FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Equine Vet J / Comparison of two techniques to blind end jejunum and ileum ...
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.
© 2025 EVJ Ltd.
Get Full Text
Publication Date: 2025-01-07 PubMed ID: 39763386DOI: 10.1111/evj.14466Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • 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.

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

References

This article includes 49 references
  1. Edwards GB. Obstruction of the ileum in the horse: a report of 27 clinical cases.. Equine Vet J 1981;13:158–166.
  2. Freeman DE, Schaeffer DJ. Comparison of complications and long‐term survival rates following hand‐sewn versus stapled side‐to‐side jejunocecostomy in horses with colic.. J Am Vet Med Assoc 2010;237(9):1060–1067.
  3. Stewart S, Southwood L, Aceto HW. Comparison of short‐ and long‐term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005–2010.. Equine Vet J 2014;46(3):333–338.
  4. Rudnick MJ, Denagamage TN, Freeman DE. Effects of age, disease and anastomosis on short‐ and long‐term survival after surgical correction of small intestinal strangulating diseases in 89 horses.. Equine Vet J 2022;54(6):1031–1038.
  5. Freeman DE, Hammock P, Baker GJ, Goetz T, Foreman JH, Schaeffer DJ. Short‐ and long‐term survival and prevalence of postoperative ileus after small intestinal surgery in the horse.. Equine Vet J 2000;32(S32):42–51.
  6. van Bergen T, Haspeslagh M, Wiemer P, Swagemakers M, van Loon G, Martens A. Surgical treatment of epiploic foramen entrapment in 142 horses (2008–2016).. Vet Surg 2019;48:291–298.
  7. Rendle DI, Wood JLN, Summerhays GE, Walmsley JP, Boswell JC, Phillips TJ. End‐to‐end jejuno‐ileal anastomosis following resection of strangulated small intestine in horses: a comparative study.. Equine Vet J 2005;37(4):356–359.
  8. Bladon BM, Hillyer MH. Effect of extensive ileal resection with a large resulting mesenteric defect and stapled ileal stump in horses with a jejunocaecostomy: a comparison with other anastomotic techniques.. Equine Vet J 2000;32(S32):52–58.
  9. Pankowski RL. Small intestinal surgery in the horse: a review of ileo and jejunocecostomy.. J Am Vet Med Assoc 1987;190:1608–1609.
  10. Blackwell RB. Jejunocaecostomy in the horse: a comparison of two techniques.. Proceedings of the second equine colic research symposium 1982. p. 288–289.
  11. Brown JA, Holcombe SJ, Southwood LL, Byron CR, Embertson RM, Hauptmann JG. End‐to‐side versus side‐to‐side jejunocecostomy in horses: a retrospective analysis of 150 cases.. Vet Surg 2015;44(4):527–533.
  12. Rocken M, Ross MW. Vergleichsstudie uber die jejunocaecostomie als end‐zu seitanastomose und seit‐zuseitanastomose.. Pferdeheilkunde 1994;10:311–315.
  13. Donawick WJ, Christie BA, Stewart JV. Resection of diseased ileum in the horse.. J Am Vet Med Assoc 1971;159:1146–1149.
  14. Huskamp B. Ileum‐resektion und Jejunocaecostomie beim Pferd.. Berl Münch Tierärztl Wochenschr 1973;86:161–163.
  15. Fugaro MN, Coté NM. Survival rates for horses undergoing stapled small intestinal anastomosis: 84 cases (1988–1997).. J Am Vet Med Assoc 2001;218(10):1603–1607.
  16. Gandini M, Giusto G. Combination of end‐to‐end jejuno‐ileal anastomosis and side‐to‐side incomplete ileocecal bypass (hybrid jejuno‐ileo‐cecal anastomosis) following subtotal ileal resection in seven horses.. J Am Vet Med Assoc 2021;259(11):1337–1343.
  17. Sullins KE, Stashak TS, Mero KN. Evaluation of intestinal staples for end‐to‐end anastomosis of the small intestine in the horse.. Vet Surg 1985;14:87–92.
  18. Latimer FG, Blackford JT, Valk N, Wan P, Patton S. Closed one‐stage functional end‐to‐end jejunojejunostomy in horses with use of linear stapling equipment.. Vet Surg 1998;27:17–28.
  19. Giusto G, Gandini M, Amedeo S. Effects of staple size, tissue thickness, and precompression time on staple shape in side‐to‐side jejunocecal anastomosis in specimens obtained from healthy horses at an abattoir.. Am J Vet Res 2014;75(7):680–684.
  20. Freeman DE. Jejunum and Ileum.. Equine Surgery 2019. p. 536–575.
  21. Sandh G. Modification of the cutting thread technique for intestinal anastomoses using diathermy.. Zentralblatt fur Veterinarmedizin Reihe A 1991;38(2):115–125.
  22. Toth J, Birke H, Huskamp B, Scheidemann W. Die Ausführung der Jejunozäkostomie beim Pferd mittels einer Sägetechnik.. Pferdeheilkunde 1998;14:385–390.
