Biomechanical comparison of four technique for pelvic flexure enterotomy closure in horses.
Authors: Gandini Marco, Iotti Bryan N, Giusto Gessica
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Pelvic Flexure Enterotomy Closure Techniques in Horses Surgical closure of pelvic flexure enterotomies represents a critical decision point in colic management, yet limited biomechanical evidence has guided technique selection in equine practice. Gandini and colleagues conducted an ex-vivo study on 48 cadaveric ascending colon specimens, creating enterotomies of 5 cm and 10 cm length and comparing closure strength, efficiency, and cost across four techniques: two-layer handsewn (HS2), single-layer handsewn (HS1), skin staples (SKS), and a TA90 automated stapling device. Two-layer handsewn closure demonstrated significantly superior bursting pressure in both groups—a critical finding given that inadequate closure strength directly correlates with postoperative dehiscence risk—whilst the TA90 device performed poorest biomechanically despite highest material costs. Whilst single-layer handsewn and skin staple techniques closed 5 cm enterotomies faster than two-layer closure, time savings were marginal in larger 10 cm incisions and should not outweigh the biomechanical advantage of two-layer closure in routine colic surgery. These findings support continued use of two-layer handsewn enterotomy closure as the gold standard for pelvic flexure procedures, particularly where incisions exceed 5 cm or when tissue quality is compromised.
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Practical Takeaways
- •Two-layer hand-sewn closure provides the strongest closure and should be considered the gold standard for pelvic flexure enterotomy, despite longer operative time
- •For routine cases where speed matters, single-layer hand-sewn or skin staple techniques are faster alternatives for 10 cm incisions without compromising lumen patency
- •Avoid TA90 automated stapling device for pelvic flexure work due to inferior biomechanical strength and high cost
Key Findings
- •Two-layer hand-sewn (HS2) technique produced significantly higher bursting pressure than skin staples and TA90 stapling device in 5 cm enterotomies, and higher than all other techniques in 10 cm enterotomies
- •HS2 was most time-consuming for 5 cm enterotomies; HS1 and skin staples were faster for 10 cm enterotomies
- •Luminal reduction did not differ significantly between any of the four closure techniques
- •TA90 stapling device had the lowest bursting pressure and highest cost