In Vitro Comparison of Two Single Layer Hand Sewn End-to-End Anastomosis Techniques in Normal Equine Jejunum: A Pilot study

2020 ◽  
Author(s):  
Heba Al-Kharraz ◽  
Rahaf Nader ◽  
Maha Al-Asmakh ◽  
Jessica P Johnson
Keyword(s):  
Pilot Study ◽  
Intestinal Anastomosis ◽  
Biomechanical Testing ◽  
Single Layer ◽  
Bursting Pressure ◽  
Construction Time ◽  
Bursting Pressures ◽  
Small Intestinal ◽  
End To End

Background: The equine small intestine can be affected by a variety of disorders, which may require some form of bypass or anastomosis procedure. Several small intestinal anastomosis techniques have been reported in scientific literature with the intention to minimize post-operative complications, however to our knowledge there are no published descriptions of the hand-sewn end-to-end single layer simple continuous Appositional technique for equine jejunojejunostomy. Objective: To compare and evaluate differences in the single layer continuous Appositional and the single layer continuous Lembert with respect to construction time, leakage pressure and bursting pressure; for the purpose of small intestinal anastomosis in the horse. Hypothesis: We hypothesized that the time spent in the execution, leakage pressure and bursting pressure will be similar between the single layer continuous Lembert and the single layer simple continuous Appositional techniques. Since this is a pilot study, it is the first step to prove the efficacy of the Appositional technique by showing its similarity with the Lembert technique, considering the latter to be the ‘gold standard’. Methodology: Thirty-Seven intestinal segments from two horses were used to compare the single layer continuous Appositional and single layer continuous Lembert techniques. The time taken to execute the anastomoses, and the number of bites taken for each pattern, were recorded. Biomechanical testing was performed to determine leakage pressure and bursting pressure. Statistical analysis was performed using GraphPad Prism 8. Result: The comparison in construction time between the Lembert group (mean, 24.23 mins, n=19) and the Appositional group (mean, 21.74 mins, n=18) were found to be statistically insignificant (P=0.3088). There was also no changes in Leakage pressure (P=0.3862) and bursting pressure (P=0.3135) between the two groups. Conclusion: This study has demonstrated that the Appositional technique is a viable alternative to the Lembert technique, with respect to construction time, leakage and bursting pressures, for the purpose of end-to-end jejunojejunal anastomosis in the horse

In Vitro Comparison of Two Single Layer Hand Sewn end‐to‐end Anastomosis Techniques in Normal Equine Jejunum: A Pilot Study

2020 ◽  
Author(s):  
Heba Alkharraz ◽  
Rahaf Nader ◽  
Maha Al‐ Asmakh ◽  
Jessica Johnson
Keyword(s):  
Pilot Study ◽  
Intestinal Anastomosis ◽  
Biomechanical Testing ◽  
Single Layer ◽  
Bursting Pressure ◽  
Construction Time ◽  
Bursting Pressures ◽  
Small Intestinal ◽  
End To End

Background: The equine small intestine can be affected by a variety of disorders, which may require some form of bypass or anastomosis procedure. Several small intestinal anastomosis techniques have been reported in scientific literature with the intention to minimize post-operative complications, however to our knowledge there are no published descriptions of the hand-sewn end-to-end single layer simple continuous Appositional technique for equine jejunojejunostomy. Objective: To compare and evaluate differences in the single layer continuous Appositional and the single layer continuous Lembert with respect to construction time, leakage pressure and bursting pressure; for the purpose of small intestinal anastomosis in the horse. Hypothesis: We hypothesized that the time spent in the execution, leakage pressure and bursting pressure will be similar between the single layer continuous Lembert and the single layer simple continuous Appositional techniques. Since this is a pilot study, it is the first step to prove the efficacy of the Appositional technique by showing its similarity with the Lembert technique, considering the latter to be the ‘gold standard’. Methodology: Thirty-Seven intestinal segments from two horses were used to compare the single layer continuous Appositional and single layer continuous Lembert techniques. The time taken to execute the anastomoses, and the number of bites taken for each pattern, were recorded. Biomechanical testing was performed to determine leakage pressure and bursting pressure. Statistical analysis was performed using GraphPad Prism 8. Results: The comparison in construction time between the Lembert group (mean, 24.23 mins, n=19) and the Appositional group (mean, 21.74 mins, n=18) were found to be statistically insignificant (P=0.3088). There was also no changes in Leakage pressure (P=0.3862) and bursting pressure (P=0.3135) between the two groups. Conclusion: This study has demonstrated that the Appositional technique is a viable alternative to the Lembert technique, with respect to construction time, leakage and bursting pressures, for the purpose of end-to-end jejunojejunal anastomosis in the horse.

