Evaluation of various gastrojejunostomy tube constructs for enteral support of small animal patients.

OBJECTIVE To evaluate the feasibility of manufacturing gastrojejunostomy tubes from jejunostomy and gastrostomy tubes that would allow for gastric and enteral feeding of and aspiration of gastric contents from small animal patients. DESIGN In vitro study. SAMPLE 9 gastrojejunostomy constructs. PROCEDURES Commercially available gastrostomy and jejunostomy tubes were combined to create 9 constructs. Three investigators tested each construct with 4 solutions (tap water, a commercial enteral diet, and 2 canned food-water mixtures) and 3 syringe sizes for ease of injection through the gastrostomy and jejunostomy tubes and aspiration through the gastrostomy tube. Flow rates were calculated and analyzed to evaluate effects of tube diameter and syringe size for each solution. RESULTS The 20F/8F, 24F/8F, 28F/8F, and 28F/10F (gastrostomy tube/jejunostomy tube) constructs allowed for injection and aspiration of all solutions. The 5F jejunostomy tubes allowed only water to be injected, whereas the 8F jejunostomy tubes did not allow injection of the canned food-water mixtures. The 20F/10F construct did not allow injection or aspiration through the gastrostomy tube, whereas the 18F/8F construct allowed injection but not aspiration through the gastrostomy tube. Faster flow rates through the gastrostomy tube were associated with larger gastrostomy tube diameter, smaller jejunostomy tube diameter, and smaller syringe size. Faster flow rates through the jejunostomy tube were associated with smaller jejunostomy tube diameter. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that homemade gastrojejunostomy constructs would allow for administration of a variety of enteral diets. Limitations to the administration and aspiration of various enteral diets as well as patient needs should be considered before a gastrojejunostomy tube combination is chosen.

Evaluation of jejunostomy tube feeding after abdominal surgery in dogs.

OBJECTIVE: To describe the use of postoperative intrajejunal feeding and to evaluate the association of preoperative plasma albumin concentrations with intrajejunal feeding-related complications and clinical outcome. DESIGN: Prospective, observational study. SETTING: University veterinary teaching hospital. ANIMALS: Sixty-four dogs. INTERVENTIONS: Jejunostomy tube placement during abdominal surgery. MEASUREMENTS AND MAIN RESULTS: Most dogs (81%) survived. The median intrajejunal feeding period was 2.1 days (range: 1-16 days; n = 64). Only 3 (5%) dogs received their estimated resting energy requirement by intrajejunal feeding. Of dogs that were fed intrajejunally (58 out of 64), most (55 out of 58) received intrajejunal feeding within 24 hours after surgery. Energy provision via the jejunal feeding tube did not differ between dogs with and without complications (P = 0.592), or between nonsurvivors and survivors (P = 0.298). Thirty-five dogs ate voluntarily concurrently with intrajejunal feeding. Of dogs that ate voluntarily concurrently with intrajejunal feeding for ≤50% of the postoperative period, most (74%) survived to discharge. Complications were seen in 22% of dogs, and none were life-threatening; gastrointestinal signs were most common. There was no difference in preoperative plasma albumin concentration between dogs with and without complications (P = 0.432) and between nonsurvivors and survivors (P = 0.727). Fecal score was not significantly different between the 2 liquid diets studied (FormulaV Enteral Care HLP and CliniCare Canine/Feline; P = 0.927). CONCLUSIONS: A jejunostomy tube placed during abdominal surgery was likely to be used at the study institution. Few complications were seen and none were life-threatening. Intrajejunal feeding was initiated early after surgery and did not interfere with the initiation of voluntary oral intake. Fecal scores were high and were useful for an objective assessment of fecal consistency in dogs with intrajejunal feeding.

In vitro evaluation of bursting pressure and intestinal luminal area of three jejunostomy tube placement techniques in dogs.

