Small Intestinal Anastomosis Research Articles

Pathological Findings in the Carcass of a Dog following Ovariohysterectomy, and Intestinal Resection and Anastomosis

This report presented the gross and histopathological findings in the carcass of a Nigerian Indigenous Dog (NID) following ovariohysterectomy, intestinal resection and anastomosis. The carcass of a 9-month-old NID was presented to the Necropsy Unit of the Veterinary Teaching Hospital, Ahmadu Bello University Zaria, Nigeria. History was obtained, general examination of the carcass and necropsy were conducted. History revealed sudden death 2 days post-abdominal surgical procedures (ovariohysterectomy, and small intestinal resection and anastomosis). The clinical signs observed before death were weakness and dyspnea, while mild tick infestations and bilateral congested ocular mucus membranes were on general examination of the carcass. The gross pathological findings were hemorrhagic trachea, congested and hemorrhagic lungs, enlarged heart with epicardial and endocardial hemorrhages, enlarged and congested liver, enlarged spleen, hemorrhage in the gastric mucosa, intestinal hemorrhages, and an area of hemorrhagic infarct at the intestinal anastomosed site. On histopathological examination, there was slightly thickened interalveolar walls with inflammatory cellular infiltrations, cardiac hemorrhage, and hepatic congestion. These gross and histopathological findings suggest possible systemic complications, thus, emphasizing the importance of comprehensive pre-operative assessment, and post-operative care and monitoring in veterinary surgeries.

Short cycles of remote ischemic preconditioning had no effect on tensile strength in small intestinal anastomoses: an experimental animal study

PurposeThis study aimed to investigate the effect of remote ischemic preconditioning (RIPC) on the healing of small intestinal anastomoses, evaluated by tensile strength and histologic wound healing on postoperative day 5. MethodsA total of 22 female pigs were randomized 1:1 into either an intervention or control group. The intervention group received 5 cycles of 3-minute ischemia followed by 3-minute reperfusion on the right forelimb. Two end-to-end anastomoses, a distal and a proximal, were created in the small intestine 30 and 60 min after RIPC, respectively. On postoperative day 5, the anastomoses were harvested and underwent a maximal anastomotic tensile strength (MATS) test (MATS 1–3) followed by histologic analyses. ResultsMATS 1, when a tear became visible in the serosa, was significantly increased in the proximal anastomoses of the RIPC group compared with the control group (4.91 N vs 3.83 N; P = .005). No other significant differences were found when comparing these 2 groups. ConclusionOur study showed no convincing results of RIPC on intestinal anastomotic healing to recommend its use in a general clinical setting. Further animal studies on RIPC’s effect after relative or absolute intestinal ischemia may be recommended.

Use of the Staple Line Reinforcement Tool to Reduce the Rate and Completely Avoid Anastomotic Leakage in Functional End-to-End Anastomosis.

Background In our hospital, anastomotic leakage (AL) is observed in approximately 2% of functional end-to-end anastomosis (FEEA) cases annually. It is also usually observed at the staple line of the entry hole closure in several reoperation cases. This study aimed to investigate whether AL would occur in FEEA using a new staple line reinforcement tool, ECHELON ENDOPATH® Staple Line Reinforcement (SLR) (Ethicon, Raritan, NJ, USA). Methods A total of 380 patients (400 anastomoses performed from September 2021, when SLR use began, to the end of February 2024) were compared retrospectively, with a total of 459 patients (469 anastomoses performed from April 2019 to August 2021), the same period before SLR was initiated. In the SLR group, ECHELON FLEX® (Ethicon) 60 mm and GST® system (Ethicon) cartridges were used as stapling devices. A p-value of <0.05 was considered statistically significant. Results No AL was observed in the SLR group, with a significant difference between the SLR and non-SLR groups (p=0.0021). By anastomotic organ, the AL rate significantly decreased for small intestine-colon anastomosis (p=0.023), but there was no significant difference in small intestine-small intestine anastomosis (p=0.061) or colon-colon anastomosis (p=0.35) between groups. Conclusion Reinforcing the staple line using SLR in FEEA may reduce the AL rate. Although AL has not been observed, we will continue to investigate its causes should it occur in the future.

