Evaluation of a biofragmentable anastomosis ring for small intestinal anastomosis in ponies.
Abstract: Six ponies divided into two groups of three were used in a double crossover study design. Group 1 ponies had a small intestinal resection and anastomosis performed using a biofragmentable anastomosis ring (BAR); group 2 ponies had a hand-sewn small intestinal resection and anastomosis using a Gambee suture pattern. Approximately 30 days later, all ponies had a second celiotomy and anastomosed segments were removed. Group 1 ponies had a hand-sewn anastomosis performed and group 2 had a BAR. The anastomotic sites were collected at necropsy approximately 30 days later. Anastomosed intestinal segments were evaluated with ultrasound to determine lumen diameter, area, circumference, and wall thickness. Gross descriptions of adhesions were recorded and sections of the anastomotic site were taken for histological evaluation. Time to perform the BAR anastomosis was significantly less (P = .0004) than for the hand-sewn Gambee anastomosis. Ponies with handsewn anastomoses had no signs of colic, whereas five of six ponies with BAR anastomoses had several episodes of abdominal discomfort, between day 16 to 18, corresponding to the time of BAR disintegration as determined by abdominal radiographs. Hand-sewn anastomoses had a tendency to have more adhesion formation than BAR anastomoses, but all anastomoses, except one BAR anastomosis, were graded as having a low obstructive potential. BAR anastomoses had a significantly larger mean index of stenosis for intraluminal diameter (76% +/- 13.6), area (93.7% +/- 6.01) and circumference (75.8% +/- 14.0) than the hand-sewn anastomoses (26.6% +/- 11.9; 44.6% +/- 19.5; 26.8% +/- 12.7). The BAR anastomoses also had a significantly smaller mean intraluminal diameter (0.96 cm +/- 0.49), area (0.838 cm2 +/- 0.65) and circumference (3.28 cm +/- 1.63) than the hand sewn anastomoses (3.11 cm +/- 0.73; 7.99 cm2 +/- 3.9; 10.3 cm +/- 2.47). In addition, the BAR anastomoses had a significantly larger (P = .0069) bowel wall thickness at the anastomoses and a significantly larger (P = .047) wall thickness proximal to the anastomosis than the hand-sewn anastomoses, indicating some degree of hypertrophy because of chronic obstruction. No significant difference was found in the diameter, area, or circumference between bowel proximal and distal to the anastomosis for either the BAR or Gambee techniques, or between the BAR and Gambee anastomosis as a measure of chronic obstruction. There was a significantly higher (P = .0043) histological score (worse healing) for mucosal healing and continuity for the BAR, as well as a tendency to score higher for inflammation, anastomotic alignment, and anastomotic fibrosis. The BAR technique had a significantly higher (P = .0043) total histological score than the Gambee technique. Although the BAR was advantageous in many respects, results of this study suggest that it should not be used for equine small intestinal anastomosis because of the potential for stricture formation.
Publication Date: 1996-07-01 PubMed ID: 8810023DOI: 10.1111/j.1532-950x.1996.tb01421.xGoogle Scholar: Lookup
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- Clinical Trial
- Controlled Clinical Trial
- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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This research focuses on comparing two techniques used for small intestinal anastomosis in ponies: the biofragmentable anastomosis ring (BAR) method and the hand-sewn Gambee suture method. The study concludes that although the BAR technique performed faster, it resulted in higher stricture formation and discomfort for the ponies, indicating it may not be suitable.
Study Design and Procedure
- The study made use of six ponies, divided into two groups of three, in a double crossover study design.
- Group 1 used the BAR method for small intestinal resection and anastomosis, while group 2 used the traditional hand-sewn Gambee suture method.
- After approximately 30 days, second celiotomy was performed on all ponies, and the anastomosis segments were removed. The techniques were interchanged among groups for this procedure.
Data Collection and Analysis
- The researchers conducted ultrasound evaluations of the anastomosed intestinal segments, providing data on lumen diameter, area, circumference, and wall thickness.
- Other evaluations included gross descriptions of adhesions (tissue growth causing organs to stick together) and histological evaluation of the anastomotic site.
Results and Findings
- The BAR method was significantly faster than the Gambee method. Nevertheless, the former caused more episodes of abdominal discomfort, which were inferred to be a result of the BAR’s disintegration.
- The study found a minor tendency of more adhesion in hand-sewn anastomoses than BAR anastomoses.
- BAR anastomoses had significantly larger stenosis indices (narrowing of the diameter) for key metrics like intraluminal diameter, area, and circumference.
- In line with this, the BAR techniques yielded significantly smaller mean intraluminal parameters.
- The BAR anastomoses led to significantly larger bowel wall thickness as compared to the hand-sewn method, which is suggestive of hypertrophy, a result of chronic obstruction.
- In terms of histological healing score, the BAR method scored significantly higher, indicating poorer healing than the Gambee method.
Conclusion
- Although BAR provides certain advantages, its potential for stricture formation, coupled with the observed increase in abdominal discomfort, makes it unsuitable for equine small intestinal anastomosis.
Cite This Article
APA
Bleyaert HF, Madison JB, Bailey JE, Johnson CM.
(1996).
Evaluation of a biofragmentable anastomosis ring for small intestinal anastomosis in ponies.
Vet Surg, 25(4), 327-335.
https://doi.org/10.1111/j.1532-950x.1996.tb01421.x Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville 32610, USA.
MeSH Terms
- Anastomosis, Roux-en-Y / instrumentation
- Anastomosis, Roux-en-Y / standards
- Anastomosis, Roux-en-Y / veterinary
- Animals
- Cross-Over Studies
- Evaluation Studies as Topic
- Horses / surgery
- Intestine, Small / diagnostic imaging
- Intestine, Small / surgery
- Surgical Equipment / standards
- Surgical Equipment / veterinary
- Suture Techniques / veterinary
- Ultrasonography
Citations
This article has been cited 1 times.- Lenoir A, Perrin BRM, 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;2021:5545758.
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