Evaluation of the effect of onlay mesenteric flaps on end-to-end jejunojejunostomy healing in horses.
Authors: Aristizabal Fabio A, Lopes Marco Aurélio, Silva Adriana, Avanza Marcel Ferreira, Nieto Jorge E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Narrowing of the anastomotic site remains a significant concern following jejunal surgery in horses, potentially compromising postoperative function and long-term outcomes. Researchers compared standard end-to-end jejunal anastomosis against the same technique reinforced with two onlay mesenteric flaps in six healthy horses, evaluating stomal diameter, peristomal luminal changes, adhesion formation, and tissue healing at two weeks post-surgery. Whilst the mesenteric flap technique did reduce stomal diameter and create a longer region of reduced jejunal diameter immediately adjacent to the anastomosis (both statistically significant), it offered no protective benefit against adhesion formation and actually increased surgical time and serosal fibrosis—undesirable inflammatory responses that could compromise long-term healing. For equine practitioners managing jejunal colic cases, this finding suggests that reinforcing jejunojejunostomies with onlay mesenteric flaps provides no clinical advantage and may be counterproductive, with the technique potentially creating the very luminal compromise surgeons attempt to prevent, making it unsuitable for routine clinical adoption.
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Practical Takeaways
- •Do not use onlay mesenteric flaps for jejunal anastomosis in horses, as they cause luminal narrowing that could compromise intestinal function and increase colic risk
- •Standard single-layer simple continuous serosubmucosal suture pattern provides adequate healing without the complications of mesenteric flap coverage
- •If considering mesenteric flap techniques for other surgical applications, expect increased operative time and fibrosis formation
Key Findings
- •Onlay mesenteric flaps decreased stomal diameter (P = .05) and increased length of jejunum with reduced stomal diameter (P = .05)
- •Mesenteric flap technique increased surgical time (P = .003) and serosal fibrosis (P = .05)
- •No significant difference in adhesion formation or inflammation degree between flap-covered and standard anastomoses
- •Onlay mesenteric flap technique resulted in problematic luminal reduction and is not recommended for end-to-end jejunojejunostomy