Pelvic Flexure Enterotomy in Horses: Scoping Review and Synthesis of the Literature (1996-2026).

Overview

• This research article reviews existing studies on surgical techniques for suturing pelvic flexure enterotomies in horses to determine the most effective method.
• The review evaluates different suturing methods based on mechanical strength, time efficiency, and cost, ultimately suggesting an approach based on current evidence.

Background and Purpose

• The pelvic flexure is a common site for intestinal surgery in horses, specifically for enterotomies (surgical incisions into the intestine).
• Choosing the best suturing technique is critical for optimal healing, minimizing complications like leakage, and restoring intestinal integrity.
• The purpose of this scoping review is to map the available literature and synthesize evidence on the most appropriate suturing techniques for pelvic flexure enterotomies.

Methodology

• A comprehensive literature search was conducted using three major databases:
• Web of Science
• Google Scholar
• National Center for Biotechnology Information (NCBI)
• The search covered publications between January 1996 and February 2026.
• Search terms related to pelvic flexure enterotomy and equine patients ensured relevance to the field.
• A total of 22,146 records were initially identified.
• After screening, only five ex vivo studies met the inclusion criteria—meaning they were performed on horse colon tissue outside the living body to test suturing techniques.

Key Variables Analyzed

• The five studies compared suturing methods based on several important variables:
• Suturing time: How long each suturing technique took to perform.
• Suture pattern: The configuration of stitches, e.g., simple continuous, double-layer closure.
• Suture material: Type of thread used for stitching.
• Bursting pressure: The pressure at which the sutured intestinal wall fails or leaks, indicating mechanical strength.
• Luminal diameter reduction: How much the intestinal opening was narrowed after stitching, which can affect function.
• Cost: Economic considerations such as expensive stapling devices.

Findings

• Mechanical strength: Double-layer hand-sewn closures generally provided the highest bursting pressures, which means better resistance to leakage or rupture under pressure.
• Operative time: Double-layer closures took more time to complete compared to other techniques.
• Cost consideration: Stapling with devices such as the TA90 was the most expensive option.
• Effect on lumen size: Not explicitly described in detail, but techniques were considered with respect to minimizing reduction in intestinal lumen size to maintain function.

Limitations of Current Evidence

• All included studies were ex vivo, meaning they used healthy colon specimens outside of a living horse.
• Ex vivo models cannot replicate biological factors such as:
• Tissue healing responses
• The interaction between sutures and living tissue over time
• Inflammatory or immune responses
• Therefore, the clinical applicability and long-term outcomes of these findings remain uncertain until in vivo studies are conducted.

Conclusions and Recommendations

• Currently, a two-layer technique with a full-thickness simple continuous suture pattern oversewn by a continuous Cushing pattern appears to provide the most reliable mechanical security based on available evidence.
• This technique balances mechanical strength and practicality, making it preferable until stronger clinical (in vivo) data become available.
• Stapling devices, while costly, may have other benefits not fully assessed in these studies.
• Further research, especially in vivo studies evaluating healing, complications, and clinical outcomes, is necessary to optimize surgical protocols for equine pelvic flexure enterotomies.