Suture Techniques for Intestines Compared (AAEP 2011)

Surgeons currently use a number of techniques to suture two pieces of intestine back together during colic surgery, a process referred to as an anastomosis. The seal must be leak-free to avoid complications that can cause future colics or even death, so using the best approach is key. A researcher from Italy recently determined the optimal anastomosis stitch pattern approach at the 2011 American Association of Equine Practitioners convention, held Nov. 18–22 in San Antonio, Texas.

Picture an electrical cord cut in half: To repair, the two ends need to be carefully reconnected so the next user does not get shocked or showered in sparks. Colic surgery is a similar situation in which a section of injured or dead intestine needs to be removed during colic surgery. The surgeon must connect the two healthy ends together to form a perfect leak-free seal. Otherwise, intestinal contents and bacteria will leak into the abdominal cavity, causing a life-threatening infection and inciting the production of fibrous tissue bands between all the intestinal organs, which increases the risk for future colic episodes if the horse survives the initial infection.

“Due to the critical condition of patients undergoing colic surgery, the goal is to execute the anastomosis in the shortest time, yet execute the job perfectly so no leakage occurs,” explained Luigi Auletta, DVM, of the Department of Veterinary Clinical Sciences, Surgery Section, at the University of Studies of Napoli Federico II, Italy. .  To determine the optimal suture (stitch) pattern for anastomosis, Auletta and colleagues collected intestines from horses and placed a rubber tube into two intestinal segments. Air was blown in through one end of each tube and the pressure was measured at the other end.

Then the two pieces of intestine were sutured together using a Lembert single layer, Gambee, or Lembert double layer pattern. Auletta and his colleagues’ key findings were:

  • The Lembert single layer pattern took significantly less time to complete than the other two patterns;
  • The Lembert single layer pattern resisted higher pressures than the other two patterns; and
  • The Lembert single layer pattern, by nature, also left a smaller amount of tissue protruding into the lumen (inside) of the intestinal tract, which means the cross area of the intestinal loop is larger.

“These data clearly indicate that the Lembert single layer pattern is faster, stronger, and less likely to impede the flow of intestinal contents than the other two patterns and therefore should be the pattern of choice in most colic cases requiring anastomoses,” concluded Auletta.



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