Comparison of one-layer Utrecht pattern with two-layer (simple continuous/Cushing) pattern for jejunojejunostomy in healthy horses in vivo.
Authors: Roessner Holly A, Hurcombe Samuel D, Klein Chelsea E, Hopster Klaus, Engiles Julie B
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Jejunal Anastomosis Techniques in Horses When surgeons repair sections of small intestine in horses, the choice between single-layer and double-layer closure patterns has long centred on balancing speed against durability. Roessner and colleagues conducted a crossover study in eight healthy horses, randomly assigning jejunal end-to-end anastomoses to either a one-layer Utrecht technique or a conventional two-layer (simple continuous/Cushing) approach, then repeating the opposite pattern 14 days later to allow direct comparison within individual animals. The one-layer method proved substantially faster at 12 minutes compared to nearly 19 minutes for two-layer closure, whilst achieving equivalent outcomes: luminal diameter reduction was minimal and comparable between techniques (18% versus 15% respectively), and histological assessment of inflammation, infection and tissue healing showed no significant differences. Two horses receiving two-layer closures developed serosal adhesions to the mesentery, though without clinical obstruction, suggesting a potential disadvantage of the more invasive technique. For practitioners managing colic cases, these findings suggest the Utrecht pattern warrants serious consideration as a viable clinical alternative. Reducing operative time by approximately seven minutes—meaningful when dealing with post-operative shock and metabolic compromise—without compromising anastomotic integrity or healing represents genuine practical benefit. Whilst this remains a small study in healthy horses, the lack of complications and equivalent tissue responses provide sufficient justification to evaluate this technique prospectively in clinical populations, particularly given that faster procedures may reduce anaesthetic risks and improve survival outcomes in genuinely compromised animals.
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Practical Takeaways
- •The faster one-layer Utrecht technique can be adopted for jejunal end-to-end anastomosis in clinical cases, saving approximately 7 minutes of surgical time without compromising healing outcomes
- •Both closure techniques produce comparable luminal patency and histological healing, so choice may be based on surgeon preference and experience
- •Two-layer closures may carry increased risk of serosal adhesions; monitor post-operative colic cases closely regardless of technique used
Key Findings
- •One-layer Utrecht closure was approximately 7 minutes faster (716±86s) compared to two-layer simple continuous/Cushing closure (1136±111s)
- •Both techniques resulted in similar luminal reduction (18% one-layer vs 15% two-layer, p=0.34) with no clinically significant difference
- •Histopathological scores for inflammation, infection, and healing showed no significant differences between one-layer and two-layer techniques
- •Serosal adhesions to mesentery were observed in 2 horses with two-layer closure but caused no clinical obstruction