In vitro comparison of three suture techniques for anastomosis of the equine small intestine

The equine small intestine can be affected by a variety of disorders that may require some form of bypass or anastomosis. Many suture patterns have been used in equine anastomoses to minimise post operative complications, which include leakage from the anastomosis site, stenosis and adhesions. Because of the critical condition of horses undergoing colic surgery, it is imperative this is performed as quickly as possible.

To evaluate, in vitro, differences in the time of execution and leakage pressure between the Lembert single layer, Gambee and Lembert double layer suture patterns for intestinal anastomosis in the horse and correlate the time taken to complete the anastomosis and hemicircumference of the anastomotic site.

Small intestinal loops were anastomosed with one of the 3 suture patterns. The intestines, immersed in polyionic solution, were insufflated via a flexible rubber hose, connected to a sphygmomanometer bulb, inserted into the lumen at one end and fixed at 25 cm from the anastomosis site with a locking clip. A tube fixed in the same manner at the other end, connected to a pressure gauge, was used to evaluate the pressure at which leakage from the anastomosis site, revealed by the presence of bubbles, was present.

The time spent in the execution of the Lembert single layer was significantly less than that for both Gambee and Lembert double layer. The leakage pressure of Lembert single layer was significantly higher than that recorded for both Gambee and Lembert double layer.

This study shows that the continuous Lembert single layer pattern takes less time to execute and fails at higher pressures than the Lembert double layer or Gambee patterns.