Trasplante de intestino delgado en el cerdo. Modelo experimental

Introducción. Para poder realizar un proyecto de trasplante de intestino delgado es preciso desarrollar previamente un modelo técnico que permita una supervivencia adecuada de los animales.
Material y métodos. Se han realizado 43 trasplantes ortotópicos (15 autotrasplantes y 28 alotrasplantes) de intestino delgado en hembras de cerdos Landrace (peso medio, 26 ± 9 kg). El alotrasplante ha sido un modelo cruzado, intercambiando el intestino entre 2 cerdos que eran simultáneamente donante y receptor. El injerto ha comprendido los dos tercios distales del intestino delgado, realizando en el receptor enterectomía completa salvo 5 cm de yeyuno proximal y 5 cm de íleon distal. Se ha realizado anastomosis término-terminal entre los troncos de la arteria y venas mesentéricas superiores con sutura continua de polipropileno 6/0. La reconstrucción digestiva ha sido realizada con anastomosis término-terminal yeyuno-yeyunal y término-terminal íleo-ileal con sutura continua de seda 3/0. Se practicó gastrostomía según Witzel para la administración de la medicación enteral.
Resultados. Los primeros 6 animales se consideraron curva de aprendizaje. La mortalidad por complicaciones durante el seguimiento fue del 21,6%, siendo el resto de los animales válidos para el estudio.
Conclusiones. Nuestro modelo ha demostrado ser seguro, reproducible y sencillo en su desarrollo, premisas necesarias para un modelo quirúrgico experimental. Nos ha permitido aprovechar en cada sesión de alotrasplante a los 2 animales al actuar cada uno a la vez como donante y receptor, con el consiguiente ahorro de tiempo y dinero

Introduction. The first step in the experimental study of small bowel transplantation (SBT) is to design a technical model that ensures a satisfactory postoperative survival rate.
Material and methods. Orthotopic SBT (15 cases of autotransplantation and 28 of allotransplantation) was performed in 43 female Landrace pigs weighing 26 ± 9 kg. Allotransplantation involved a cross-transplantation model in which each pig was both a donor and a recipient. To receive the grafts, which were comprised of the distal two thirds of the small bowel, recipients underwent enterectomy that left only 5 cm of proximal jejunum and 5 cm of distal ileum. End-to-end anastomosis with a continuous 6/0 suture was performed to join the trunks of the superior mesenteric arteries and veins. Reconstruction of the digestive tract consisted of end-to-end jejunojejunostomy and end-to-end ileo-ileal anastomosis with continuous suture using 3/0 silk thread. The Witzel gastrostomy procedure was performed to allow the enteral administration of medication.
Results. The first six animals were considered as corresponding to the learning curve. The rate of mortality due to complications during follow-up was 21.6%; the surviving animals were valid for the study.
Conclusions.. Our model was found to be safe, reproducible and simple to perform, prerequisites for an experimental surgical model. It has enabled us to gain twice as much experience from each trial since the two animals served both as donor and recipient, with the resulting savings in time and expense.