Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010.

REASONS FOR PERFORMING THE STUDY: There is disagreement among surgeons over whether jejunoileostomy (JI) or jejunocaecostomy (JC) is the better method of anastomosis following proximal ileal resection. OBJECTIVE: To compare short- and long-term complications and outcome in horses undergoing jejunojejunostomy (JJ), JI and JC and to test the hypotheses that a higher proportion of horses undergoing JI would have short-term complications and mortality compared with horses undergoing JC or JJ and that JC would be associated with a higher long-term mortality and occurrence of colic. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Medical records of horses undergoing celiotomy for a small intestinal obstruction and JJ, JI or JC from 2005 to 2010 were reviewed. Post operative complications were recorded. Short-term outcome was alive vs. dead at hospital discharge and was analysed using a Chi-squared test. Long-term follow-up was obtained and a Kaplan-Meier estimate of the survivor function was performed. RESULTS: There were 112 horses included. A higher proportion of JI horses had a repeat celiotomy during hospitalisation compared with horses undergoing JC. The number of horses alive at hospital discharge was not different between groups: JJ 79% (95% confidence interval [CI] 68-90%), JI 78% (95% CI 61-96%), JC 83% (95% CI 71-96%). Among horses discharged with long-term follow-up, more horses had colic after JC compared with JJ or JI. Long-term post discharge survival based on the Kaplan-Meier survivor function was lower for horses undergoing JC than JJ or JI (P = 0.04). CONCLUSION: While there was no difference in short-term outcome between groups, more horses with JI underwent a repeat celiotomy during hospitalisation. Horses with a JC were more likely to have long-term complications with colic. Horses that were subjected to euthanasia because of colic within 12 months of hospital discharge either had a JC or repeat celiotomy. The results suggest that, when possible, a JI may be the preferred method of anastomosis based on more favourable survival and lower occurrence of colic long term.

Clinical evaluation of a closed, one-stage, stapled, functional, end-to-end jejuno-ileal anastomosis in 5 horses.

This study describes the outcome and complications in horses that had a closed, one-stage, stapled, functional, end-to-end (COSFE) jejuno-ileal anastomosis (JIA) following resection of compromised small intestine. Medical records were reviewed to identify all horses that had a COSFE JIA performed during exploratory laparotomy and to determine post-operative complications and final outcome. All 5 horses that were identified had successful COSFE JIA with resection of various amounts of distal jejunum and proximal ileum. Post-operative ileus occurred in 1 of the 5 horses. All horses survived at least 1 year after surgery. The survival times and incidence of post-operative ileus compared favorably with published results for other types of small intestinal resection and anastomoses. A COSFE JIA is a viable surgical procedure to correct lesions of the distal jejunum and proximal ileum.This study describes the outcome and complications in horses that had a closed, one-stage, stapled, functional, end-to-end (COSFE) jejuno-ileal anastomosis (JIA) following resection of compromised small intestine. Medical records were reviewed to identify all horses that had a COSFE JIA performed during exploratory laparotomy and to determine post-operative complications and final outcome. All 5 horses that were identified had successful COSFE JIA with resection of various amounts of distal jejunum and proximal ileum. Post-operative ileus occurred in 1 of the 5 horses. All horses survived at least 1 year after surgery. The survival times and incidence of post-operative ileus compared favorably with published results for other types of small intestinal resection and anastomoses. A COSFE JIA is a viable surgical procedure to correct lesions of the distal jejunum and proximal ileum.

RésuméÉvaluation clinique d'une anastomose jéjuno-iléale fermée, en un temps, agrafée, fonctionnelle et termino-terminale chez 5 chevaux. Cette étude décrit le résultat et les complications d'une anastomose jéjuno-iléale (AJI) fermée, en un temps, agrafée, fonctionnelle et termino-terminale (FTAFTT) chez des chevaux après la résection d'un petit intestin compromis. Les dossiers médicaux ont été examinés pour identifier tous les chevaux qui avaient subi une AJI FTAFTT durant une laparotomie exploratoire et déterminer les complications postopératoires et le résultat final. Les 5 chevaux qui ont été identifiés ont tous subi une AJI FTAFTT réussie avec résection de diverses quantités du jéjunum distal et de l'iléon proximal. Une occlusion intestinale postopératoire s'est produite chez 1 des 5 chevaux. Tous les chevaux ont survécu au moins 1 an après la chirurgie. Le temps de survie et l'incidence d'une occlusion intestinale postopératoire ont présenté une comparaison favorable avec les résultats publiés pour d'autres types de résection du petit intestin et d'anastomoses. Une AJI FTAFTT est une intervention chirurgicale viable pour corriger les lésions du jéjunum distal et de l'iléon proximal.(Traduit par Isabelle Vallières).

