Ex vivo comparison of one-layer versus two-layer closures in end-to-end anastomoses in normal equine descending colon.
Authors: St Blanc Michael P, Mirza Mustajab H, Riggs Laura M, Leise Britta S
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Surgical anastomosis of the equine colon remains a critical challenge, particularly regarding technique selection and functional outcomes post-operatively. This ex vivo study compared one-layer (continuous Lembert) and two-layer (simple continuous oversewn with Cushing pattern) end-to-end anastomotic techniques using eight horses' descending colon segments to evaluate closure time, anastomotic integrity, and luminal preservation. The single-layer technique proved significantly faster to complete (18.6 minutes versus 21.35 minutes), whilst the two-layer approach resulted in substantial luminal diameter reduction (47 mm versus 65 mm), representing approximately 28% narrowing that could compromise faecal transit. Whilst bursting pressures could not be meaningfully compared due to remote failure locations in nearly all specimens, the marked lumenal compromise associated with double-layer closure warrants reconsideration of this approach in clinical practice, as even modest narrowing may predispose to impaction and postoperative complications. For practitioners managing post-operative colic cases or advising on surgical outcomes, these findings suggest single-layer anastomotic technique offers superior functional anatomy without sacrificing structural integrity, potentially reducing morbidity associated with stricture formation and transit dysfunction.
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Practical Takeaways
- •Single-layer end-to-end anastomoses in equine descending colon preserve larger luminal diameter and take less surgical time than two-layer techniques
- •Two-layer closure technique may compromise post-operative intestinal diameter and increase operative time without demonstrated strength advantage in this ex vivo model
- •These findings suggest one-layer Lembert pattern may be preferable for equine colon anastomosis, though clinical validation in vivo is needed
Key Findings
- •One-layer closure was significantly faster (18.6 min) compared to two-layer closure (21.35 min, p=0.003)
- •Two-layer closures significantly reduced luminal diameter (47 mm) versus one-layer closures (65 mm, p<0.0001)
- •Bursting pressure comparison was not determinable as failure occurred remote to anastomosis in all but one segment