Evaluation of three techniques for end-to-end anastomosis of the small colon in horses

In an attempt to determine the best method for surgical removal of devitalized small colon lesions, 12 horses underwent a double small colon resection and end-to-end anastomosis. In 4 horses (study 1), an appositional single-layer (APP-1) suture pattern was compared with an inverting 2-layer (INV-2) suture pattern. In 8 horses (study 2), an appositional 2-layer (APP-2) suture pattern was compared with the INV-2 suture technique. Polydioxanone suture (size 1-0), was used. Horses were evaluated at necropsy 3, 10, 14, 28, or 56 days after surgery. Postoperative complications (peritonitis, impaction, or excessive adhesions) were encountered in 100, 42, and 13% of the APP-1, INV-2, and APP-2 anastomoses, respectively. Postmortem eva luation of the small colon revealed dehiscence of the anastomotic site, diffuse peritonitis, and adhesion formation in 3 of the 4 horses in which the resection line was closed with the APP-1 pattern. With the INV-2 and APP-2 techniques, more intestinal inversion was present in the nontaenial than in the taenial portion of the small colon. More postoperative impactions were found with the INV-2 (n = 5) anastomoses than with the APP-2 (n = 1) technique; this appeared to be the result of excessive tissue inversion. There was no difference in lumen diameter between the INV-2 and the APP-2 techniques (P greater than or equal to 0.05). However, horses with unresponsive impactions at the INV-2 site had a smaller luminal diameter compared with the INV-2 anastomoses that did not impact or that impacted and resolved with therapy (P less than or equal to 0.001). Difference in adhesion formation between the INV-2 and the APP-2 techniques was minimal. Bursting pressure studies (7 APP-2, 7 INV-2, and 14 control) were performed in study 2. All segments consistently burst away from the anastomotic site along the mesenteric or antimesenteric taenial band. Differences in bursting pressure (P greater than or equal to 0.05) were not evident between the 2 groups. Histologic evaluation revealed the APP-1 pattern had no intestinal inversion. However, a wide full-thickness deposition of dense fibrous connective tissue in the submucosal and muscular layer was evident. The INV-2 and the APP-2 patternshad pronounced inversion of the anastomotic layers along the nontaenial portion of the anastomoses, with minimal deposition of fibrous connective tissue between the anastomotic layers. The inversion formed a protruding ridge into the lumen that was more pronounced in the INV-2 than in the APP-2 anastomoses. At 28 days, the inverted tissues were held firmly together by maturing fibrous connective tissue that was covered by a mucosal layer. The inverted tissues were as pronounced at 56 days as they were at 3 days. In light of these findings, we concluded that an APP-2 pattern was the preferred surgical technique.