  23. Pritchett LC, Ulibarri C, Roberts MC, Schneider RK, Sellon DC. Identification of potential physiological and behavioral indicators of postoperative pain in horses after exploratory celiotomy for colic.. Appl Anim Behav Sci 2003;80:31–43.
  24. 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(3):407–415.
  25. Grosche A, Morton AJ, Polyak MM, Matyjaszek S, Freeman DE. Detection of calprotectin and its correlation to the accumulation of neutrophils within equine large colon during ischaemia and reperfusion.. Equine Vet J 2008;40(4):393–399.
  26. Parker JE, Fubini SL, Todhunter RJ. Retrospective evaluation of repeat celiotomy in 53 horses with acute gastrointestinal diseases.. Vet Surg 1989;18:424–431.
  27. Frankeny RL, Wilson DA, Messer NT, Campbell‐Beggs C. Jejunal intussusception: a complication of functional end‐to‐end stapled anastomoses in two ponies.. Vet Surg 1995;24(6):515–517.
  28. 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(10):2072–2077.
  29. Lowe JE. Intussusception in three ponies following experimental enterotomy.. Cornell Vet 1968;58(2):288–292.
  30. Boswell JC, Schramme MC, Gains M. Jejunojejunal intussusception after an end‐to‐end jejunojejunal anastomosis in a horse.. Equine Vet Educ 2000;12:303–306.
  31. Schumacher J, Hanrahan L. Ileocecocolic intussusception as a sequel to jejunocecostomy in a mare.. J Am Vet Med Assoc 1987;190(3):303–304.
  32. Erkert RS, Crowson CL, Moll HD, Bentz BG, Confer AW, Blaik MA. Obstruction of the cecocolic orifice by ileocecocolic intussusception following jejunocecostomy in a horse.. J Am Vet Med Assoc 2003;222(12):1743–1745.
  33. Vasey JR, Julian RJ. Elective inversion of the distal ileal stump into the caecum of the horse.. Equine Vet J 1987;19(3):223–225.
  34. Gandini M, Giusto G. Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses.. Equine Vet J 2023;55(6):1021–1028.
  35. Herdt TH. Motility patterns of the gastrointestinal tract.. Textbook of veterinary physiology 2020. p. 293–306.
  36. Hocking MP, Carlson RG, Courington KR, Bland KI. Altered motility and bacterial flora after functional end‐to‐end anastomosis.. Surgery 1990;108:384–392.
  37. Bracamonte JL, Devick I, Thomas KL, Hendrick S. Comparison of hand‐sewn and oversewn stapled jejunojejunal anastomoses in horses.. Can Vet J 2018;59(1):67–73.
  38. Morton AJ, Blikslager AT. Surgical and postoperative factors influencing short‐term survival of horses following small intestinal resection: 92 cases (1994–2001).. Equine Vet J 2002;34(5):450–454.
  39. 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(4):360–365.
  40. Bowlby C, Mudge M, Schroeder E, Godman J, Hurcombe S. Equine inflammatory response to abdominal surgery in the absence of gastrointestinal disease.. J Vet Emerg Crit Care 2021;31(5):601–607.
  41. Busk P, Jacobsen S, Martinussen T. Administration of perioperative penicillin reduces postoperative serum amyloid a response in horses being castrated standing.. Vet Surg 2010;39:638–643.
  42. Jacobsen S, Jensen JC, Frei S, Jensen AL, Thoefner MB. Use of serum amyloid a and other acute phase reactants to monitor the inflammatory response after castration in horses: a field study.. Equine Vet J 2005;37:552–556.
  43. Jacobsen S, Vinther AM, Kjelgaard‐Hansen M, Nielsen LN. Validation of an equine serum amyloid A assay with an unusually broad working range.. BMC Vet Res 2019;15(1):462.
  44. Aitken MR, Stefanovski D, Southwood LL. Serum amyloid A concentration in postoperative colic horses and its association with postoperative complications.. Vet Surg 2019;48:143–151.
  45. Daniel AJ, Leise BS, Burgess BA, Morley PS, Cloninger M, Hassel DM. Concentrations of serum amyloid A and plasma fibrinogen in horses undergoing emergency abdominal surgery.. J Vet Emerg Crit Care 2016;263:351–433.
  46. Morello S, Southwood LL, Engiles J, Slack J, Crack A, Springate CMK. Effect of intraperitoneal peridan™ concentrate adhesion reduction device on clinical findings, infection, and tissue healing in an adult horse jejunojejunostomy model.. Vet Surg 2012;41:568–581.
  47. Hanson RR, Nixon AJ, Gronwall R, Meyer D, Pendergast J. Evaluation of peritoneal fluid following intestinal resection and anastomosis in horses.. Am J Vet Res 1992;53(2):216–221.
  48. Santschi EM, Grindem CB, Tate LP Jr, Corbett WT. Peritoneal fluid analysis in ponies after abdominal surgery.. Vet Surg 1988;17(1):6–9.
  49. 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(7):1483–1494.
Subscribe to our newsletter
Join 99,001 horse owners like you who receive our email updates on horse health and nutrition.