Use of a linear stapling device to construct an inverted, triangulated, end-to-end anastomosis of the equine jejunum.

The research investigates the impact of a new surgical technique, using a stapling device to create an inverted, triangulated, end-to-end anastomosis, on the jejunum of horses. The technique exhibited no immediate postoperative issues but showed significant complications at later stages in most horses, and did not demonstrate an advantage over existing methods.

Methodology and Results

• The investigators used a novel surgical technique to join the jejunum, a part of the small intestine, in four horses. The method known as inverting, triangulated, stapled, end-to-end anastomosis involved using a linear stapling device.
• Initial observations indicated that none of the horses experienced gastrointestinal complications following the procedure.
• However, long-term examinations showed significant narrowing (strictures) and adhesion formations in three of the subjects. These issues were observed 10 days, one month, and two months post-operation.
• The horse examined four months after the procedure demonstrated no adhesions at the anastomosis site and only mild narrowing of the intestinal lumen. This suggests that initial recovery may have been successful, but complications developed later on.

Findings on Histological Examination

• Upon histologic examination, a lack of a normal mucosal lining was noted in some parts of the anastomoses up to two months after surgery. This signals a compromised healing process.
• Although mucosal and serosal continuity were ultimately reestablished, such recovery was not noted in the muscularis, where fibrous tissue instead joined the ends.
• Further, irregularities in the staple line, along with malalignment and loss of staples, were found in the horse examined four months after surgery, indicating less-than-optimal staple performance.

Comparison with Everting Techniques

• The new inverting, triangulated staple technique displayed no clear advantages over existing everting techniques based on previously reported results, making its use questionable.
• The adhesions seen with the inverting technique were so severe it suggests that the adhesions observed with similar everting techniques may not be solely due to the everted nature of the anastomosis. This challenges the prevailing view on the cause of these adhesions.