A comparison of the mechanical strength of two stapled anastomosis techniques for equine small intestine.
Authors: Bickers R Jay, Blackford James T, Eiler Hugo, Rohrbach Bart
Journal: Veterinary surgery : VS
Summary
# Editorial Summary When small intestinal rupture occurs intraoperatively or during post-operative recovery, surgeons must decide between functional end-to-end (FEE) and side-to-side (STS) stapled anastomosis techniques, each with theoretical advantages and practical trade-offs. Bickers and colleagues compared these approaches in a randomised block design using seven horses, creating three anastomoses of each type per animal and measuring bursting strength, construction time, and cost at failure. Both techniques proved mechanically equivalent—neither FEE nor STS showed significant differences in bursting pressure or bursting wall tension—though both were substantially weaker than intact jejunal tissue. The FEE technique, however, demonstrated clear practical advantages: it required significantly less operative time and lower material costs whilst preserving physiologic peristalsis direction and minimising tissue manipulation. For practitioners managing emergency small intestinal cases, the FEE method offers a mechanically sound alternative that reduces anaesthetic burden and expense without compromising anastomotic integrity, making it the more clinically pragmatic choice when time and resources matter.
Read the full abstract on PubMed
Practical Takeaways
- •When performing stapled jejunojejunostomy in horses, choose functional end-to-end (FEE) technique over side-to-side (STS) as it offers equivalent mechanical strength with reduced surgical time and cost
- •FEE anastomosis preserves normal intestinal peristalsis direction, which may improve postoperative function and recovery compared to STS
- •Both stapling techniques produce weaker anastomoses than native intestine; monitor for complications and follow appropriate postoperative management protocols
Key Findings
- •No significant difference in bursting strength or bursting wall tension between functional end-to-end (FEE) and side-to-side (STS) stapled anastomosis techniques
- •Control jejunal segments were significantly stronger than both anastomosis types (P ≤ 0.0001)
- •FEE anastomosis was significantly faster to construct and less costly than STS (P ≤ 0.0001)
- •FEE technique maintained physiologic peristalsis direction and required less tissue manipulation