OBJECTIVE: To compare pursestring, Witzel (seromuscular inversion), and seromuscular incision jejunostomy tube placement techniques in vitro. SAMPLE: Jejunal specimens from 10 dogs. PROCEDURES: Jejunal segments (50 cm) were harvested immediately prior to euthanasia from 10 mixed-breed dogs Specimens were harvested with the orad and aborad ends clamped and stored in saline (0.9% NaCl) solution-soaked towels during instrumentation. Three jejunostomy tubes were placed via 3 techniques (pursestring, Witzel, and seromuscular incision), and 2 double lumen central venous catheters were placed at each intestinal end for luminal filling and leak testing. Intestinal luminal area was measured ultrasonographically with specimens suspended in a warm undyed saline solution bath with the intestinal lumen filled with dyed saline solution (intraluminal pressure, 6 mm Hg). Leak testing was performed by means of infusion of dyed saline solution (4 mL/min) until each jejunostomy site failed. Intestinal luminal area and leakage pressure were compared between the 3 tube placement techniques. RESULTS: The Witzel and seromuscular incision techniques decreased the intestinal luminal area measured at the tube insertion site, albeit nonsignificantly. For the seromuscular incision technique, a significant decrease in intestinal luminal area at the intraluminal site of measurement was found. For 2/30 specimens (1/10 pursestring and 1/10 seromuscular incision), failure occurred at pressures within the range of previously reported peak peristaltic pressure for dogs. Failure occurred at supraphysiologic peristaltic pressures for the remaining 28 specimens, including all 10 specimens for the Witzel technique. CONCLUSIONS AND CLINICAL RELEVANCE: In this in vitro study, all specimens for the Witzel technique withstood physiologic peristaltic pressures during leak testing. Both tunneling techniques (Witzel and seromuscular incision) created a decrease in intestinal luminal area. Further investigation, including in vivo testing, is indicated to evaluate the clinical relevance of these findings.

Evaluation of the effect of onlay mesenteric flaps on end-to-end jejunojejunostomy healing in horses.

OBJECTIVE: To evaluate the effect of onlay mesenteric flaps (MFs) with end-to-end jejunojejunostomy on stomal diameter, length of jejunum with reduced stomal diameter, abdominal adhesion formation, and healing. STUDY DESIGN: Experimental study. ANIMALS: Healthy adult horses (n = 6). METHODS: Two hand sewn end-to-end jejunal anastomoses using a 1 layer simple continuous serosubmucosal suture pattern were performed in each horse ∼ 2 and 5 m oral to the ileocecal fold. Using a random design for selection anastomosis location (oral or aboral), 1 anastomosis was covered with 2 adjacent onlay MFs secured with interrupted sutures and cyanoacrylate glue. Two weeks later, adhesion formation, stomal diameter, length of reduced jejunal stomal diameter, and healing were evaluated. RESULTS: Use of onlay MFs decreased stomal diameter (P = .05), increased length of reduced peristomal jejunal diameter (P = .05), surgical time (P = .003), and serosal fibrosis (P = .05). No difference was evident for adhesion formation, and degree of inflammation between techniques. CONCLUSION: End-to-end jejunojejunostomy covered with 2 onlay MFs is not recommended because this technique results in luminal reduction.

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.

Effect of intraperitoneal PERIDAN™ concentrate adhesion reduction device on clinical findings, infection, and tissue healing in an adult horse jejunojejunostomy model.

OBJECTIVE: To evaluate the effect of PERIDAN™ Concentrate on clinical findings, infection, and tissue healing in adult horses undergoing celiotomy and jejunojejunostomy. STUDY DESIGN: Block randomized blinded experimental in vivo study. ANIMALS: Adult horses (n = 12). METHODS: Horses had jejunojejunostomy at 2 sites and were administered 5 L of diluted PERIDAN™ Concentrate (6 horses) or Lactated Ringer's Injection (LRS) control intraperitoneally (6 horses) before body wall closure. Postoperative monitoring comprised physical examinations, serial hematology, coagulation and chemistry panels, and ultrasonographic examination. Horses were euthanatized 10 days postoperatively. Anastomoses and linea alba incisions were tested for mechanical strength; and tissue healing, inflammation, and infection were assessed by histological evaluation. Data were analyzed using a mixed model ANOVA. Level of significance was P < .05. RESULTS: No physical examination differences were observed between groups. Statistically significant differences were observed in leukocyte and neutrophil counts, prothrombin time, antithrombin III activity, intestinal bursting pressures, and histologic healing grade in the mid region of the linea alba. These differences were minimal, and of no observable clinical significance. Other blood variable and histologic differences between groups were not significant. CONCLUSIONS: PERIDAN™ Concentrate was safely administered intraperitoneally to healthy horses undergoing celiotomy and anastomosis.

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.

