Veterinary surgery : VS2026; doi: 10.1111/vsu.70161

Comparison of blind end closure techniques in equine ileum.

Hilliard, RL
·
Prisk, A
·
Wang, S
·
Hansen, S
·
Munsterman, A

Abstract: To determine the difference in bursting pressure (BP), bursting wall tension (BWT), and closure speed between commonly utilized methods of ileal stump closure. Methods: Randomized experimental study. Methods: A total of 71 ileal segments from 18 healthy horses. Methods: Ileum was collected postmortem from 18 horses and divided into four segments. One end of each segment was closed using one of three techniques: Parker-Kerr (PK), gastrointestinal staples (ST), or gastrointestinal staples with a Lembert staple oversew (SO). Closure time was recorded. Control (C) segments were not altered. Segments were distended until failure. BP and infusion volume were documented, and BWT was calculated. Results: BP and BWT were higher for controls compared to all closure methods (p < .001). No differences in BP (p > .999) or BWT (p > .77) were found between closure methods. ST technique was 27.1 times faster than PK (p < .001) and 23.4 times faster than SO (p < .001). SO was 1.2 times faster than PK (p < .001). Mechanisms of failure were predictable within each technique. Conclusions: No difference in BP or BWT was observed between closure techniques in healthy ileum. ST and SO were significantly faster than PK. Conclusions: The similarity in bursting strength across techniques suggests that closure method should be chosen based on other factors. The ST closure was faster compared to other techniques, and the addition of an oversewing pattern did not improve security of closure.

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Publication Date: 2026-09-22 PubMed ID: 42773789DOI: 10.1111/vsu.70161Google Scholar: Lookup

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This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

This study compared three common techniques for closing the blind end of the equine ileum to evaluate their strength, wall stress resistance, and speed of closure.
The research found no difference in strength or wall tension resistance between the methods, but stapling techniques were much faster than hand suturing.

Purpose of the Study

To assess differences between three ileal stump closure techniques in horses: Parker-Kerr suture (PK), gastrointestinal staples (ST), and staples with a Lembert staple oversew (SO).
Key variables measured included bursting pressure (BP), bursting wall tension (BWT), and time required to close the ileal segments.

Study Design and Methods

Sample: 71 ileal segments from 18 healthy horses collected postmortem.
Each ileum was divided into four segments; one end of each segment was closed with one of three methods or left open as a control (C).
Closure techniques:
- Parker-Kerr suture (PK): a hand-sewn method using sutures to invert and secure the ileum end.
- Stapling (ST): use of gastrointestinal staples for closure.
- Stapling plus oversew (SO): staples plus an additional Lembert suture pattern oversewing the staples.
Closure time was recorded.
Segments were distended via infusion until rupture to measure bursting pressure and volume at failure.
Bursting wall tension (BWT) was calculated from the distension data.

Key Findings

Controls (unclosed segments) had significantly higher bursting pressure and wall tension than any closed segments, implying closure always reduces the ileum’s ability to withstand pressure.
Between the three closure methods, no statistically significant differences were found in bursting pressure or wall tension (BP p > 0.999, BWT p > 0.77), indicating similar strength and resilience.
Closure time varied greatly:
- Stapling (ST) was 27.1 times faster than Parker-Kerr (PK) and 23.4 times faster than staple + oversew (SO).
- SO was roughly 20% faster than PK (1.2 times faster).
Mode of failure during bursting tests was consistent and predictable based on the technique used, suggesting reliable mechanical behavior for each method.

Interpretation and Clinical Implications

Since all three closure methods demonstrated similar strength and resistance to bursting under pressure, surgeons can select closure technique based on factors other than strength, such as speed and ease of use.
Stapling techniques offer a major advantage in operative time, which may reduce anesthesia duration and associated risks.
The addition of the Lembert staple oversew did not improve closure security, implying that the extra step may be unnecessary when using staples.
Understanding predictable failure modes for each technique can aid surgeons in anticipating potential complications and tailoring their approach accordingly.

Limitations and Future Directions

Study used ileal tissue from healthy horses postmortem, so in vivo factors like healing, infection, and tissue condition were not assessed.
Further investigation in clinical scenarios is needed to confirm these findings regarding safety and long-term outcomes.
Studies evaluating closure performance in diseased or damaged ileum would be beneficial to guide surgical decisions in pathological conditions.

Cite This Article

APA

Hilliard RL, Prisk A, Wang S, Hansen S, Munsterman A. (2026). Comparison of blind end closure techniques in equine ileum. Vet Surg. https://doi.org/10.1111/vsu.70161

Publication

Veterinary surgery : VS

ISSN: 1532-950X

NlmUniqueID: 8113214

Country: United States

Language: English

Researcher Affiliations

Hilliard, Rachel L

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.

Prisk, Amanda

Department of Large Animal Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA.

Wang, Sichao

Center for Statistical Training and Consulting (CSTAT), Michigan State University, East Lansing, Michigan, USA.

Hansen, Stefanie

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.

Munsterman, Amelia

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.

Grant Funding

Tufts Cummings School of Veterinary Medicine Department of Clinical Sciences Faculty Development Fund

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