Ex Vivo Comparison of a UV-Polymerizable Methacrylate Adhesive versus an Inverting Pattern as the Second Layer of a Two-Layer Hand-Sewn Jejunal Anastomosis in Horses: A Pilot Study.

Augustin Lenoir,Bertrand R M Perrin,Olivier M Lepage,Carlos Alberto Hussni

doi:10.1155/2021/5545758

Abstract

Resection and anastomosis of small intestine during colic can lead to adhesions and recurrent colic. Several methods are available to reduce the rate of adhesions in the postoperative period, such as the use of serosal barriers. Surgical glues form a smooth surface, are fast to apply, and could reduce surgery time when performing anastomosis. A recently developed UV-polymerizable methacrylate adhesive (UV-PMA) is designed to anchor into the biological tissues' top surface offering sealant and a smooth cover over the anastomosis site. This adhesive was used ex vivo on fifteen samples of equine jejunum as the second layer of a two-layer anastomosis (1L-UV-PMA group) and compared to a two-layer anastomosis (simple continuous pattern covered with a Cushing pattern; 2L-CT group), in terms of feasibility, bursting strength pressure (BSP), luminal diameter reduction (LDR), and time of construction. Data were analysed using a paired t-test or a chi2-test (P < 0.05). The results showed no statistical difference in BSP, LDR, or any mode of failure between the two anastomosis types. However, the glue anastomosis formed a tunnel-like anastomosis and shredded under pressure, before apparition of leakage, preventing its usage in clinical cases with this methodology. It was concluded that modification of the technique is warranted before testing in clinical cases. A preprint of a former version of the manuscript is available on researchsquare.com, which was not conducted to print and publication after peer reviewing. Since then, the manuscript has been modified to this current version.

Highlights

Involvement of the small intestine, mainly jejunum, during emergency exploratory laparotomy is reported in about 34% of cases [1]
Clinical signs associated with adhesions are scarce and not specific; they include recurrent colic within 2 months after surgery, and 18–53% of horses require repeated celiotomy
A segment of 1.5 to 2 meters of jejunum was harvested. ree to five centimeters of mesentery were kept on the mesenteric border. e segment was rinsed with tap water to remove any ingesta and stored in a saline (0.9% NaCl (Osalia, 75009, Paris, France)) solution at room temperature throughout the study except during anastomosis and testing procedures. ree samples of 30 to 40 cm were obtained from each harvested segment to perform a two-layer hand-sewn anastomosis (2L-CT group), a one-layer hand-sewn anastomosis sealed with an UV-polymerizable methacrylate adhesive (UV-PMA) layer (1L-UV-PMA group) and a control segment, not subject to anastomosis (Control group)

Summary

Introduction

Involvement of the small intestine, mainly jejunum, during emergency exploratory laparotomy is reported in about 34% of cases [1]. Resection and anastomosis is the method of choice when a segment of devitalized small bowel is found. Several methods of resection and anastomosis of the jejunum have been described, including hand-sewn techniques (one or two layers using Lembert, Cushing, or Gambee patterns, and lately the use of barbed sutures), staples, and biofragmentable anastomosis ring [2,3,4,5,6]. Intra-abdominal adhesions can cause recurrent colic after intestinal surgery in horses [7,8,9,10]. Clinical signs associated with adhesions are scarce and not specific; they include recurrent colic within 2 months after surgery, and 18–53% of horses require repeated celiotomy

Methods

Results

Conclusion