Chanutin Sierra, Bauck Anje G, Roberts John F, Denagamage Thomas N, Freeman David E
Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Equine Vet J. 2025 Nov;57(6):1690-1702. doi: 10.1111/evj.14466. Epub 2025 Jan 7.
Jejunocaecostomy (JC) is frequently required to bypass diseased ileum as a side-to-side (SS) anastomosis with blind end closure of the small intestine. The effects of the blind end closure method on the performance of the anastomosis have not been studied.
To compare handsewn and stapled blind end closures of the ileum and jejunum.
In vivo experiments.
JC was performed with either Parker-Kerr (PK; 6 horses) or oversewn stapled technique (OS; 6 horses) to close jejunum and ileum for an SS anastomosis. At surgery, peritoneal fluid was analysed and various anastomotic measurements and time to complete the anastomosis were recorded. Physical and haematological findings and serum amyloid A (SAA) were recorded postoperatively. At necropsy on day 7, anastomotic measurements and peritoneal fluid analysis were repeated. Tissues collected at surgery and necropsy underwent histological and immunohistological evaluations.
Two PK horses developed intussusception of the jejunal blind end into the caecum and another PK horse was euthanised because of anastomotic impaction. One OS horse had mild postoperative colic. Postoperative peripheral neutrophil counts and SAA were similar between groups but SAA significantly (0.5 mg/L [0.3, 0.7], p < 0.001) increased with time in both. The OS jejunal blind ends (4.7 cm [4.41, 6.85]) were significantly larger (PK = 3.5 cm [3.3, 4.08], p = 0.004) and the OS blind ends (18.6 min ± 1.32) were significantly slower to complete (11.3 min ± 0.37, p = 0.002). Inflammation developed between the everting staple line and inverting suture line in the OS closure and along transected edges in the PK. Peritoneal fluid total protein increased significantly between surgery (19 g/L [19, 19]) and necropsy (34 g/L [30, 41], p < 0.001) without differences between groups.
Small sample size and short follow-up.
Both blind-end techniques could be acceptable, although more complications developed with the PK method. The anastomotic intussusceptions were unexpected and possibly unique to the anastomotic design.
空肠盲肠造口术（JC）常需绕过病变的回肠，作为小肠侧侧（SS）吻合术并封闭小肠盲端。尚未研究盲端封闭方法对吻合术效果的影响。
比较回肠和空肠手工缝合与吻合器封闭盲端的效果。
体内实验。
采用帕克 - 克尔（PK；6匹马）或连续缝合吻合器技术（OS；6匹马）进行JC，以封闭空肠和回肠进行SS吻合。手术时，分析腹腔液并记录各种吻合测量数据及完成吻合的时间。术后记录身体和血液学检查结果以及血清淀粉样蛋白A（SAA）。在第7天尸检时，重复吻合测量和腹腔液分析。收集手术和尸检时的组织进行组织学和免疫组织学评估。
2匹采用PK方法的马发生空肠盲端套叠进入盲肠，另一匹采用PK方法的马因吻合口梗阻而实施安乐死。1匹采用OS方法的马术后出现轻度绞痛。两组术后外周中性粒细胞计数和SAA相似，但两组中SAA均随时间显著增加（0.5mg/L [0.3, 0.7]，p < 0.001）。采用OS方法的空肠盲端（4.7cm [4.41, 6.85]）明显更大（采用PK方法的为3.5cm [3.3, 4.08]，p = 0.004），且采用OS方法封闭盲端的时间（18.6分钟±1.32）明显更长（采用PK方法的为11.3分钟±0.37，p = 0.002）。在采用OS方法封闭时，外翻吻合器缝线和内翻缝合线之间出现炎症，而在采用PK方法时，炎症沿横断边缘出现。手术时（19g/L [19, 19]）至尸检时腹腔液总蛋白显著增加（至34g/L [
