Sutured End‐to‐End and Stapled Side‐to‐Side Jejunal Anastomoses in the Horse

Abstract

Hand sutured end-to-end (EE) and stapled side-to-side (SS) small intestinal anastomoses were performed in 10 healthy adult horses. In five SS anastomoses, staple lines on the blind ends of the jejunum were inverted (SSI) and in five they were not (SSNI). Five EE anastomoses were sutured with polydioxanone and five were sutured with polyglyconate. All horses were euthanatized on day 30. Intra-abdominal adhesions were graded (0-4), and stomal areas were calculated from contrast radiographs made with the bowel distended. Histopathology scores for the anastomoses were based on the degree of inflammation (0-3), fibrosis (0-3), and alignment and healing of intestinal layers (0-3). Mean surgery times +/- standard deviations for EE, SSI, and SSNI techniques were 33.9 +/- 5.4, 36.2 +/- 5.6, and 29.6 +/- 5.9 minutes, respectively. Mean and median stomal areas were 9.4 +/- 5.5 and 8.9 cm2 for EE anastomoses and 17.2 +/- 16.5 and 12.1 cm2 for SS anastomoses. Intra-abdominal adhesions developed in three horses, one of which had clinical signs of colic. Mean histopathology scores for EE and SS anastomoses were 4.8 +/- 2.0 (median = 5) and 4.4 +/- 1.8 (median = 4), respectively. There were no statistically significant differences in surgery times, intra-abdominal adhesion scores, stomal areas, or histopathology scores between small intestinal EE and SS anastomoses in these horses.

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

“…Reduction in lumen diameter may progress as the anastomosis heals. An average of 50% reduction in luminal diameter 30 days after construction of a 2C anastomosis was found previously (Baxter et al . 1992).…”

“…Although no difference in complication rates between techniques were detected in some reports of clinical cases (Semevolos et al . 2002) or experimentally (Baxter et al . 1992), the end‐to‐end technique was found to have a lower risk of complications in comparison to the functional end‐to‐end anastomosis technique (Franheny et al .…”

Differential survival in horses requiring end‐to‐end jejunojejunal anastomosis compared to those requiring side‐to‐side jejunocaecal anastomosis

“…However, this uptake of modern technology has been accompanied by few rigorous assessments of its benefits or disadvatages. In experimental studies on healthy horses, surgery time, abdominal adhesion scores, stomal areas and histopathology score were found to be similar between handsewn end-to-end and stapled side-to-side jejunojejunal anstomoses (Baxter et al 1992). The present study is the first direct comparison of stapled vs. handsewn jejunocaecal anastomoses in clinical cases.…”

Clinical assessment and outcome of three techniques for jejunal resection and anastomosis in horses: 59 cases (1989–2000)

“…There were 14 Thoroughbreds, 10 Quarter Horses, 6 Appaloosas, 6 Arabians, 4 Standardbreds, and 4 mixed-breed horses, with other breeds represented in small numbers. The most common reasons for small intestinal obstruction were strangulating lipoma (n = 24), jejunal volvulus (7), adhesions (6), inguinal hernia (4), and mesenteric hernia (3). No difference in frequency of lesion types was found among anastomotic groups (P = 0.472).…”