Ex vivo comparison of the biomechanical properties of hand-sewn and stapled jejunoileal anastomoses in horses.

This research compares the effectiveness and biomechanical properties of hand-sewn and stapled techniques in jejunoileal anastomoses (surgical connections between two parts of the intestine) in horses. The study reveals that while both techniques are of comparable strength, hand-sewn methods result in less reduction of the intestinal lumen’s diameter.

Research Methodology

• The study involved ex vivo experimentation on adult horses. The jejunoileal anastomoses were created using harvested segments of the ileum (the final section of small intestine) and distal jejunum (middle section of small intestine).
• Different anastomotic methods were used, including a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique (SS), and stapled functional end-to-end technique (FEE).
• The construction time for each anastomosis was recorded. Metrics such as bursting pressures (BP), bursting wall tension (BWT), percentage of anastomotic luminal diameter reduction, and stomal (opening) length were calculated.

Findings

• FEE was found to have the shortest construction time.
• The bursting strength (BP) of both the hand-sewn techniques (1HS and 2HS) was significantly higher than the stapled techniques (FEE and SS) which had similar strength.
• The reductions in the luminal diameter, both mean and relative to adjacent ileal and jejunal diameters, were less for the single-layer hand-sewn technique (1HS) than for double-layer hand-sewn technique (2HS), but these differences were not statistically significant.
• However, notably, luminal diameter reduction relative to ileal diameter was statistically significantly less with 1HS technique compared to 2HS.
• Stomal length was considerably larger for SS than FEE.

Conclusions

• The study concludes that in terms of strength, hand-sewn jejunoileal anastomoses (1HS and 2HS techniques) are similar but they prove to be stronger than both the stapled methods (SS and FEE).
• However, the 1HS technique results in less diameter reduction of the luminal, which could potentially impact post-operative recovery and function.
• When comparing stapled methods, the SS method offers a larger stomal length than FEE, potentially impacting functionality and healing ability.

The findings of this research could be crucial for veterinary surgery decisions, particularly when dealing with gastrointestinal surgeries involving the jejunoileal segment in horses.