In vitro comparison of a single-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end jejunoileal anastomosis in normal equine small intestine.
Authors: Lee Wesley L, Epstein Kira L, Sherlock Ceri E, Mueller P O Eric, Eggleston Randall B
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Single-Layer versus Two-Layer Jejunoileal Anastomosis in Horses When faced with irreparable small intestinal damage requiring resection, surgeons must balance construction efficiency against concerns about anastomotic integrity—particularly the risk of dehiscence. This in vitro study examined whether a simplified single-layer (continuous Lembert) closure could match the mechanical strength of the traditional two-layer (simple continuous/Cushing) approach in equine jejunoileal anastomoses. Using harvested intestinal segments from six horses, researchers measured construction time, bursting pressure (an indicator of structural integrity), and relative luminal diameter for both techniques. The single-layer technique proved significantly faster to construct (21 versus 27 minutes) and maintained a larger anastomotic lumen diameter relative to adjacent jejunum (78% versus 69%), yet both approaches withstood equivalent bursting pressures without significant difference from normal jejunal tissue. For equine practitioners, these findings suggest that single-layer jejunoileostomy may offer practical advantages in surgical time and luminal preservation during post-operative healing, though the in vitro nature of this study means clinical validation through caseload analysis would be valuable before wholesale adoption of technique modification.
Read the full abstract on PubMed
Practical Takeaways
- •Single-layer Lembert jejunoileostomy is faster to construct (5-6 minutes shorter) while maintaining equivalent structural integrity to two-layer techniques
- •Single-layer anastomosis preserves greater luminal diameter, potentially reducing stricture risk and improving postoperative intestinal flow
- •In vitro findings support single-layer anastomosis as a time-efficient alternative in equine small intestinal surgery, though clinical outcome validation is needed
Key Findings
- •Single-layer (Lembert) anastomosis completed in 21.0 ± 0.91 minutes versus 26.71 ± 1.16 minutes for two-layer technique (P = 0.005)
- •Single-layer anastomosis maintained larger relative lumen diameter at 77.67 ± 4.46% of jejunal diameter compared to 69.37 ± 2.8% for two-layer (P = 0.035)
- •No significant differences in bursting pressure between single-layer, two-layer, and control jejunal segments (P = 0.155)