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The Canadian veterinary journal = La revue veterinaire canadienne2018; 59(1); 67-73;

Comparison of hand-sewn and oversewn stapled jejunojejunal anastomoses in horses.

Abstract: The objective of this study was to compare the biomechanical properties of hand-sewn jejunojejunal anastomoses to those of oversewn stapled jejunojejunal anastomoses. Jejunojejunal anastomoses were constructed from harvested jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique oversewn with Cushing pattern (SS), and closed 1-stage stapled functional end-to-end technique oversewn with Cushing pattern (FEE). Anastomosed segments were distended with fluid until the point of biomechanical failure. The 2HS had the longest construction time of all anastomoses. Bursting pressures were significantly higher for hand-sewn jejunojejunostomies than those for oversewn stapled jejunojejunostomies. No significant differences were found in bursting pressures between 1HS and 2HS or between SS and FEE. Hand-sewn jejunojejunostomies proved to be biomechanically stronger than oversewn stapled jejunojejunostomies when initially constructed. However, all anastomotic types would be secure techniques to be used clinically based on the supraphysiological pressures they are capable of withstanding. Cette étude avait pour objectif de comparer les propriétés biomécaniques des anastomoses jéjuno-jéjunales cousues à la main et celles des anastomoses jéjuno-jéjunales agrafées et cousues. Des anastomoses jéjuno-jéjunales ont été construites à partir de segments jéjunaux prélevés en utilisant la technique Lembert à couche unique (1HS), la technique Cushing à double couche simple continue (2HS), la technique agrafée côte à côte selon la méthode Cushing (SS) et la technique fonctionnelle de bout en bout fermée en 1 étape avec couture selon la méthode Cushing (FEE). Des segments anastomosés ont été dilatés avec du liquide jusqu’au point de défaillance biomécanique. La technique 2HS présentait le temps de construction le plus long de toutes les anastomoses. Les pressions de rupture étaient significativement supérieures pour les jéjuno-jéjunostomies cousues par rapport aux jéjuno-jéjunostomies agrafées et cousues. Aucune différence significative n’a été constatée au niveau des pressions de rupture entre 1HS et 2HS ou entre SS et FEE. Les jéjuno-jéjunostomies cousues à la main se sont avérées plus fortes sur le plan mécanique que les jéjuno-jéjunostomies agrafées et cousues lors de la construction initiale. Cependant, tous les types anastomotiques seraient des techniques sûres pour utilisation clinique en se basant sur les pressions supra-physiologiques qu’elles sont capables de supporter.(Traduit par Isabelle Vallières).
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Publication Date: 2018-01-06 PubMed ID: 29302105PubMed Central: PMC5731393
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  • Journal Article

Summary

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.

This study compared the strength of four techniques for joining pieces of horse intestine together: two hand-sewn methods and two stapled methods. The hand-sewn methods were found to be able to withstand significantly higher pressure before failing, but all techniques could withstand more pressure than they’d be expected to encounter in a normal horse.

Methods

  • The researchers harvested jejunal segments, which is a part of the small intestine, from horses.
  • They used these segments to construct jejunojejunal anastomoses. Anastomoses are surgical connections between parts that normally wouldn’t be connected, like blood vessels or segments of the intestine.
  • The jejunojejunal anastomoses were constructed using four different techniques: a single-layer Lembert technique (1HS), a double-layer simple continuous/Cushing technique (2HS), a stapled side-to-side technique oversewn with a Cushing pattern (SS), and a closed 1-stage stapled functional end-to-end technique oversewn with a Cushing pattern (FEE).

Findings

  • Once the anastomoses were constructed, the researchers applied fluid pressure to them until they failed. This was meant to test their strength and durability.
  • The 2HS technique took the longest time to construct.
  • The bursting pressures, or the pressures at which the anastomoses failed, were significantly higher for the hand-sewn techniques than for the stapled techniques.
  • However, there were no significant differences in bursting pressures between the two hand-sewn techniques (1HS and 2HS) or between the two stapled techniques (SS and FEE).

Conclusion

  • The researchers concluded that while the hand-sewn techniques led to stronger anastomoses initially, all of the techniques they tested would be safe to use in a medical setting.
  • This is because even the weakest of the four techniques was able to withstand “supraphysiological” pressures, or pressures that are higher than what the anastomoses would normally encounter in a live horse.

Cite This Article

APA
Bracamonte JL, Devick I, Thomas KL, Hendrick S. (2018). Comparison of hand-sewn and oversewn stapled jejunojejunal anastomoses in horses. Can Vet J, 59(1), 67-73.

Publication

The Canadian veterinary journal = La revue veterinaire canadienne
ISSN: 0008-5286
NlmUniqueID: 0004653
Country: Canada
Language: English
Volume: 59
Issue: 1
Pages: 67-73

Researcher Affiliations

Bracamonte, José L
  • Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4.
Devick, Ian
  • Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4.
Thomas, Keri L
  • Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4.
Hendrick, Steven
  • Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4.

MeSH Terms

  • Anastomosis, Surgical / methods
  • Anastomosis, Surgical / veterinary
  • Animals
  • Biomechanical Phenomena
  • Cadaver
  • Horses / surgery
  • Jejunum / surgery
  • Surgical Stapling / veterinary
  • Suture Techniques / veterinary

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Citations

This article has been cited 1 times.
  1. Averay K, van Galen G, Ward M, Verwilghen D. Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments. BMC Vet Res 2021 Apr 15;17(1):167.
    doi: 10.1186/s12917-021-02871-4pubmed: 33858391google scholar: lookup
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