In vitro description of a new technique for stapled side-to-side jejunocecal anastomosis in horses and CT scan anatomical comparison with other techniques.
Abstract: Stapled jejunocecal anastomoses are commonly performed in equine abdominal surgery. They carry higher complication rates compared to handsewn techniques. In human surgery various causes likely to lead to failure of stapled techniques have been evaluated, including staple line failure. Recently Freeman proposed a technique to perform a stapled jejunocecal anastomosis in horses while avoiding blind pouch formation. The aim of this study is to describe a method for stapled side-to-side jejunocecal anastomosis in horses and to compare it with other techniques with computed tomography to assess stomal area, shape and blind pouch size. Methods: Intestinal specimens comprising the cecum, ileum and jejunum from 18 horses were collected and were divided into three groups. In Group S a standard stapled side-to-side jejunocecal anastomosis was performed. In Group F the anastomosis was performed using a modified technique proposed by Freeman. In Group G the anastomosis was performed with a modified technique proposed by the authors. Inflated bowel segments were CT scanned to obtain a MultiPlanar Reconstruction of the stoma and afferent small intestine before calculating the cross-sectional area of each of these regions. The ratio of the measured areas was compared between the three techniques. The volume of the blind-end pouch was measured and its ratio with the intestinal area compared between techniques. The cecum was opened and the length of the stoma measured with a caliper and compared to the intended initial length. Results: The stomal/intestinal area ratio was not significantly different between techniques. Conclusions: Both the Freeman and the new (G) technique were comparable to the standard technique in terms of stomal area, stomal shape and difference in stomal elongation. They consistently produced a smaller blind pouch and allowed easier placement of the staplers.
Publication Date: 2014-07-07 PubMed ID: 25238113PubMed Central: PMC4122904DOI: 10.1186/1746-6148-10-S1-S9Google Scholar: Lookup
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Summary
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This research article details the development of a new method for stapled side-to-side jejunocecal anastomosis in horses and compares it with pre-existing techniques. Its focus is on minimizing the rate of complications and maximizing the efficacy of these surgical procedures by evaluating the anastomosis construction using computed tomography.
Understanding Stapled Jejunocecal Anastomosis
- The research is centered on the surgical procedure known as ‘stapled jejunocecal anastomosis’ in horses, which is a common procedure in equine abdominal surgery.
- Traditionally, this technique has had a higher complication rate compared to manual or ‘handsewn’ techniques.
- The aim of the study is to detail a different approach for stapled side-to-side jejunocecal anastomosis that reduces the likelihood of complications such as blind pouch formation—a frequent concern with conventional procedures.
The Methodology of the Study
- The research was conducted with intestinal specimens collected from 18 horses, which were divided into three groups.
- Each group employed a different technique: a standard stapled method (Group S), Freeman’s modified method (Group F), and a newly proposed method by the authors (Group G).
- After the surgical procedure, the inflated bowel segments underwent a CT scan. The scan produced a MultiPlanar Reconstruction that would allow for the detailed study of stomal and small intestinal regions.
- An assessment was made comparing the cross-sectional areas between the standard, Freeman’s, and the new technique. The volume of the blind-end pouch was also compared in reference to the intestinal area probed.
- The final measurement took account of the length of the stoma, cross-checking it against the intended initial length.
Result and Implication of the Research
- The comparison of the techniques showed that the stomal/intestinal area ratio was not significantly different among the three methods.
- Both Freeman’s method and the new technique proposed by the authors were comparable to the standard method in terms of stomal area, shape, and difference in stomal elongation.
- However, the critical advantage of the modified methods by Freeman and the authors was their consistent ability to create a smaller blind pouch. Additionally, they facilitated easier placement of the staplers during the surgery.
Cite This Article
APA
Gandini M, Giusto G, Iotti B, Valazza A, Sammartano F.
(2014).
In vitro description of a new technique for stapled side-to-side jejunocecal anastomosis in horses and CT scan anatomical comparison with other techniques.