Identification of risk factors for the development of complications and the outcome of horses undergoing small intestinal resection and anastomosis

Identification of risk factors for the development of complications and the outcome of horses undergoing small intestinal resection and anastomosis

Congenital mesenteric cysts: rare but important entities in abdominal surgery

Mesenteric cysts are rare, benign, intra-abdominal tumors with an incidence of 1 case per 2,50,000 hospital admission. They present with non-specific clinical symptoms and signs which mostly lead to misdiagnosis. In many conditions mesenteric cysts are discovered either accidentally during radiological examination or during laparotomy for management of complications. Mesenteric cysts are usually non-cancerous and can be lined by different kinds of tissues. The exact cause of mesenteric cysts is not known, but there are various theories regarding it. In children they are considered as congenital i.e., due to abnormalities in development of embryonic mesentery and in adults it might be due to lymphatic malformation, occult trauma or infection. Treatment of mesenteric cyst includes enucleation or surgical excision depending on type of cyst. Since the case is very rare, pre-operative diagnosis and treatment is a challenge. We report a case of five-year-old female child with enterogenous mesenteric cyst in the small intestine. The differentials of ultrasound showed para ovarian cyst or mesenteric cyst. Abdominal computed tomography (CT) revealed an attached cystic mass at mesentery measuring 96×28×17 mm (CC×AP×AR). The child underwent exploratory laparotomy with cyst excision and intestinal resection with end-to-end anastomosis of small intestine. The knowledge about these cysts is important because many times they go undiagnosed and cause serious complications like rupture, torsion or intestinal obstruction.

Intestinal anastomoses in children: Experience of pediatric surgeons in the Russian Federation

BACKGROUND: In pediatric surgery, intestinal anastomosis is a standard and responsible operative method used for all age groups. Although advancements in medical technology have significantly changed and expanded the range of surgical interventions, many questions remain, including the safety of intestinal anastomosis in newborns with significant segment discordance, the use of laparoscopic intestinal sutures, the use of mechanical stitching devices, and intestinal anastomosis in peritonitis.&#x0D; AIM: To determine current problems and future directions in the field of intestinal anastomosis in children in the Russian Federation.&#x0D; MATERIALS AND METHODS: The study is based on data from 4,558 intestinal anastomosis operations, including 1,735 in newborns, provided by the chief pediatric surgeons of 75 constituent entities of the Russian Federation during 20212022, including the Donetsk and Lugansk Peoples Republics. Based on a questionnaire, the data were summarized and statistically processed.&#x0D; RESULTS: The study reports on the results of intestinal anastomosis in children in the Russian Federation across various segments of the intestine and age groups. The risks of failure and re-reconstruction significantly increased when duodenal anastomosis was performed laparoscopically and in settings of peritonitis or a compromised intestinal wall (p 0.05). Conversely, the use of laparoscopy and suturing devices in older children for small intestine anastomosis was carried out practically without complications. However, it was performed twice as often in emergencies and against the background of combined problems. In general, the results of small bowel anastomosis under poor conditions were statistically insignificant from intestinal anastomosis with stoma closure (p 0.05). The data revealed that colon surgery, repeated reconstructions, duodenal anastomoses, and small intestine anastomoses in newborns with poor blood flow to the intestinal wall posed the highest risks of anastomotic failure. Small and large intestine surgery in newborns has the highest mortality rate, particularly with peritonitis and circulatory disorders.&#x0D; CONCLUSIONS: Thus at the current stage of development, intestinal anastomosis in the Russian Federation is characterized by good results, the expansion of indications for anastomosis in conditions of compromised intestine or peritonitis, and the use of laparoscopic techniques and mechanical staplers.

