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Short bowel syndrome is a devastating gastrointestinal disorder in which decreased bowel length results in inadequate absorption causing nutritional deficiencies. Current treatment options are accompanied by significant morbidity. We have proposed spring-mediated distraction enterogenesis as a method to lengthen bowel with success seen in porcine jejunum. We hypothesize that spring-mediated distraction enterogenesis can be demonstrated in porcine ileum with preservation of ileal structure and function.Laparotomy was performed on juvenile female mini-Yucatan pigs and a gelatin-encapsulated compressed nitinol spring was inserted into the ileal lumen and affixed proximally and distally. A control segment distal to the spring segment was marked with sutures. Postoperatively, pigs were placed on a liquid diet and euthanized on postoperative day 7. Spring and control segments were measured and processed for immunohistochemistry to evaluate for the presence of vitamin B12-intrinsic factor cotransporter, chromogranin A-producing cells, and 5-HT producing cells.All seven pigs survived to postoperative day 7 with no adverse effects. On average, pigs gained 84.3 ± 66.4 g/d. Spring segments lengthened 1.5 ± 0.7 cm with a relative lengthening by 128% ± 56%, which was statistically significant when compared to control (P 0.01). The average density of chromogranin-A cells in control compared to spring segments was not significantly changed (2.9 ± 1.1 cells/mm versus 3.2 ± 1.2 cells/mm, P = 0.17). Both vitamin B12-intrinsic factor cotransporter and 5-HT producing cells were present in both control and lengthened ileum.Intraluminal nitinol springs significantly lengthened porcine ileum. The increase in density of enteroendocrine cells may indicate enhanced endocrine function of the lengthened ileum.

Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT).131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P 0.05 was considered statistically significant.101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were 18 years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p 0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL.Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.

Adolescents with severe obesity achieve superior health outcomes following metabolic and bariatric surgery (MBS) than medical treatment alone. Surgery results in significant and sustained decrease in BMI and reduces associated comorbidity. We characterized the changing demographics of adolescents who had MBS over a 15-year time period.Using ICD-9 and ICD-10 codes, the 2005-2019 National Inpatient Sample database was queried for patients 20 years who underwent MBS. National trends, socio-demographics, and hospital resource utilization were analyzed.Between 2005 and 2019, there were 16,381 pediatric hospitalizations for MBS. The annual MBS procedures increased from 839 cases in 2005 to 1785 in 2019. There was a significant shift away from laparoscopic gastric bypass (LGB) to sleeve gastrectomy (SG). Initially, LGB represented 67% of cases with no SG. In 2019, SG constituted 85% of MBS procedures, while LGB comprised only 14%. Patients were predominantly female (76%) and White (56%). Over time, there were considerable increases in patients with public insurance (12 to 46%) and Hispanics (11 to 30%). There was also a shift away from urban, non-teaching hospitals to urban, teaching hospitals. The average length of stay (LOS) decreased, while mean charges remained similar.Our study demonstrates a gradual increase in the utilization of MBS among adolescents and a significant shift to SG. We observed a shift in MBS cases to teaching institutions, along with an increase in Hispanics and patients with public insurance. However, MBS remains underutilized, and effort should be made to increase early referral of adolescents for MBS evaluation.