Ex vivo comparison of three hand sewn end‐to‐end anastomoses in normal equine jejunum

Abstract

) for end-to-end equine jejunojejunostomies. Methods: End-to-end jejunojejunostomies were constructed using 2C (n = 7), 1L (n = 7) and 1C (n = 7) in harvested equine jejunum and construction times were recorded. Anastomosed and control segments were distended with gas until failure. Intraluminal pressure at failure and mode of failure were recorded. Lumen size reduction was calculated as a percentage decrease from control jejunum. Results were compared using an ANOVA and P<0.05 was considered significant. Results: The 1C anastomoses were faster to construct than the 1L anastomoses, which were faster to construct than the 2C anastomoses. There were no differences in bursting pressures between the different anastomoses and control jejunum. All anastomoses decreased lumen size from control values but there were no differences in lumen reduction between types of anastomoses. Conclusions: Single layer anastomoses are faster to construct than double layer anastomoses, with the 1C being fastest. Single layer anastomoses are as strong and result in comparable lumen size reduction as traditional 2C anastomoses. Potential relevance: As the 1C anastomosis results in less exposed potentially adhesiogenic suture material than the 1L while providing adequate strength and similar luminal size reduction, the 1C may be better for equine small intestine anastomosis and further in vivo studies are warranted.

Ex Vivo Comparison of the Biomechanical Properties of Hand‐Sewn and Stapled Jejunoileal Anastomoses in Horses

“…In horses, evaluation of the mechanical characteristics of anastomotic techniques have been limited to jejunojejunostomy . We are unaware of studies comparing the mechanical strength and characteristics of hand‐sewn and stapled jejunoileal anastomoses in horses using the same ex vivo model.…”

“…For end‐to‐end jejunojejunostomy, a single‐layer continuous Lembert pattern has equivalent BS but a larger stoma than a double‐layer simple continuous pattern oversewn with a Cushing pattern . BS and luminal diameter reduction were not significantly different for single‐layer Lembert, single‐layer Cushing, and double‐layer (simple continuous/Cushing) anastomoses of equine jejunum . Single‐layer Lembert jejunoileostomy has comparable BS but a larger lumen diameter than double‐layer jejunoileostomy in horses …”

“…Many surgical techniques have been described for small intestine anastomosis in horses, including end‐to‐end, side‐to‐side, and functional end‐to‐end using either hand‐sewn or stapling techniques . Mechanical studies have been performed to determine the bursting strength (BS) and characteristics of hand‐sewn and stapled anastomotic techniques in equine jejunum . BS of a stapled side‐to‐side jejunojejunostomy are not significantly different than those of a closed, one‐stage, stapled, functional end‐to‐end jejunojejunostomy .…”

Post‐operative reflux – a surgeon's perspective

“…One possible explanation for this is that the continuous patterns used in that study reduced lumen size by 15–20% in a cadaver study by the same surgeons (Sherlock et al . ), whereas the interrupted Lembert pattern can increase cadaver stoma size by 9% over control segments (A.G. Bauck, D.E. Freeman, A.J.…”

A Retrospective Study Comparing the Outcome of Horses Undergoing Small Intestinal Resection and Anastomosis With A Single Layer (Lembert) or Double Layer (Simple Continuous and Cushing) Technique

“…A 2 layer end‐to‐end hand sewn small intestinal anastomosis consisting of a simple continuous technique for the mucosa/submucosa followed by an inverting continuous technique in the seromuscular layer is most commonly performed by equine surgeons . However, recent ex vivo studies have demonstrated that 1 layer techniques are biomechanically equivalent, faster to perform, and may result in anastomoses with larger lumen diameters compared with 2 layer techniques …”