A comparison of three techniques for closure of pelvic flexure enterotomies in normal equine colon.

The study explores the effectiveness of three different surgical techniques in healing incisions made on the colon of five adult horses. It concludes that two-layer closure method showed improved healing and alignment compared to single and three-layer methods.

Methodology

• The researchers made six 3cm long incisions, spaced 3cm apart, in the antimesenteric border of the pelvic flexure of the equine’s ascending colon.
• Each incision was then sewn using varying techniques: 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).
• Every pattern was bound once both with chromic gut and polyglactin 910, two types of sutures.
• On the sixth day after the procedure, the pelvic flexure was excised and the colonic vessels were injected with a radio-opaque mass for observation.
• Sections of each enterotomy (surgical incision made into the intestine) were examined under light microscopy and high detail radiography.

Findings

• The single-layer closure resulted in a thin bowel wall, with healing occurring from the serosa (outermost layer of the bowel) to the mucosa (innermost layer).
• The three-layer closure introduced distortion to the bowel wall, primarily through the formation of a hematoma (a swelling of clotted blood within the tissues) and contamination of the submucosa (the layer of the bowel just beneath the mucosa) with ingesta (the material taken in by the digestive tract).
• Meanwhile, the two-layer closure demonstrated good alignment and enhanced healing.
• Additionally, the reaction to inflammation was noted to be considerably less with polyglactin 910 (a synthetic absorbable suture) compared with chromic gut (an absorbable suture of natural origin).