Use of Single Layer Small Intestinal Submucosa for Long Segment Ureteral Replacement: A Pilot Study.

2004 ◽  
Vol 171 (5) ◽  
pp. 1939-1942 ◽  
Author(s):  
AHMED EL-ASSMY ◽  
ASHRAF T. HAFEZ ◽  
MOHAMED T. EL-SHERBINY ◽  
MOHAMED ABD EL-HAMID ◽  
TAREK MOHSEN ◽  
...  
Keyword(s):  
Pilot Study ◽  
Single Layer ◽  
Small Intestinal Submucosa ◽  
Ureteral Replacement ◽  
Small Intestinal ◽  
Intestinal Submucosa

scholarly journals Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Kate Averay ◽  
Gaby van Galen ◽  
Michael Ward ◽  
Denis Verwilghen
Keyword(s):  
Intestinal Resection ◽  
Bursting Pressure ◽  
Construction Time ◽  
Needle Holder ◽  
Group 4 ◽  
Bursting Pressures ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Background Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated. Results Construction times were not statistically different between groups (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792). Conclusions The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications.

scholarly journals Single layer versus double layer intestinal anastomoses: a comparative study

2020 ◽  
Vol 7 (9) ◽  
pp. 2991
Author(s):  
Ajit Kumar ◽  
Vinod Kumar
Keyword(s):  
Comparative Study ◽  
Anastomotic Leak ◽  
Double Layer ◽  
Intestinal Anastomosis ◽  
Single Layer ◽  
Anastomosis Group ◽  
Layer Versus ◽  
Intestinal Anastomoses ◽  
Significant Difference ◽  
End To End

Background: There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. This prospective single blinded randomized comparative study conducted at Rajendra Institute of Medical Sciences to assess various aspects viz. safety, efficacy, duration of hospital stays and chances of perforation in single- and double-layer anastomotic surgery.Methods: 26 patients each in single layer and double layer anastomosis group were included in the study.  Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 3-0 silk lembert sutures for the outer layer and a continuous 2-0 vicryl for the inner layer. End to end colocolic, end to end ileocolic, end to side ileocolic, end to end ileoileal, side to side ileoileal, end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis, cost incurred, and length of hospital stay.Results: Findings of the study indicated that single layer is economical in comparison to double layer anastomosis and took significant less time to operate. There was no significant difference in hospital stay of the patients in two groups. There was no anastomotic leak in group-S (single layer) while one (3.8%) patient in group-D (double layer) suffered from anastomotic leak.Conclusions: It was concluded that single layer anastomosis method is beneficial and safe as it required less operative time, suturing material and no leak took place after surgery.

333 Use of single-layer small intestinal submucosa (SIS) for long-segment ureteral replacement: A pilot study

2004 ◽  
Vol 3 (2) ◽  
pp. 86
Author(s):  
A. Assmy ◽  
A. Hafez ◽  
M. El-Sherbiny ◽  
M. Abd El-Hamid ◽  
T. Mohsen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Single Layer ◽  
Small Intestinal Submucosa ◽  
Ureteral Replacement ◽  
Small Intestinal ◽  
Intestinal Submucosa
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