%0 Journal Article
%T Ex Vivo Anatomical Characterization of Handsewn or Stapled Jejunocecal Anastomosis in Horses by Computed Tomography Scan
%A Gessica Giusto
%A Bryan Iotti
%A Federica Sammartano
%A Alberto Valazza
%A Marco Gandini
%J Journal of Veterinary Medicine
%D 2014
%R 10.1155/2014/234738
%X The aim of this study is to compare handsewn and stapled jejunocecal anastomosis with different stomal lengths in terms of anatomical differences. Group 1 underwent a two-layer handsewn jejunocecal side-to-side anastomosis (HS); Group 2 received a stapled jejunocecal side-to-side anastomosis (GIA). Each group was divided into two subgroups (HS80 and HS100, GIA80 and GIA100). Specimens were inflated and CT scanned. The stomal/jejunal area ratio and blind end pouch volume/area were measured and compared. Effective length of the stoma was measured and compared with the initial length. Stomal/jejunal area ratio was 1.1 for both 80 techniques, 1.6 for the GIA100, and 1.9 for the HS100 technique. Both HS and GIA techniques produced a blind end pouch and exhibited a mean increase of the final stomal length ranging from 6 to 11% greater than the original stomal length. All techniques will exhibit a length increase of the final stomal length compared to the intended stomal length, with a consequent increase in stomal area. Stapled techniques consistently produced a large distal blind end pouch. Length of a jejunocecal anastomosis should be selected in accordance with the diameter of afferent jejunum, and the 80£żmm stomal length could be deemed sufficient in horses. 1. Introduction Jejunocecal anastomoses with resection are commonly performed in equine abdominal surgery whenever the ileum is damaged to such an extent that will not allow performing an end-to-end anastomosis. Although end-to-side anastomosis was considered as the original technique [1], side-to-side techniques can have fewer complications and offer a better prognosis [2]. Nevertheless, the complication rates of these techniques are still high while survival rates are lower when compared to end-to-end jejunojejunal anastomosis for both handsewn and stapled techniques [3, 4]. Possible explanations have been proposed mostly from a functional point of view, related to the peculiarity that this anastomosis joins two segments with very specific and different physiology and motility patterns. The overcoming of intracecal pressure by the jejunum [5] without the coordination normally produced by the ileocecal valve [2, 6] and the fact that most of the proximal jejunum has already been distended and possibly damaged by the primary pathology [7] are the main factors that could explain the poor performance of this type of anastomosis, both handsewn and stapled. Furthermore, it is still being debated whether a handsewn or stapled technique should be preferred in order to reduce complications and improve
%U http://www.hindawi.com/journals/jvm/2014/234738/