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Home / Equine Research Bank / Vet Surg / An ex vivo comparison of jejunal transection angles and the ...
Veterinary surgery : VS2025; doi: 10.1111/vsu.14294

An ex vivo comparison of jejunal transection angles and the effect on lumen diameter following end-to-end jejunojejunal anastomoses.

Abstract: To evaluate three different jejunal transection angles for end-to-end jejunojejunostomies, comparing construction time, lumen size, and suture number. Methods: Ex vivo cadaver study. Methods: Eight euthanized horses each had three mid-jejunal specimens harvested. Methods: Jejunal segments were assigned to one of three groups (A30, A45, and A60) and transected at 30, 45, or 60°, respectively. Following transection, a standardized handsewn single-layer interrupted modified Lembert anastomosis was performed, and construction time and number of sutures placed were recorded. Anastomotic index (AI) was calculated. Statistical analysis was performed using a one-way ANOVA. Statistical significance was set at p < .05. Results: Transected jejunal lengths increased as the transection angle decreased (p  .333). Mean AI were 93.37, 114.29, and 135.07 for groups A60, A45, and A30 and the AI increased as the transection angle decreased (p < .001). Conclusions: A 60° transection angle reduced lumen size at the anastomosis but a 45 and 30° transection angle resulted in an increased lumen size at the anastomosis. The 45° angle did not increase the number of sutures required. The 30° angle significantly increased the number of sutures required. Conclusions: A 45° angle of transection does not result in increased surgical time or number of sutures placed. Further investigation is required to determine the ideal angle of transection.
© 2025 The Author(s). Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.
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Publication Date: 2025-06-17 PubMed ID: 40525474DOI: 10.1111/vsu.14294Google Scholar: Lookup
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Summary

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This study investigates the impact of different transection angles on the diameter of the jejunal lumen in horses, also assessing factors like construction time and the number of sutures required. It concluded that a 45° transection angle does not lead to increased surgical time or the number of sutures, while enhancing the lumen size.

Research Methodology

  • The study was carried out ex vivo, meaning it was performed outside a living organism, using specimens of the equine jejunum segments harvested from euthanized horses.
  • These jejunal segments were divided into three groups for the experiment. Each group represents a different transection angle – 30 degrees (A30), 45 degrees (A45), and 60 degrees (A60).
  • After the transection at the respective angles, a standard hand-sewn single-layer interrupted modified Lembert anastomosis was performed. An anastomosis is the surgical connection of separate or severed channels such as blood vessels or loops of the intestine.
  • Construction time and the number of sutures applied were then recorded. The researchers also calculated the Anastomotic index (AI), a measure used to reflect the quality and efficacy of an anastomosis.
  • Statistical analysis of the data gathered was done using one-way ANOVA, with statistical significance set at p < .05.

Research Findings

  • The research found that as the transection angle decreased, transected jejunal lengths increased significantly (p < .001).
  • However, the time taken to construct the anastomoses showed no significant variation among the different groups.
  • The number of sutures required to complete the anastomosis was higher for the A30 group as compared to the A60 group, but there was no notable difference between A60 and A45 or A45 and A30.
  • The Anastomotic index also increased notably as the transection angle decreased.

Conclusions and Implications

  • The study concluded that a 60° transection angle reduced the lumen size at the anastomosis, while a 45° and 30° transection angles resulted in an increased lumen size at the anastomosis.
  • A significant finding was that the 45° transection angle did not increase the number of sutures required or the surgical time, but increased lumen size, making it a potentially relevant technique in such surgeries.
  • The researchers emphasized that further investigation is necessary to conclusively establish the ideal transection angle.

Cite This Article

APA
Baldwin CM, Gillen A. (2025). An ex vivo comparison of jejunal transection angles and the effect on lumen diameter following end-to-end jejunojejunal anastomoses. Vet Surg. https://doi.org/10.1111/vsu.14294

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English

Researcher Affiliations

Baldwin, Christopher M
  • Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, UK.
Gillen, Alexandra
  • Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, UK.

