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Equine veterinary journal2025; doi: 10.1111/evj.14466

Comparison of two techniques to blind end jejunum and ileum for jejunocaecostomy in horses.

Abstract: Jejunocaecostomy (JC) is frequently required to bypass diseased ileum as a side-to-side (SS) anastomosis with blind end closure of the small intestine. The effects of the blind end closure method on the performance of the anastomosis have not been studied. Objective: To compare handsewn and stapled blind end closures of the ileum and jejunum. Methods: In vivo experiments. Methods: JC was performed with either Parker-Kerr (PK; 6 horses) or oversewn stapled technique (OS; 6 horses) to close jejunum and ileum for an SS anastomosis. At surgery, peritoneal fluid was analysed and various anastomotic measurements and time to complete the anastomosis were recorded. Physical and haematological findings and serum amyloid A (SAA) were recorded postoperatively. At necropsy on day 7, anastomotic measurements and peritoneal fluid analysis were repeated. Tissues collected at surgery and necropsy underwent histological and immunohistological evaluations. Results: Two PK horses developed intussusception of the jejunal blind end into the caecum and another PK horse was euthanised because of anastomotic impaction. One OS horse had mild postoperative colic. Postoperative peripheral neutrophil counts and SAA were similar between groups but SAA significantly (0.5 mg/L [0.3, 0.7], p < 0.001) increased with time in both. The OS jejunal blind ends (4.7 cm [4.41, 6.85]) were significantly larger (PK = 3.5 cm [3.3, 4.08], p = 0.004) and the OS blind ends (18.6 min ± 1.32) were significantly slower to complete (11.3 min ± 0.37, p = 0.002). Inflammation developed between the everting staple line and inverting suture line in the OS closure and along transected edges in the PK. Peritoneal fluid total protein increased significantly between surgery (19 g/L [19, 19]) and necropsy (34 g/L [30, 41], p < 0.001) without differences between groups. Conclusions: Small sample size and short follow-up. Conclusions: Both blind-end techniques could be acceptable, although more complications developed with the PK method. The anastomotic intussusceptions were unexpected and possibly unique to the anastomotic design. Hintergrund: Die Jejunocecostomie (JC) ist häufig erforderlich, um ein erkanktes Ileum zu umgehen milhilfe einer Side‐to‐Side (SS)‐Anastomose mit blindem Endverschluss des Dünndarms. Die Auswirkungen der Methode des blinden Endverschlusses auf die Sicherheit der Anastomose sind nicht untersucht worden. Zielsetzung: Vergleich von handgenähten und geklammerten Blindverschlüssen des Ileums und Jejunums. Studiendesign: In‐vivo‐Versuche. Methodik: JC wurde entweder mit der Parker–Kerr‐Technik (PK; 6 Pferde) oder der Oversewn‐Stapled‐Technik (OS; 6 Pferde) durchgeführt, um Jejunum und Ileum für eine SS‐Anastomose zu verschliessen. Bei der Operation wurde die Peritonealflüssigkeit analysiert und verschiedene Anastomosenmaβe sowie die Zeit bis zum Verschluss der Anastomose aufgezeichtet. Postoperativ wurden die allgemeinen körperlichen (physischen) und hämatologischen Befunde sowie das Serum‐Amyloid A (SAA) erfasst. Bei der Nekropsie an Tag 7 wurden die Anastomosemessungen und die Analyse der Peritonealflüssigkeit wiederholt. Die bei der Operation und Nekropsie entnommenen Gewebe wurden histologisch und immunhistologisch untersucht. Ergebnisse: Zwei PK‐Pferde entwickelten eine Intissuszeption des jejunalen Stumpfes in das Zäkum, und ein weiteres PK‐Pferd wurde aufgrund einer Anastomosen‐Obstipation eingeschläfert. Ein OS‐Pferd hatte eine geringgradige postoperative Kolik. Die postoperative periphere Neutrophilenzahl und SAA waren ähnlich zwischen den Gruppen, aber SAA stieg in beiden Gruppen mit der Zeit significant an (0,5 mg/L [0,3; 0,7], p<0,001). Die jejunalen OS‐Stümpfe (4,7cm [4,41; 6,85], p=0,004) waren signifikant gröβer (PK=3,5 cm [3,3; 4,08], p=0,004) und die OS‐Stümpfe (18,6 Minuten ± 1,32) waren signifikant langsamer fertigzustellen (11,3 Minuten ± 0,37, p=0,002). Die Entzündung entwickelte sich beim OS‐Verschluss zwischen der evertierenden Klammerlinie und der invertierenden Nahtlinie und beim PK‐Verschluss entlang der durchtrennten Kanten. Das Gesamtprotein der Peritonealflüssigkeit stieg zwischen der Operation (1,9g/dL [1,9; 1,9]) und der Nekropsie (3,4g/dL [3; 4,1], p<0,00001) signifikant an, ohne Unterschiede zwischen den Gruppen. Haupteinschränkungen: Kleine Stichprobengröβe und kurze Nachbeobachtungszeit. Schlussfolgerung: Beide Stumpftechniken könnten akzeptabel sein, obwohl bei der PK‐Methode mehr Komplikationen auftraten. Die Anastomosen‐Intussuszeptionen waren unerwartet und möglicherweise auf das Anastomosen‐Design zurückzuführen.
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Publication Date: 2025-01-07 PubMed ID: 39763386DOI: 10.1111/evj.14466Google Scholar: Lookup
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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.