BMC Vet Res, 10 Suppl 1(Suppl 1), S9.
https://doi.org/10.1186/1746-6148-10-S1-S9 Publication
Researcher Affiliations
MeSH Terms
- Anastomosis, Surgical / methods
- Anastomosis, Surgical / veterinary
- Animals
- Cecum / surgery
- Horses / surgery
- Jejunum / surgery
- Surgical Stapling / veterinary
References
This article includes 21 references
- Freeman DE. In: The Equine Acute Abdomen. White NA, Mair TS, Moore JN, editor. Teton Newmedia, Jackson WY; 2009. Surgical techniques; pp. 497–537.
- 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 Nov 1;237(9):1060-7.
- Proudman CJ, Edwards GB, Barnes J. Differential survival in horses requiring end-to-end jejunojejunal anastomosis compared to those requiring side-to-side jejunocaecal anastomosis.. Equine Vet J 2007 Mar;39(2):181-5.
- Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D. Stapled versus handsewn methods for colorectal anastomosis surgery.. Cochrane Database Syst Rev 2012 Feb 15;(2):CD003144.
- Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses.. Cochrane Database Syst Rev 2011 Sep 7;(9):CD004320.
- Davis B, Rivadeneira DE. Complications of colorectal anastomoses: leaks, strictures, and bleeding.. Surg Clin North Am 2013 Feb;93(1):61-87.
- Gandini M, Giusto G, Iotti B. Ex-vivo computed tomography scan and anatomical characterization of jejuno(ileo)cecal anastomoses in horses. Proceedings of the 11th International Equine Colic Research Symposium, Dublin 2014.
- Chen KC, Seife B, Grishman E, Rao MV. Blind pouch syndrome: a case report.. Am J Gastroenterol 1985 Nov;80(11):882-6.
- Klingler PJ, Seelig MH, Floch NR, Branton SA, Metzger PP. Small-intestinal enteroliths--unusual cause of small-intestinal obstruction: report of three cases.. Dis Colon Rectum 1999 May;42(5):676-9.
- Magell J. Ileocolic blind loops following side-to-side anastomosis.. J R Soc Med 1981 Mar;74(3):227.
- Botsford TW, Gazzaniga AB. Blind pouch syndrome. A complication of side to side intestinal anastomosis.. Am J Surg 1967 Apr;113(4):486-90.
- Schlegel DM, Maglinte DD. The blind pouch syndrome.. Surg Gynecol Obstet 1982 Oct;155(4):541-4.
- Gin FM, Maglinte DD, Chua GT. General case of the day. Enterolith in a blind pouch (blind pouch syndrome secondary to side-to-side enteroanastomosis).. Radiographics 1993 Jul;13(4):965-7.
- LEVINE M, KATZ I, LAMPROS PJ. Blind pouch formation secondary to side-to-side intestinal anastomosis.. Am J Roentgenol Radium Ther Nucl Med 1963 Apr;89:706-19.
- Maglinte DD. "Blind pouch" syndrome: a cause of gastrointestinal bleeding.. Radiology 1979 Aug;132(2):314.
- Adachi Y, Matsushima T, Mori M, Sugimachi K, Oiwa T. Blind loop syndrome: multiple ileal ulcers following side-to-side anastomosis.. Pathology 1993 Oct;25(4):402-4.
- Sandrasegaran K, Maglinte DD, Rajesh A, Tann M, Kopecky KK. CT findings for postsurgical blind pouch of small bowel.. AJR Am J Roentgenol 2006 Jan;186(1):110-3.
- Senati E, Di Simone A, Stipa F, Egidi A, Ojetti S. [Blind pouch syndrome: a delayed complication of side-to-side anastomosis].. Ann Ital Chir 1980;52(4):391-7.
- Gandini M. Handsewn semiclosed single-layer jejunocecal side-to-side anastomosis in the horse.. Vet Surg 2010 Aug;39(6):771-5.
- 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 Jul;75(7):680-4.
- Freeman DE. Surgery of the small intestine.. Vet Clin North Am Equine Pract 1997 Aug;13(2):261-301.
Citations
This article has been cited 1 times.- Giusto G, Iotti B, Sammartano F, Valazza A, Gandini M. Ex Vivo Anatomical Characterization of Handsewn or Stapled Jejunocecal Anastomosis in Horses by Computed Tomography Scan.. J Vet Med 2014;2014:234738.
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