Ex vivo comparison of the biomechanical properties of hand-sewn and stapled jejunoileal anastomoses in horses.
Authors: Bracamonte José L, Anderson Stacy L, Hendrick Steven, Barber Spencer M, Deutscher David, Sumner David
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Hand-sewn versus Stapled Jejunoileal Anastomoses in Horses When horses require small intestinal surgery, surgeons must choose between different techniques for reconnecting bowel segments, each with trade-offs between strength, construction time, and functional outcomes. This ex vivo study compared four jejunoileal anastomotic techniques using harvested bowel segments from 12 horses: single-layer hand-sewn (1HS), double-layer hand-sewn (2HS), stapled side-to-side (SS), and stapled functional end-to-end (FEE), measuring bursting pressure, construction time, and luminal diameter changes. Both hand-sewn techniques demonstrated significantly greater bursting strength than either stapled method, with 1HS and 2HS performing equally well mechanically despite 2HS taking longer to construct; stapled techniques offered speed advantage but failed at substantially lower pressures. Crucially, single-layer hand-sewn anastomosis produced less relative luminal narrowing compared to the adjacent ileal diameter (15.2% versus 28.5%), a finding relevant to post-operative intestinal flow dynamics and potential stricture formation. For equine practitioners, these results suggest that hand-sewn techniques offer biomechanical advantages in strength and luminal preservation, whilst stapled methods may be preferred when surgical time is critical, though the strength differential raises questions about their suitability in compromised patients or when tension on anastomoses is anticipated.
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Practical Takeaways
- •For jejunoileal anastomosis in horses, single-layer hand-sewn technique offers superior strength and less luminal narrowing compared to double-layer, making it the preferred hand-sewn approach
- •Stapled techniques are faster to perform but provide significantly lower bursting strength; hand-sewn methods should be preferred when tissue quality permits
- •Single-layer hand-sewn anastomosis may offer better long-term patency due to reduced luminal diameter reduction relative to native bowel diameter
Key Findings
- •Hand-sewn single-layer (1HS) and double-layer (2HS) jejunoileal anastomoses had significantly higher bursting pressures than stapled techniques (P < 0.001)
- •Single-layer hand-sewn technique resulted in 25.1% luminal diameter reduction compared to 34.8% for double-layer, with significantly less reduction relative to ileal diameter (15.2% vs 28.47%, P = 0.012)
- •Stapled functional end-to-end (FEE) had shortest construction time but failed at significantly lower bursting pressures than hand-sewn techniques
- •Single-layer hand-sewn and double-layer hand-sewn anastomoses were equivalent in bursting strength despite differences in luminal diameter reduction