A Comparison of Three Techniques for Closure of Pelvic Flexure Enterotomies in Normal Equine Colon

Abstract

Six enterotomies 3 cm long, spaced at 3 cm intervals, were made in the antimesenteric border of the pelvic flexure of the ascending colon in five adult horses. Ten incisions each were sutured with a Utrecht pattern (single layer), a full-thickness simple continuous oversewn with a Cushing pattern (two layer), and a mucosal simple continuous with a seromuscular simple continuous oversewn with a Cushing pattern (three layer). In all horses, chromic gut and polyglactin 910 were each used once for each pattern. On day 6, the pelvic flexure was excised and the colonic vessels were injected with a radio-opaque mass. Sections of each enterotomy were studied by light microscopy and high detail radiography. The single-layer closure led to serosa-to-mucosa healing and a thin bowel wall, and the three-layer closure resulted in distortion of the bowel wall by hematoma formation and submucosal contamination with ingesta. The two-layer closure resulted in good alignment and improved healing. There was less inflammatory reaction with polyglactin 910 than with chromic gut.

Biomechanical comparison of four technique for pelvic flexure enterotomy closure in horses

“…HS2 . A handsewn 2 layer closure was achieved by a simple continuous full thickness layer oversewn with a Cushing seromuscular suture using 2–0 polyglactin 910.…”

“…Handsewn and stapled techniques are used to close enterotomies of the ascending colon pelvic flexure in horses . A 2 layer closure (full thickness, simple continuous pattern oversewn with a Cushing pattern) is superior in terms of layers alignment and healing to a 1‐layer pattern .…”

Life‐threatening hemorrhage from enterotomies and anastomoses in 7 horses

“…The possible hemostatic effects of different closure techniques should also be considered. Closure of the pelvic flexure mucosa as a separate layer can result in hematoma formation between the mucosa and the submucosa 2 . This may occur because mucosal closure alone may not compress vessels adequately and also leaves a dead space between the mucosa and submucosa 2 .…”

“…Closure of the pelvic flexure mucosa as a separate layer can result in hematoma formation between the mucosa and the submucosa 2 . This may occur because mucosal closure alone may not compress vessels adequately and also leaves a dead space between the mucosa and submucosa 2 . A full‐thickness simple continuous pattern oversewn with a Cushing pattern was superior to other techniques for apposing all layers of the enterotomy and provided adequate hemostasis 2 .…”

“…Enterotomy and anastomosis are commonly performed in horses during abdominal surgery for colic. Complications, including anastomotic leakage and dehiscence, adhesions, and stricture formation, have been reported after these procedures 1‐3 . Although hemorrhage from mesenteric vessels has been described as a complication of anastomosis, 1 severe hemorrhage from an intestinal incision is a seemingly rare and isolated complication.…”