significantly less in GP III 3 weeks postoperatively (66 ± 11 vs 85 ± 8 cm, P < 0.05) as was mucosal protein content (4.1 ± 1.8% vs 6.2 ± 1.9%) but villus height was similar in GPs II and III (505 ± 131 vs 508 ± 110 μm). In vitro mucosal function was similar in all three groups. Crypt cell production rate was significantly lower while ornithine decarboxylase and diamine oxidase activity were higher in GP III compared to GP II. However, polyamine levels were similar in all three groups. Serosal patching impairs intestinal adaptation following massive enterectomy. This is due in part to a decrease in proliferative activity which is not directly related to altered polyamine levels. Thus, procedures intended to improve intestinal function after massive intestinal resection should not be performed until intestinal adaptation is complete.