Morphological features of bordering zones with anastomosis during surgical correction of congenital intestinal obstruction

Introduction. Despite the numerous studies carried out to improve the technique for abdominal operations using new suture materials, stitching technologies and various types of intestinal sutures, the failure of intestinal anastomoses sutures remains a serious surgical problem in both adult and pediatric practice. The purpose of our study is a comparative analysis of the healing of the interintestinal fistula using various types of sutures in an experiment on animals (newborn rabbits). Materials and methods. The experiment was performed on 15 newborn rabbits with reproduction of a model of intestinal obstruction at the level of the ileum and the imposition of end-to-end small-intestinal anastomoses and de Lorimier-Harrison plication with interrupted and continuous sutures. 3 groups were formed: the imposition of a plication anastomosis using a single-row continuous suture (group I (n = 5)), an end-to-end anastomosis using a single-row continuous suture (group II (n = 5)), group III (n = 5) - end-to-end anastomosis with a single-row interrupted suture. With the help of modern morphological research methods, the degree of the infiltrative-destructive process in the peri-anastomosed areas has been studied. Results. It was found that when using all types of sutures in the areas surrounding the anastomosis (with an implicit advantage of a continuous suture), similar morphological changes were observed, indicating the remodeling of the mucous membrane (RM), low regenerative potential of the small intestine. Deeper degenerative changes in the small intestine SO were observed during the correction of intestinal obstruction using an interrupted suture. Conclusion. The use of a continuous suture (in some cases (3 out of 5) has some advantage over the interrupted suture in the form of a relative preservation of the proliferative compartment zone with the presence of highly specialized cells. Counting Paneth cells, as an indicator of the regenerative capabilities of the small intestine CO, is a promising and objective method for assessing the quality small bowel anastomosis.

An ex vivo preliminary investigation into the impact of parameters on tissue welding strength in small intestine mucosa-mucosa end-to-end anastomosis.

Background: Tissue welding is an electrosurgical technique that can fuse tissue for small intestine anastomosis. However, limited knowledge exists on its application in mucosa-mucosa end-to-end anastomosis. This study investigates the effects of initial compression pressure, out-put power, and duration time on anastomosis strength ex vivo in mucosa-mucosa end-to-end anastomosis. Methods: Ex vivo porcine bowel segments were used to create 140 mucosa-mucosa end-to-end fusions. Different experimental parameters were employed for fusion, including initial com-pression pressure (50kPa-400kPa), output power (90W, 110W, and 140W), and fusion time (5, 10, 15, 20s). The fusion quality was measured by burst pressure and optical microscopes. Results: The best fusion quality was achieved with an initial compressive pressure between 200 and 250kPa, an output power of 140W, and a fusion time of 15s. However, an increase in output power and duration time resulted in a wider range of thermal damage. There was no significant difference between the burst pressure at 15 and 20s (p > 0.05). However, a substantial increase in thermal damage was observed with longer fusion times of 15 and 20s (p < 0.05). Conclusion: The best fusion quality for mucosa-mucosa end-to-end anastomosis ex vivo is achieved when the initial compressive pressure is between 200 and 250kPa, the output power is approximately 140W, and the fusion time is approximately 15s. These findings can serve as a valuable theoretical foundation and technical guidance for conducting animal experiments in vivo and subsequent tissue regeneration.

СЛУЧАЙ ЭТАПНОГО ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ТРОМБОЗА ПОРТАЛЬНОЙ И НИЖНЕЙ ПОЛОЙ ВЕНЫ С СЕГМЕНТАРНЫМИ НЕКРОЗАМИ ТОНКОЙ КИШКИ

Acute venous mesenteric thrombosis can be combined with thrombosis of the inferior vena cava, portal vein, or be their result. In this situation, small bowel ischemia manifests itself as segmental necrosis, with the appearance of new foci of necrosis in time. Diagnostics of the prevalence of venous thrombosis and attack control surgery in the background of anticoagulant therapy, described in clinical observation, allowed the determination of the level of damage to the inferior vena cava, control the formation of new necrosis of the intestinal wall, improve blood supply to the remaining parts of the intestine after double resection, and perform delayed distal anastomosis of the proximal small intestine with ileostomy under conditions of confirmed adequate viability of preserved sections of small intestine.

Characteristics of Collagen Changes in Small Intestine Anastomoses Induced by High-Frequency Electric Field Welding.

