Clinical comparison between a continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane with an interrupted Lembert pattern for one-layer jejunojejunostomy in horses.
Authors: Freeman D E, Schaeffer D J
Journal: Equine veterinary journal
Summary
# Editorial Summary Freeman and Schaeffer's retrospective analysis of 32 horses undergoing jejunojejunostomy between 1993–2002 compared clinical outcomes of two surgical techniques: traditional interrupted Lembert pattern versus continuous Lembert pattern reinforced with carboxymethylcellulose and hyaluronate membrane. The researchers examined short- and long-term survival rates, postoperative complications, and colic recurrence using Kaplan-Meier survival analyses, stratifying cases by lesion type (strangulating versus nonstrangulating). Whilst both techniques demonstrated excellent immediate results—with short-term survivals of 92–100% and no cases of postoperative ileus or endotoxaemia—long-term outcomes favoured the continuous wrapped pattern, which showed significantly lower mortality and colic recurrence rates over follow-up periods extending to 9 years, particularly in horses with strangulating small intestinal disease (80% versus 70% survival probability). For practitioners managing postoperative jejunojejunostomy patients, these findings suggest that membrane-reinforced continuous patterns may reduce the risk of late anastomotic complications and recurrent colic, though the superior long-term benefit must be weighed against increased surgical time and cost considerations at the point of intervention.
Read the full abstract on PubMed
Practical Takeaways
- •Consider using continuous Lembert pattern with membrane wrap for jejunojejunostomy in horses with strangulating lesions, as it shows significantly better long-term outcomes and reduced colic recurrence
- •Both surgical techniques perform well acutely, but the membrane-wrapped continuous pattern provides meaningful long-term advantages that could improve client outcomes and survival expectations
- •This is a clinical validation study showing that experimental findings translate to real-world practice—the membrane-wrapped technique warrants consideration in surgical decision-making
Key Findings
- •Continuous Lembert pattern with carboxymethylcellulose-hyaluronate membrane demonstrated superior long-term outcomes with lower colic and mortality rates compared to interrupted Lembert pattern (P<0.05)
- •Long-term survival probability was 80% at 5 years for continuous pattern versus 70% at 9 years for interrupted pattern in strangulating lesions
- •Short-term survival rates were excellent for both techniques: 100% for interrupted pattern with nonstrangulating lesions and 93% for interrupted pattern with strangulating lesions
- •Neither technique resulted in post-operative ileus or endotoxaemia in any of the 32 horses studied