Comparison of two techniques to blind end jejunum and ileum for jejunocaecostomy in horses.
Authors: Chanutin Sierra, Bauck Anje G, Roberts John F, Denagamage Thomas N, Freeman David E
Journal: Equine veterinary journal
Summary
# Jejunocaecostomy blind end closure: comparing Parker-Kerr and oversewn stapled techniques Jejunocaecostomy (JC) is a common surgical bypass for diseased ileum, yet the optimal method for closing the blind ends of the transected bowel has never been directly compared. This study evaluated two approaches—traditional handsewn Parker-Kerr (PK) inversion and an oversewn stapled (OS) technique—in 12 horses undergoing side-to-side anastomosis, examining surgical parameters, postoperative recovery markers, and tissue healing at seven days. Complications arose more frequently with the PK method: two horses developed jejunal blind-end intussusception into the caecum and one required euthanasia for anastomotic impaction, whereas only one OS horse experienced mild colic. The OS technique produced significantly larger blind-end remnants (4.7 cm versus 3.5 cm, p=0.004) but took considerably longer to complete (18.6 versus 11.3 minutes, p=0.002); inflammatory responses differed histologically, with OS closure showing inflammation between staple and suture lines. Postoperatively, both groups displayed similar neutrophil counts and serum amyloid A elevation over time, suggesting comparable systemic responses despite differing technical approaches. Whilst the unexpected intussusceptions with PK closure raise questions about this technique's suitability for this specific anastomotic design, neither method proved overwhelmingly superior in this small cohort—practitioners should weigh operative efficiency against complication risk, recognising that longer-term follow-up and larger patient numbers are needed to inform clinical practice decisively.
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Practical Takeaways
- •Parker-Kerr blind end closure for jejunocaecostomy carries higher complication risk (50% in this study); intussusception of the blind end into the caecum is a serious, unexpected complication with this technique
- •Oversewn stapled technique appears safer with fewer complications despite longer operative time, though both methods are associated with some degree of postoperative inflammation
- •Careful postoperative monitoring for signs of colic and intussusception is critical regardless of technique used, particularly in the immediate postoperative period
Key Findings
- •Parker-Kerr handsewn technique resulted in 3 of 6 horses developing complications (2 jejunal blind end intussusceptions into caecum, 1 anastomotic impaction requiring euthanasia)
- •Oversewn stapled technique had larger jejunal blind ends (4.7 cm vs 3.5 cm, p=0.004) but only 1 of 6 horses developed mild postoperative colic
- •Oversewn stapled closure required significantly longer operative time (18.6 min vs 11.3 min, p=0.002) to complete
- •Both techniques showed similar postoperative inflammatory markers (neutrophil counts and SAA) with peritoneal fluid total protein increasing significantly from surgery to day 7 necropsy in both groups