High-frequency electric field welding-induced tissue fusion has been explored as an advanced surgical method for intestinal anastomoses; however, intrinsic mechanisms remain unclear. The aim of this study was to investigate microcosmic changes of collagen within the fusion area, with various parameters. Ex vivo small intestine was fused with mucosa-mucosa. Four levels of compressive pressure (100 kPa, 150 kPa, 200 kPa, 250 kPa) were applied for 10 s in order to fuse the colons under a power level of 140 W. Then, collagen fibers of the fusion area were examined by fibrillar collagen alignment and TEM. Three levels of power (90 W, 110 W, 140 W) and three levels of time (5 s, 10 s, 20 s) were applied in order to fuse colons at 250 kPa, and then collagen within the fusion area was examined by Raman spectroscopy. Fibrillar collagen alignment analysis showed that with the increase in compression pressure, alignment of the collagen in the fusion area gradually increased, and the arrangement of collagen fibers tended to be consistent, which was conducive to the adhesion of collagen fibers. TEM showed that pressure changed the distribution and morphology of collagen fibers. Raman spectroscopy showed that increased power and time within a certain range contributed to collagen cross linking. Peak positions of amide I band and amide III band changed. These results suggested that higher power and a longer amount of time resulted in a decrease in non-reducible cross links and an increase in reducible cross links. Compression pressure, power, and time can affect the state of collagen, but the mechanisms are different. Compressive pressure affected the state of collagen by changing its orientation; power and time denatured collagen by increasing temperature and improved the reducible cross linking of collagen to promote tissue fusion.

Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses.

To compare single-layer anastomoses (modified continuous Lembert [mod-CL] and modified-interrupted Lembert [mod-IL]) and a 2-layer simple continuous anastomosis (2L; seromuscular and mucosal) for jejunojejunal anastomoses in equine cadavers and to compare ex vivo to in vivo time to complete the anastomosis and stoma size with a mod-IL pattern. Measurements in jejunum from cadaver and anesthetized horses. Ten live horses and 18 equine cadavers. Time to complete anastomosis, bursting pressures (BP), leakage sites, and anastomotic index (size ratio of anastomotic lumen to control lumen) were recorded. Time to completion and lumen size were compared between in vivo and ex vivo mod-IL patterns. The mod-CL pattern was fastest (8.44 ± 1.30 min, p< .05), and the 2L pattern was slower (17.07 ± 2.0min) than the mod-CL and mod-IL (p< .05). The anastomotic index exceeded 100 and did not differ between patterns. Segments reached higher bursting pressures when anastomosed with mod-IL (145.94 ± 24.18 mm Hg) than mod-CL (p< .05). In vivo closure was approximately 8minutes slower than ex vivo, and with a smaller anastomotic index. All anastomoses increased lumen size over control segments ex vivo. Lumen size after placement of a mod-IL was greater ex vivo than in vivo, and completion was slower in vivo than ex vivo. [Corrections added on 26 Dec 2022, after online publication: added "ex vivo" to the first line of Conclusions in the Abstract.] CLINICAL SIGNIFICANCE: Slower and smaller anastomoses should be anticipated in vivo compared to ex vivo results. Anastomoses with a mod-IL pattern appear clinically advantageous, producing a comparable lumen size in less time than 2L.

Magnetic Compression Technique for Esophageal Anastomosis in Rats

The magnetic compression technique (MCT) is used for the anastomosis of hollow organs by the means of suction between magnets. The MCT is useful for establishing digestive tract anastomoses in rats, for example, end-to-side small intestinal anastomosis and colonic anastomosis. We aim to determine the feasibility of MCT-based esophageal anastomosis in rats. Twenty-four Sprague-Dawley albino rats (230-250g) were randomly divided into an MCT group and a control group (hand-sewn esophageal anastomosis). The time required to construct the anastomosis, postoperative complications, and survival rate was compared between the two groups. At 2wk postoperatively, the animals were sacrificed to assess the burst pressure and histological features of the anastomoses. The mean anastomosis time was significantly lower for MCT (11.17±1.64min) than for the hand-sewn technique (27.42±2.23min; P<0.001). The survival rate was slightly higher in the MCT group (91.67%) than in the control group (66.67%, P=0.317). The magnets were discharged from the body after 8.33±0.89d (range, 7-10d). No anastomotic leakage or stenosis occurred in the MCT group. Three rats developed anastomotic stenosis and two rats developed anastomotic leakage in the control group. The burst pressures were similar in the two groups. An histological examination showed that compared with the control group, the MCT group had better alignment of the tissue layers and less inflammation. The MCT is a simple and feasible technique for esophageal anastomosis in rats and has the potential for clinical application.

