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Closed one-stage functional end-to-end jejunojejunostomy in horses with use of linear stapling equipment
F G Latimer1, J T Blackford, N Valk
1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA.
Objective:
To use gastrointestinal linear stapling instrumentation to perform a closed one-stage functional end-to-end jejunojejunostomy in adult horses as an alternative to a stapled side-to-side jejunojejunostomy.
Study Design:
Clinical outcome, anatomic and histological architecture, and anastomotic dimensions were determined at 2, 4, 8, 16, and 24 weeks postoperatively.
Animals Or Sample Population:
18 adult horses.
Methods:
The anastomosis and peritoneal cavity were inspected for adhesions. The diameter and circumference of the anastomosis and jejunum oral and aboral to the anastomosis were determined from digitized contrast radiographs and linear measurements. Healing of anastomotic sites was evaluated histologically.
Results:
Three horses were euthantized in the immediate postoperative period. In the 15 surviving horses, there were no peritoneal adhesions or distortion of the anastomoses and stomas remodeled in an end-to-end fashion. The mean anastomotic staple line (7.48 cm) and mucosa (6.89 cm) diameters were significantly (P < .05) larger than the mean jejunal diameter oral (6.03 cm) and aboral (6.01 cm) to the anastomosis. The mean anastomotic luminal circumference (13.61 cm) was significantly (P < .01) larger than the mean oral (11.43 cm) and aboral (11.12 cm) jejunal circumference. Histologically, there was adequate mucosal and muscularis mucosae reapposition with a moderate degree of fibrosis and inflammation.
Conclusions:
Closed one-stage functional end-to-end jejunojejunostomy resulted in an acceptable functional anastomosis.
Clinical Relevance:
This technique appears to be an acceptable alternative to linearly stapled, side-to-side jejunojejunostomies performed in horses.