Differential survival in horses requiring end-to-end jejunojejunal anastomosis compared to those requiring side-to-side jejunocaecal anastomosis.
Authors: Proudman C J, Edwards G B, Barnes J
Journal: Equine veterinary journal
Summary
# Editorial Summary When small intestinal resection becomes necessary during colic surgery, the choice of anastomotic technique significantly influences post-operative outcomes. Proudman and colleagues conducted a prospective observational study of 362 horses undergoing either end-to-end jejunojejunal or side-to-side jejunocaecal anastomosis, tracking mortality and morbidity through post-operative hospitalisation and follow-up telephone questionnaires. Horses requiring side-to-side jejunocaecal anastomosis demonstrated substantially higher mortality rates and greater incidence of post-operative colic recurrence compared to those receiving end-to-end jejunojejunal anastomosis, suggesting that the anatomical location and configuration of the anastomotic site influences long-term viability. Within the jejunocaecal group, no significant difference emerged between hand-sutured and stapled techniques, indicating that method of anastomosis closure was less critical than anatomical placement. These findings have important implications for surgical decision-making: whilst jejunocaecal anastomosis may sometimes be unavoidable depending on resection location and extent, surgeons should understand the prognostic implications and discuss these realistic expectations with owners, whilst feeling confident that their choice between handsewn and mechanical closure methods need not compromise survival outcomes.
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Practical Takeaways
- •Counsel owners that horses requiring jejunocaecal anastomosis have worse long-term survival outcomes than those requiring jejunojejunal anastomosis; discuss realistic prognosis pre-operatively
- •Monitor post-operative jejunocaecal anastomosis cases closely for colic recurrence, which occurs more frequently than after jejunojejunal anastomosis
- •Choose between handsewn and stapled jejunocaecal anastomosis methods based on surgeon preference and experience, as outcomes are equivalent
Key Findings
- •Horses undergoing side-to-side jejunocaecal anastomosis had significantly higher mortality rates than those undergoing end-to-end jejunojejunal anastomosis
- •Post-operative colic incidence was greater in horses with side-to-side jejunocaecal anastomosis compared to end-to-end jejunojejunal anastomosis
- •No significant difference in mortality or morbidity between handsewn and stapled side-to-side jejunocaecal anastomoses (184 vs 178 horses)