The first experience of applying a new pancreatoenteroanastomosis with a «soft» pancreatic stump in pancreatoduodenal resection

The OBJECTIVE was to improve the results of pancreatoduodenal resection by reducing the incidence of pancreatoenteroanastomotic leak and postoperative pancreatitis with a «soft» pancreatic stump.METHODS AND MATERIALS. A new method for the formation of pancreatoenteroanastomosis has been developed and implemented: precision wirsungojejunoanastomosis with additional wide atraumatic peritonization of the pancreatic stump cutoff with the loop of the small intestine. From February 2016 to March 2018, this method was tested in 18 patients.RESULTS. Pancreatoenteroanastomotic leak of class A was noted in 2 (11.1 %) patients, was transient, asymptomatic, did not require additional medical measures and did not extend the duration of the postoperative period. There were no pancreatoenteroanastomotic leak of classes B and C, pancreonecrosis of the stump, lethal outcomes. Objectively worst statistical results were obtained in the comparison group.CONCLUSION. The formation of the small intestine anastomosis with a «soft» pancreatic stump according to the proposed method for pancreatoduodenal resection reduces the incidence of postoperative pancreatitis of the stump and pancreatoenteroanastomotic leak.

COMPARATIVE STUDY BETWEEN SINGLE LAYER VERSUS DOUBLE LAYER ANASTOMOTIC TECHNIQUE FOR SMALL INTESTINAL ANASTOMOSIS IN ADULTS

Background: Anastomosis of gastrointestinal tract more commonly used in most of abdominal operations including esophagus, stomach, small intestine, large intestine, and biliary system. However single layer versus double layer anastomotic technique is still a matter of discussion as regard safety and efficacy. Objective: To study efficacy and safety of single layer intestinal anastomosis against double layer anastomosis as regard leakage, cost effectiveness, and the time of the procedure. Patients and methods: This prospective randomized study included 40 patients requiring small intestinal resection and anastomosis at Al- Hussein University Hospital and Damanhur Medical National Institute (Al-Behira) during the period between May 2019 and October 2020. The cases of this study were subjected to full history taking, full clinical examination, along with routine laboratory and radiological investigations. The cases of this study were divided into two equal groups randomly; Group A was subjected to one-layer anastomosis, and group B underwent double layered anastomosis. All cases were subjected to the standard post-operative care. Oral intake and hospital stay were recorded. In addition, post-operative complications including leakage, ileus, and mortality were recorded. Results: Mean time of operation in the single layer intestinal anastomosis was statistically significantly shorter as compared with double layered intestinal anastomosis (28.29 ± 8.15 minutes and 35.19 ± 9.96 minutes) respectively. The early postoperative findings and late postoperative complications were comparable in both groups with no statistically significant difference. Conclusion: Single layer intestinal anastomosis was less time consuming, less utilization of packing material, in addition to equal efficacy and safety as compared with double layer intestinal anastomosis.

The use of a modified “end-to-side” small intestine anastomosis in patients with acute obstruction of the terminal section of the small and right colon

Introduction. The prevalence of colorectal cancer in the world is increasing every year. In more than 40% of patients, the disease debuts with a clinical picture of acute intestinal obstruction, while in one third of cases the tumor is located in the right half of the colon. This leads to the necessity to perform colon resection or bypass surgery, the main stage of which is making entero- colic anastomosis. However, up to 15% of these anastomoses has a leakage. Development of methods of forming a reliable anastomosis is thus critical.Materials and methods. 37 patients with acute intestinal obstruction, divided into 2 groups (17 and 20 people), are included into the study. All of them, as a surgical stage of treatment, underwent a right hemicolectomy with the formation of an entero- colic anastomosis or a bypass surgery. A double-row side-to-side anastomosis was used in the comparison group, and a single-row “end-to-side” anastomosis in the main group (patent No. 2709253). The incidence of anastomotic leakage and mortality were assessed. Comparison was performed using Fisher’s exact test.Results. There were no cases of anastomotic leakage and mortality in the main group. In the comparison group, there were 5 leakages and 1 death.Discussion. When a modified entero-colic anastomosis is formed, adequate blood flow is maintained in the walls of the anastomosed intestinal loops, which contributes to adequate regeneration.Conclusion. The first clinical experience with the modified end-to-side entero- colic anastomosis is successful. It is planned to further recruit patients and study the features of the postoperative period.

