In vitro evaluation of a closed-bowel technique for one-layer hand-sewn inverting end-to-end jejunojejunosotomy in the horse.
Authors: Gandini Marco
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Jejunal anastomosis remains a critical surgical skill for equine practitioners managing small intestinal disease, yet the ideal balance between surgical efficiency and tissue healing outcomes remains contested. Gandini's cadaveric study compared a novel closed-bowel, single-layer inverting technique (performed with a modified Doyen clamp) against the traditional two-layer approach using jejunal segments from 12 horses, measuring both construction time and anastomotic bursting pressure under controlled laboratory conditions. The single-layer closed technique required significantly less time to complete whilst maintaining luminal narrowing below 30%—comparable to established inverting methods—though two-layer anastomoses demonstrated statistically superior bursting pressures; notably, both techniques exceeded the pressure thresholds reported for alternative jejuojejunal anastomosis methods. For practitioners seeking operational efficiency without apparent compromise to functional integrity, this single-layer approach warrants consideration, though the authors appropriately emphasise that in vivo validation is essential before clinical adoption, as cadaveric tissue behaviour does not fully replicate the inflammatory and healing responses of living intestine.
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Practical Takeaways
- •A faster one-layer anastomosis technique could reduce surgical time in colic cases, potentially improving patient outcomes by decreasing general anaesthesia duration
- •The technique appears mechanically sound in cadaveric testing, but clinical validation is essential before adoption in live cases
- •Consider this as an alternative when surgical time is critical, but current evidence does not yet support routine clinical use
Key Findings
- •One-layer closed-bowel anastomosis was significantly faster to construct than standard two-layer technique
- •Luminal narrowing was <30% in both techniques and comparable to other inverting methods
- •Two-layer technique had significantly higher bursting pressure, but one-layer technique still exceeded pressures reported for other jejunal anastomosis methods
- •One-layer closed technique produced functional characteristics similar to two-layer technique despite reduced construction time