The study investigates two different methods to close the open ends of the small intestine in horses during a jejunocaecostomy procedure – Parker-Kerr (PK) handsewn and oversewn stapled technique (OS). The results showed that both methods were acceptable, although there were more complications observed with the PK method.

Objective of the Research

The research aims to compare the effects of two different techniques of closing the open ends of ileum and jejunum during a jejunocaecostomy procedure, frequently required to bypass diseased ileum in horses. Jejunocaecostomy is a surgical procedure that creates an anastomosis, a connection between the jejunum (part of small intestine) and caecum (part of large intestine). It aims to redirect the flow of digestion to bypass a diseased or damaged portion of the ileum.

Research Methods

  • Twelve horses were involved in the experiment, in which two methods were used to perform a side-to-side (SS) anastomosis. Six horses underwent the Parker-Kerr hand-sewn technique (PK) and the other six underwent the oversewn stapled technique (OS).
  • The experiment assessed various criteria like the time taken to complete the anastomosis, anastomotic measurements, the analysis of peritoneal fluid at surgery, and postoperative physical and hematological conditions.
  • The health of the horses was checked postoperatively, concentrating on neutrophil counts and serum amyloid A (SAA) levels, indicators of inflammation and infection.
  • The horses were euthanized on the 7th day for necropsy, where the measurements and evaluations made during the surgery were repeated. Tissues collected at the surgery and necropsy underwent histological and immunohistological evaluations.

Research Findings

  • Two horses that underwent PK technique developed intussusception, a complication where a part of the intestine “telescopes” into another section. One horse was euthanized due to impaction of the anastomotic area.
  • One horse from the OS group experienced mild colic postoperatively.
  • There was no significant difference between the groups concerning the neutrophil count and SAA levels postoperatively, though SAA levels increased over time in both groups.
  • Jejunal blind ends in the OS group were significantly larger and took longer to complete than those in the PK group.
  • Inflammation developed along the everted staple line and inverting suture line in OS closures, and along the cut edges in PK closures.
  • The levels of total protein in the peritoneal fluid significantly increased from the time of surgery to necropsy without any difference between both the groups.

Conclusion

The study concluded that both techniques could be used effectively for closing the open ends of the small intestine during a jejunocaecostomy procedure, although complications were seen more with the PK method. The intussusception noticed was unexpected and may relate to the design of the technique itself. However, the results were based on a small sample size and short follow-up time, which are considered limitations.

Cite This Article

APA
Chanutin S, Bauck AG, Roberts JF, Denagamage TN, Freeman DE. (2025). Comparison of two techniques to blind end jejunum and ileum for jejunocaecostomy in horses. Equine Vet J. https://doi.org/10.1111/evj.14466

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Chanutin, Sierra
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Bauck, Anje G
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Roberts, John F
  • Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Denagamage, Thomas N
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Freeman, David E
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.

Grant Funding

  • Arden and Claudia Sims Ljufur Fund for Colic Research

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