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Veterinary surgery : VS2022; 52(3); 407-415; doi: 10.1111/vsu.13881

Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses.

Abstract: To compare single-layer anastomoses (modified continuous Lembert [mod-CL] and modified-interrupted Lembert [mod-IL]) and a 2-layer simple continuous anastomosis (2 L; seromuscular and mucosal) for jejunojejunal anastomoses in equine cadavers and to compare ex vivo to in vivo time to complete the anastomosis and stoma size with a mod-IL pattern. Methods: Measurements in jejunum from cadaver and anesthetized horses. Methods: Ten live horses and 18 equine cadavers. Methods: Time to complete anastomosis, bursting pressures (BP), leakage sites, and anastomotic index (size ratio of anastomotic lumen to control lumen) were recorded. Time to completion and lumen size were compared between in vivo and ex vivo mod-IL patterns. Results: The mod-CL pattern was fastest (8.44 ± 1.30 min, p < .05), and the 2 L pattern was slower (17.07 ± 2.0 min) than the mod-CL and mod-IL (p < .05). The anastomotic index exceeded 100 and did not differ between patterns. Segments reached higher bursting pressures when anastomosed with mod-IL (145.94 ± 24.18 mm Hg) than mod-CL (p < .05). In vivo closure was approximately 8 minutes slower than ex vivo, and with a smaller anastomotic index. Conclusions: All anastomoses increased lumen size over control segments ex vivo. Lumen size after placement of a mod-IL was greater ex vivo than in vivo, and completion was slower in vivo than ex vivo. [Corrections added on 26 Dec 2022, after online publication: added "ex vivo" to the first line of Conclusions in the Abstract.] CLINICAL SIGNIFICANCE: Slower and smaller anastomoses should be anticipated in vivo compared to ex vivo results. Anastomoses with a mod-IL pattern appear clinically advantageous, producing a comparable lumen size in less time than 2 L.
© 2022 American College of Veterinary Surgeons.
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Publication Date: 2022-09-09 PubMed ID: 36084150DOI: 10.1111/vsu.13881Google Scholar: Lookup
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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 research investigates the effectiveness of various intestinal surgical procedures in horses, specifically looking at two variations of Lembert suturing patterns against a two-layer simple technique. By comparing the processes performed in both horse cadavers and live horses, the study assesses factors such as completion time, bursting pressure, and size of the surgically created connections.

Methods of the Study

  • The research compared single-layer anastomoses (modified continuous Lembert [mod-CL] and modified-interrupted Lembert [mod-IL]) and a 2-layer simple continuous anastomosis (2 L; seromuscular and mucosal) for jejunojejunal anastomoses in equine cadavers.
  • The tests involved ten live horses as well as 18 equine cadavers, providing a mix of in vivo (living) and ex vivo (postmortem) specimens.
  • The study recorded data relating to time taken to complete the anastomosis (surgical connection), the bursting pressures (BP), leakage sites, and the anastomotic index (a ratio determining the size of the anastomotic lumen relative to a control lumen).

Results of the Study

  • The results showed that the mod-CL pattern was the fastest to complete, followed by the mod-IL, and finally the two-layer pattern, which was the slowest.
  • The anastomotic index was found to exceed 100 for all procedures, indicating a larger lumen size compared to the control lumen, and did not significantly vary between the different suturing patterns.
  • Segments that underwent the mod-IL procedure reached higher bursting pressures than segments with the mod-CL procedure.
  • The study showed that in vivo closure was slower and had a smaller anastomotic index compared to ex vivo procedures.

Conclusions of the Study

  • All anastomoses or surgical connections increased the lumen size when performed ex vivo.
  • Lumen size after the application of a mod-IL was greater ex vivo than in vivo, with completion also being slower in vivo than ex vivo. This suggests that results seen in a controlled, postmortem setting may not directly translate to a live, clinical scenario.
  • The study cautions that slower and smaller anastomoses should be anticipated in real-world, in vivo scenarios compared to laboratory, ex vivo results.
  • However, the mod-IL pattern appears to provide clinical benefits, resulting in a comparable lumen size in less time when compared to the two-layer technique.

Cite This Article

APA
Seitz-Cherner E, Bauck AG, Denagamage T, Freeman DE. (2022). Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses. Vet Surg, 52(3), 407-415. https://doi.org/10.1111/vsu.13881

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English
Volume: 52
Issue: 3
Pages: 407-415

Researcher Affiliations

Seitz-Cherner, Emma
  • Rood and Riddle Equine Hospital, Wellington, Florida, USA.
Bauck, Anje G
  • Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Denagamage, Thomas
  • Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Freeman, David E
  • Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.

MeSH Terms

  • Horses / surgery
  • Animals
  • Suture Techniques / veterinary
  • Intestine, Small / surgery
  • Jejunum / surgery
  • Anastomosis, Surgical / veterinary
  • Anastomosis, Surgical / methods
  • Cadaver
  • Horse Diseases / surgery

Grant Funding

  • Island Whirl Equine Colic Research Laboratory
  • College of Veterinary Medicine
  • University of Florida

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Citations

This article has been cited 2 times.
  1. Baldwin CM, Gillen A. An ex vivo comparison of jejunal transection angles and the effect on lumen diameter following end-to-end jejunojejunal anastomoses. Vet Surg 2026 Feb;55(2):484-490.
    doi: 10.1111/vsu.14294pubmed: 40525474google scholar: lookup
  2. Verhaar N, Hammer E, Reineking W, Hewicker-Trautwein M, Geburek F. Ex vivo comparison of full-thickness biopsy techniques in the equine small intestine. Vet Surg 2025 Jan;54(1):208-218.
    doi: 10.1111/vsu.14178pubmed: 39404177google scholar: lookup
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