References

This article includes 27 references
  1. Freeman DE. Jejunum and Ileum. In: Auer JA, Stick JA, eds. Equine Surgery. 5th ed. Elsevier Health Sciences; 2018:536‐575.
  2. Reinertson E. Comparison of three techniques for intestinal anastomosis in horses. J Am Vet Med Assoc 1976;169:209‐212.
  3. Roessner HA, Hurcombe SD, Klein CE, Hopster K, Engiles JB. Comparison of one‐layer Utrecht pattern with two‐layer (simple continuous/Cushing) pattern for jejunojejunostomy in healthy horses in vivo. Vet Surg 2021;50:1483‐1494.
  4. Seitz‐Cherner E, Bauck AG, Denagamage T, Freeman DE. Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses. Vet Surg 2023;52:407‐415.
  5. Dean PW, Robertson JT, Jacobs RM. Comparison of suture materials and suture patterns for inverting intestinal anastomosis of the jejunum in the horse. Am J Vet Res 1985;46:2072‐2077.
  6. Mendez‐Angulo JL, Ernst NS, Mudge MC. Clinical assessment and outcome of a single‐layer technique for anastomosis of the small intestine in horses. Vet Rec 2010;167:652‐655.
  7. Freeman D, Shaeffer DJ. Clinical comparison between continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane with an interrupted Lembert pattern for one‐layer jejunojejunostomy in horses. Equine Vet J 2011;43:708‐713.
  8. Sherlock C, Lee W, Mueller PO, Eggleston R, Epstein K. Ex vivo comparison of three hand sewn end‐to‐end anastomoses in normal equine jejunum. Equine Vet J 2011;43:76‐80.
  9. Gandini M, Bertuglia A. In vitro evaluation of an inverted end‐to‐end equine jejunojejunal anastomosis using skin staples. Vet Surg 2006;35:678‐682.
  10. Aristizabal FA, Lopes MA, Silva A, Avanza MF, Nieto JE. Evaluation of the effect of onlay mesenteric flaps on end‐to‐end jejunojejunostomy healing in horses. Vet Surg 2014;43:479‐486.
  11. Close K, Epstein KL, Sherlock CE. 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. Vet Surg 2014;43:471‐478.
  12. Nelson BB, Hassel DM. In vitro comparison of V‐LocTM versus BiosynTM in a one‐layer end‐to‐end anastomosis of equine jejunum. Vet Surg 2014;43:80‐84.
  13. Lenoir A, Perrin BR, Lepage OM. Ex vivo comparison of a UV‐polymerizable methacrylate adhesive versus an inverting pattern as the second layer of a two‐layer hand‐sewn jejunal anastomosis in horses: a pilot study. Vet Med Int 2021;1:5545758.
  14. Nieto J, Dechant J, Snyder J. Comparison of one‐layer (continuous Lembert) versus two‐layer (simple continuous/Cushing) hand‐sewn end‐to‐end anastomosis in equine jejunum. Vet Surg 2006;35:669‐673.
  15. Lee WL, Epstein KE, Sherlock C. Ex vivo comparison of one‐layer (continuous Lembert) versus two‐layer (simple continuous/Cushing) hand‐sewn end‐to‐end jejuno‐ileal anastomosis in normal equine small intestine. Vet Surg 2012;41:581‐593.
  16. Gandini M. In vitro evaluation of a closed‐bowel technique for one‐layer hand‐sewn inverting end‐to‐end jejunojejunosotomy in the horse. Vet Surg 2006;35:683‐688.
  17. Bracamonte JL, Anderson SL, Hendrick S, Barber SM, Deutscher D, Sumner D. Ex vivo comparison of the biomechanical properties of hand‐sewn and stapled jejunoileal anastomoses in horses. Vet Surg 2014;43:451‐458.
  18. Agrodnia M, Hauptman J, Walshaw R. Use of atropine to reduce mucosal eversion during intestinal resection and anastomosis in the dog. Vet Surg 2003;32:365‐370.
  19. Shields MA, Dudley HAF. Oedema at the site of small bowel anastomoses. Br J Surg 1971;58:598‐600.
  20. Coolman BR, Ehrhart N, Pijanowski G. Comparison of skin staples with sutures for anastomosis of the small intestine dogs. Vet Surg 2000;29:293‐302.
  21. Phillips TJ, Walmsley JP. Retrospective analysis of the results of 151 exploratory laparotomies in horses with gastrointestinal disease. Equine Vet J 1993;25:427‐431.
  22. Proudman CJ, Smith JE, Edwards GB, French NP. Long‐term survival of equine surgical colic cases. Part 2: modelling postoperative survival. Equine Vet J 2002;34:438‐443.
  23. Proudman CJ, Edwards GB, Barnes J, French NR. Factors affecting long‐term survival of horses recovering from surgery of the small intestine. Equine Vet J 2005;37:360‐365.
  24. Wilson DA, Baker GJ, Boero MJ. Complications of celiotomy incisions in horses. Vet Surg 1995;24:506‐514.
  25. Smith LJ, Mellor DJ, Marr CM, Reid SWJ, Mair TS. Incisional complications following exploratory celiotomy: does an abdominal bandage reduce the risk?. Equine Vet J 2007;39:277‐283.
  26. Freeman KD, Southwood LL, Lane J, Lindborg S, Aceto HW. Postoperative infection, pyrexia and perioperative antimicrobial drug use in surgical colic patients. Equine Vet J 2012;44:476‐481.
  27. Ducharme NG. Enterotomy, resection, and anastomosis techniques. In: Mair TS, Divers T, Ducharme NG, eds. Manual of Equine Gastroenterology. Saunders, Elsevier Limited; 2002:168‐181.

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