Comparison of one-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end anastomosis in equine jejunum.
Authors: Nieto Jorge E, Dechant Julie E, Snyder Jack R
Journal: Veterinary surgery : VS
Summary
# Editorial Summary When surgeons must repair jejunal damage in horses, the choice between single and double-layer anastomosis techniques affects both operative time and long-term outcomes. Nieto and colleagues conducted an in vitro mechanical study using mid-jejunal segments from 12 healthy horses, comparing a one-layer continuous Lembert suture pattern against the traditional two-layer approach (simple continuous with oversewn Cushing pattern). They measured bursting pressure and wall tension under controlled fluid distension, alongside construction time and the degree of luminal narrowing at the anastomotic site. The single-layer Lembert technique proved substantially faster to perform whilst achieving identical bursting pressures and wall tension to the two-layer method—both patterns withstood equivalent mechanical stress at failure. Critically, the one-layer approach produced significantly less luminal reduction compared with control tissue, meaning a larger functional stoma remained patent post-operatively. For field practitioners managing jejunal ruptures or segmental resections, these findings suggest the continuous Lembert pattern warrants consideration as a viable alternative to double-layer techniques, offering practical advantages in reduced operative time without compromising anastomotic strength, and potentially lowering the risk of stenosis through preservation of luminal diameter.
Read the full abstract on PubMed
Practical Takeaways
- •Single-layer Lembert anastomosis offers equivalent strength to two-layer techniques while reducing surgical time—a practical advantage in colic surgery where speed matters
- •The larger stoma created by single-layer anastomosis may reduce postoperative stricture risk, though clinical outcomes need confirmation
- •Consider single-layer Lembert technique for routine jejunojejunostomy to improve surgical efficiency without compromising anastomotic integrity
Key Findings
- •Single-layer continuous Lembert anastomosis was constructed in significantly less time than two-layer anastomosis
- •One-layer Lembert anastomosis resulted in less luminal reduction compared to two-layer technique
- •No significant differences in bursting pressure or bursting wall tension between single and two-layer anastomotic patterns
- •Single-layer Lembert anastomosis produced a larger stoma while maintaining equivalent structural strength