Introduction

• Resection/anastomosis, intestinal decompression Gastrointestinal: decompression and lavage and enterotomy Gastrointestinal: enterotomy are the most common techniques used in the surgical treatment of bowel disease.
• The stomach, small intestine, cecum and colon of the horse differ in size, shape and digestive function, but in intestinal wall structure and blood supply they follow a similar basic design.
• Accordingly the principles for intestinal resection and anastomosis are similar for all segments of the intestinal tract.

Uses

• End-to-end anastomosis:
  • When bowel segments of equal diameters are being united, eg jejunum Jejunum: jejunojejunostomy, small colon or small segments of the left dorsal or ventral colon.
• Side-to-side anastomosis:
  • Used to unite bowel segments with unequal diameters or adjacent segments of the large colon that cannot be positioned end-to-end due to short mesocolon, or in the case of stapled procedures, to work through a smaller, less invasive enterotomy.
  • Commonly used in jejunocecostomy Jejunum: jejunocecostomy, ileocecostomy, gastrojejunostomy and colostomy Colon: resection.
  • Some surgeons prefer side-to-side techniques for jejunal anastomosis Jejunum: jejunojejunostomy.
• Functional end-to-end:
  • Has been described for jejunojenostomy.
  • Performed similarly to a side-to-side, except that the resected ends of bowel are positioned adjacent to each other, rather than opposing.
• End-to-side anastomosis:
  • Has been used for jejunocecostomy Jejunum: jejunocecostomy.

Advantages

• Allows complete removal of a section of diseased bowel.
• Similar technique may be used for various diseases, eg strangulation/necrosis, intussusception or neoplasia.
• Re-establishes functional bowel.

Disadvantages

• Excessive resection may → malabsorption or other gastrointestinal disturbances.
• Anastomosis may → smaller gut lumen → site predisposed to obstruction.

Requirements

Preparation

Procedure

Aftercare

Outcomes

Prognosis

• Good to Guarded.
• See individual disease entities, eg:
  • Volvulus Gastrointestinal: small intestine - torsion.
  • Internal herniations such as epiploic foramen Gastrointestinal: epiploic foramen hernia.
  • Mesenteric defects.
  • Congenital abnormalities.
  • External hernias such as inguinal/scrotal Inguinal ring: hernia.
  • Intussusception Gastrointestinal: small intestine - intussusception.
  • Pedunculated lipoma Abdomen: lipoma - pedunculated.

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Biasutti S, Dart A J, Dart C M, Uquillas E & Jeffcott L B (2017) End-to-side anastomosis of the left ventral colon to the small colon in a neonatal foal with segmental agenesis of the large colon. Aust Vet J 95 (6), 217-219 PubMed.
• Espinosa P, Le Jeune S S, Cenani A, Kass P H & Brosnan R J (2017) Investigation of perioperative and anesthetic variables affecting short-term survival of horses with small intestinal strangulating lesions. Vet Surg 46 (3), 345-353 PubMed.
• Close K, Epstein K L & Sherlock C E (2014) A retrospective study comparing the outcome of horses undergoing small intestinal resection and anastomosis with a single layer (Lembert) or double layer (simple continuous and Cushing) technique. Vet Surg 43 (4), 471-478 PubMed.
• Stewart S, Southwood L L & Aceto H W (2014) Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010. Equine Vet J 46 (3), 333-338 PubMed.
• Lee W L, Epstein K L, Sherlock C E, Mueller P O & Eggleston R B (2012) In vitro comparison of a single-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end jejunoileal anastomosis in normal equine small intestine. Vet Surg 41 (5), 589-593 PubMed.
• Freeman D E & Schaeffer D J (2011) Clinical comparison between a continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane with an interrupted Lembert pattern for one-layer jejunojejunostomy in horses. Equine Vet J 43 (6), 708-713 PubMed.
• Proudman C J, Edwards G B & Barnes J (2007) Differential survival in horses requiring end-to-end jejunojejunal anastomosis compared to those requiring side-to-side jejunocaecal anastomosis. Equine Vet J 39 (2), 181-185 PubMed.
• Rendle D I, Woodt J L, Summerhays G E, Walmsley J P, Boswell J C & Phillips T J (2005) End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study. Equine Vet J 37 (4), 356-359 PubMed.
• Boswell J C, Schramme M C & Gains M (2000) Jejunojejunal intussusception after an end-to-end jejunojejunal anastamosis in a horse. Equine Vet Educ 2 (6), 395-398 VetMedResource.
• Latimer E G et al (1998) Closed one-stage functional end-to-end jejunoejunostomy in horses with use of linear stapling equipment. Vet Surg 27 (1), 17-28 PubMed.
• Mueller P O & Allen D (1996) Instrumentation and techniques in equine gastrointestinal surgery. Vet Clin North Am Equine Pract 12 (2), 207-233 PubMed.

Other sources of information

• Freeman D (2012) Small Intestine. In: Equine Surgery. Eds: Aeur J A & Stick J A. Elsevier. pp 416-453. ISBN: 978-1-4377-0867-7.
• McIlwraith C W & Turner A S (1987) Equine Surgery Advanced techniques. Lea & Febiger, USA. ISBN: 0-8121-1055-2.