Modified stapled jejunocecostomy in horses.

Overview

• This study developed and evaluated a modified stapled jejunocecostomy (MS) surgical technique in healthy horses to improve the procedure’s ease and effectiveness compared to the traditional stapled side-to-side (SS) approach.
• The research compared the MS technique outcomes to historical results from the SS method, focusing on healing, anastomosis time, and postoperative recovery.

Background and Purpose

• Jejunocecostomy (JC) is a surgical procedure to connect the jejunum (part of the small intestine) to the cecum (a pouch connected to the large intestine) in horses, often done to bypass a diseased intestinal segment.
• Traditional stapled side-to-side (SS) techniques can be complex and costly due to multiple applications of the stapler and oversewing of bowel ends to prevent leakage or narrowing.
• This study aimed to develop and assess a modified stapled (MS) JC technique that simplifies the procedure by eliminating oversewn ends and using a single stapler application, potentially reducing surgical time and cost.

Methods

• The study was an in vivo experimental trial involving six healthy adult horses undergoing ventral midline celiotomy (a surgical incision into the abdomen).
• Each horse had a resection of a segment of the jejunum followed by the MS jejunocecostomy.
• Key measurements included:
• Time taken to complete the anastomosis (surgical connection).
• Anastomotic length assessed at necropsy.
• Postoperative monitoring, including physical examinations every 6 hours for the first 5 days, then daily until euthanasia at day 7.
• For comparison, data were taken from a historical control group of seven horses that had undergone the traditional stapled side-to-side (SS) JC and were euthanized 28 days after surgery.

Results

• All six MS horses recovered without major complications, although:
• One horse experienced transient mild colic (abdominal pain).
• Another horse had a brief episode of pyrexia (fever) and diarrhea.
• Postoperative heart rates quickly returned to normal, indicating stable recovery.
• At necropsy (7 days post-surgery), the MS anastomoses showed good gross healing and formed a wide, triangulated stoma (opening), which is beneficial for intestinal flow.
• Statistical comparison showed no significant differences between MS and SS techniques in:
• Time to complete anastomosis (p=0.49).
• Lumen size of the anastomosis at necropsy (p=0.32), suggesting comparable functional opening sizes.

Conclusions and Implications

• The modified stapled (MS) jejunocecostomy was easy to perform and appeared effective in promoting healing and maintaining intestinal flow in healthy horses.
• The triangulated shape of the stoma created by the MS technique may reduce the risk of intestinal impaction by facilitating better flow through the anastomosis.
• Compared with the traditional SS technique, MS offers comparable outcomes while simplifying the procedure by:
• Eliminating the need to oversew the bowel ends after stapling.
• Allowing completion of the anastomosis with a single stapler application.
• Potentially reducing surgical time and material costs.
• Although the sample size in this study was small and involved healthy horses, the promising results support considering the MS technique for clinical use in equine surgery.
• Further studies with larger sample sizes and longer follow-up would be valuable to confirm these findings and evaluate long-term outcomes.