Intraoperative surgeon probe inspection compared to leak testing for detecting gaps in canine jejunal continuous anastomoses: A cadaveric study.

To compare the detection of gaps in jejunal continuous anastomoses by probing (PT) versus leak testing (LT). Experimental study. Normal jejunal segments (n=24) from two fresh canine cadavers. Intestinal segments were randomly selected by four volunteers who created six simple continuous anastomoses: two constructs using standard technique with 2-3 mm suture spacing (ST, 8 total), and four constructs with one 4-mm gap (IG, 16 total). All 24 anastomoses were examined with PT (1 volunteer) prior to LT (3 volunteers). LT was performed within a maximal peristaltic pressure range (34-54 cmH2 O). The presence and location of anastomotic leaks (LA ) detected with LT were compared with gaps detected with PT. Nineteen out of twenty-four (79.2%) samples had at least one probe drop, and four out of twenty-three (17.4%) samples leaked. LT results from one sample were excluded due to iatrogenic suture failure. PT was 100% sensitive (95% CI: 51.01, 100%) with a 100% negative predictive value (95% CI: 56.55, 100%) at detecting gaps compared with LT. The location of all LA was accurately identified with PT and confirmed during LT. PT was highly sensitive at detecting gaps compared with LT. All LA were accurately detected by PT. None of the segments negative during PT leaked. The diagnostic value of PT appears adequate to recognize gaps in cadaveric small intestinal anastomoses. PT offers surgeons an alternative to detect suture gaps that may contribute to postoperative dehiscence of intestinal anastomoses.

COMPARATIVE STUDY OF SINGLE LAYER CONTINUOUS VERSUS SINGLE LAYER INTERRUPTED EXTRA MUCOSAL TECHNIQUES IN SMALL INTESTINE ANASTOMOSIS

Background: Intestinal anastomosis is most commonly performed surgical procedure both in emergency and elective settings therefore its leak and disruption is a common cause of post-operative morbidity and mortility. Gut anastomosis heals by the same mechanism as that of wound healing. The submucosa, is the strongest layer of gut wall therefore ideal anastomotic technique is the one which includes apposition and approximation of this layer. Aim:The outcome of comparative study of single layer continuous extra mucosal technique and single layer interrupted extra mucosal technique for the anastomosis of small bowel. Methods:This was a prospective study based on randomization and was carried out in surgery department of ANMMC&amp;H, Gaya from 1 st March 2019 to 29th February 2020. Total Fifty patients were included in study requiring small intestine anastomosis and were divided in two groups based on randomization. Group Aincluded those patients in which the anastomosis performed by single layer continuous extra mucosal technique and Group B patients underwent single layer interrupted extramucosal technique for creation of anastomosis, Group Aincluded 24 patients (n=24) and Group B 26 patients (n=26) . The demographic features, time taken to create anastomosis , postoperative complications , number of deaths if any and hospital stay in days were recorded on a printed proforma and data analysis was done through computer soft ware SPSS 16. Results: Group Aand B were similar as for as the demographic features, postoperative complications and duration of hospital stay are concerned. 4.2% patients of Group A and 7.7% of Group B developed anastomotic dehiscence with non signicant p value. Mean time taken for creation of anastomosis was 10.04 minutes in continuous extra mucosal anastomosis group (Group A ) and 19.2 minutes in interrupted extra mucosal anastomosis [Group B ] (p=0.0001) Overall hospital mortality was 2%. Conclusion: Single layer continuous extra mucosal technique is as safe as interrupted extra mucosal anastomosis technique but can be performed in shorter time and can be a cost effective alternative for construction of bowel anastomosis.

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008-2019).

To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine. 131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA). Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up. Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques. Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments

BackgroundEquine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine.The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time.Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated.ResultsConstruction times were not statistically different between groups (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792).ConclusionsThe tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications.

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.

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.