Efectos de la transposición ileal, el bypass gastroyeyunal y la gastroplastia vertical en la regulación de la ingesta en un modelo experimental de obesidad relacionada con diabetes mellitus tipo 2 / The effects of ileal transposition, gastrojejunal bypass and vertical gastroplasty on the regulation of ingestion in an experimental obesity model associated with diabetes mellitus type 2

Introducción: En el marco de la cirugía metabólica, este estudio pretende valorar la transposición ileal como tratamiento quirúrgico de la obesidad mórbida relacionada con la diabetes mellitus no insulinodependiente gracias a la acción del péptido GLP-1, en relación con el bypass gástrico y la gastroplastia vertical. También determinar las concentraciones de grelina y su contribución a la pérdida de peso para cada técnica. Material y métodos: Animales de experimentación del tipo Zucker Diabetic Fatty, ratas obesas y modelo de diabetes tipo 2. Tres grupos de 10 animales cada uno: a) transposición ileal; b) bypass gastroyeyunal, y c) gastroplastia vertical. Parámetros determinados: pérdida de peso, cambios en la ingesta, valores de glucemia, GLP-1, insulina y grelina en sangre de cada uno de los animales una semana antes de la intervención quirúrgica y a los 15 días de la cirugía. Resultados: La intervención que produce una mayor pérdida de peso es el bypass gastroyeyunal. Hay una disminución de la ingesta calórica significativa para los tres tipos de intervención. No se consigue corregir el estado de hiperglucemia intensa en los tres grupos, aunque en el grupo de la transposición se logra frenar el estado de cetosis. El aumento de GLP-1 es sólo significativo en la transposición ileal. Conclusiones: En la respuesta metabólica a la cirugía no sólo se modifica una única hormona, sino que se establece un estado de regulación y contrarregulación como traducción de una determinada acción quirúrgica. Los animales obesos, cuyo exceso de peso es de causa exógena, pueden ser un buen modelo para otros estudios en esta dirección (AU)

Aim: The continual advances in our knowledge of the pathogenesis and hormonal disorders of morbid obesity lead to new studies in experimental animals and the development of new technical options. The aim is to asses whether ileal transposition can be a good treatment of morbid obesity associated with diabetes mellitus due to the action of intestinal peptide Glp-1 (enteroglucagon) compared to gastric bypass and vertical gastroplasty (VGB). Material and methods: Trial enviroment: experimental animals ZDF rats (Zucker Diabetic Fatty rats). Subjects of the study: three groups of 10 animals each one divided as: a) ileal tranposition; b) gastro-jejunal bypass; c) vertical gastroplasty. Parameters to determine: weight loss, levels of glycaemia, enteroglucagon, insulin and ghrelin in blood, one week before the operation as a baseline control, and 15 days after the surgical procedure. Results: Gastrojejunal bypass produces the most significant weight loss. There is a significant decrease in intake in all groups. Hyperinsulinaemia and hyperglycaemia tend to decrease after surgery in all groups, but in ileal transposition there is better control of ketosis. After gastrojejunal bypass and ileal transposition, we observed an increase in GLP-1 levels but were only significant in ileal transposition. Conclusions: Ileal transposition produces a decrease in plasma glucose and better control of diabetes mellitus, which could benefit patients affected by morbid obesity and poor metabolic control. More studies are needed on other models of obesity. A model of exogenous and reversible obesity could be a good option to study the real benefits of the interventions (AU)

End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study.

REASONS FOR PERFORMING STUDY: Small intestinal resection and anastomosis is a relatively common procedure in equine surgical practice. This study was designed to test objectively the subjective opinions of surgeons at the Liphook Equine Hospital that an end-to-end jejuno-ileal anastomosis (JIA) is an effective and clinically justifiable procedure, contrary to conventional recommendations. HYPOTHESIS: An end-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end jejunojejunal anastomosis (JJA). METHODS: A retrospective observational study was performed on a population of 100 horses that had undergone small intestinal resection and end-to-end anastomosis. Two groups were identified; Group 1 (n = 30) had undergone an end-to- end JIA and Group 2 (n = 70) an end-to-end JJA. The 2 populations were tested for pre- and intraoperative comparability and for their equivalence of outcomes. RESULTS: The 2 populations were comparable in terms of their distributions of preoperative parameters and type of lesion present. The observations used as outcome parameters (incidence risk of post operative colic, incidence risk of post operative ileus, duration of post operative ileus, rates of functioning original anastomoses at the time of discharge and at 12 months, survival rates at 6 months and 12 months) were equivalent between the 2 groups. CONCLUSION: End-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end JJA. POTENTIAL RELEVANCE: Surgeons faced with strangulating obstructions involving the jejuno-ileal junction in which there remains an accessible length of viable terminal ileum may reasonably perform an end-to-end JIA. This has the potentially significant advantage over a jejunocaecal anastomosis of preserving more anatomical and physiological normality to the intestinal tract. The study was, however, relatively small for an equivalence study and greater confidence would be gained with higher numbers.

Bypass surgery for the treatment of small intestinal ileus in the horse. A report of three cases.

The medical management of three horses with simple and strangulating small intestinal obstructions was unsuccessful and was therefore supported by surgical bypasses. Jejunocecostomies were used to treat horses with postoperative paralytic ileus that was unresponsive to medical management. These horses had abdominal pain, gastric distention, heart rate elevations greater than 60/minute, and small intestinal distention on rectal palpation. Two horses experienced weight loss which responded to bypass removal. The bypass effectively decreased the need for intravenous fluid administration and repeated nasogastric intubation.