REASONS FOR PERFORMING STUDY: Although experimental studies have demonstrated differences in performance between methods for handsewn jejunojejunostomy in horses, information on clinical results after different methods of anastomosis are rare. HYPOTHESIS: A continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane would perform better than an interrupted Lembert pattern for jejunojejunostomy in horses. METHODS: Data was reviewed on 32 horses that underwent jejunojejunostomy from 1993-2002. Kaplan-Meier analyses and rates for post operative colic and death were used to compare outcomes after an interrupted Lembert pattern (15 horses with strangulating lesions and 5 horses with nonstrangulating lesions) and a continuous Lembert pattern with membrane (12 horses with strangulating diseases). RESULTS: None of the 32 horses had post operative ileus or post operative endotoxaemia. One horse with a continuous pattern required a repeat celiotomy for anastomotic impaction. Short-term survivals for the interrupted Lembert were 100% (nonstrangulating lesions) and 93% (strangulating lesions) and for the continuous pattern 92% (all strangulating). Long-term rates for mortality and colic episodes were less for the continuous Lembert pattern with membrane compared with the interrupted Lembert for strangulating lesions (P<0.05) and were less for strangulating lesions than for nonstrangulating lesions (P<0.05). For strangulating lesions, Kaplan-Meier analyses yielded a survival probability of 70% for up to 9 years after the interrupted Lembert pattern and 80% for up to 5 years for the continuous Lembert pattern. CONCLUSIONS AND RELEVANCE: Both Lembert patterns performed well in clinical use, although the continuous pattern with the carboxymethylcellulose and hyaluronate membrane had superior long-term outcomes with less colic and mortality from colic.

Effects of mosapride on motility of the small intestine and caecum in normal horses after jejunocaecostomy.

The purpose of the present study was to evaluate the prokinetic effects of mosapride with non-invasive assessment of myoelectrical activity in the small intestine and caecum of healthy horses after jejunocaecostomy. Six horses underwent celiotomy and jejunocaecostomy, and were treated with mosapride (treated group) at 1.5 mg/kg per osos once daily for 5 days after surgery. The other six horses did not receive treatment and were used as controls (non-treated group). The electrointestinography (EIG) maximum amplitude was used to measure intestinal motility. Motility significantly decreased following surgery. In the treated group, the EIG maximum amplitude of the small intestine was significantly higher than in the controls from day 6 approximately 31 after treatment. These findings clearly indicate that mosapride could overcome the decline of intestinal motility after jejunocaecostomy in normal horses.

Cirugía endoscópica transluminal NOTES: resultados experimentales iniciales / Natural orifice transluminal endoscopic surgery (NOTES): initial experimental results

Introducción: La aparición de la cirugía endoscópica transorificial (NOTES) y de nuevos prototipos para su realización nos llevó a diseñar un programa de cirugía experimental. Material y métodos: Se ha realizado durante 1 año cirugía de NOTES en cerdas, cumpliendo la normativa europea de experimentación animal. Se han practicado 90 intervenciones sin supervivencia animal. En este estudio se ha evaluado: a) complejidad de las vías de acceso (transgástrica, transvaginal, transesofágica y transumbilical); b) técnicas de ayuda para la orientación temporoespacial, y c) posibilidades técnicas de cierre de los orificios viscerales (clips, t-bars®, clips de Obesco® y sutura por endoscopia). Las intervenciones practicadas mediante uno o dos endoscopios han sido: anexectomía, colecistectomía, biopsia de adenopatías mediastínicas, pancreatectomía distal y gastroyeyunostomía. Resultados: Esta experiencia nos ha permitido conocer una serie de aspectos técnicos imprescindibles para el desarrollo del NOTES: a) el neumoperitoneo con CO2 es más seguro para la entrada; b) el tamaño del orificio es importante para limitar la contaminación; c) la entrada con punción y dilatación con guía es más segura; d) la buena localización de la salida gástrica facilita el abordaje de las vísceras a disecar; e) la hemorragia intrabdominal es de difícil control; f) el cierre con garantías absolutas de fuga no existe, los clips no lo garantizan, los t-bars® y clips de Obesco® y la sutura endoscópica pueden funcionar, y g) la posibilidad de utilizar endoscopios que triangulan facilita la disección. Conclusiones: La NOTES requiere de un equipo multidisciplinario con cirujanos laparoscopistas y endoscopistas. La realización de NOTES pura es compleja; posiblemente las formas híbridas o la vía transumbilical sean fases intermedias (AU)

Introduction: The advent of natural orifice endoscopic surgery (NOTES) and new prototypes for performing this surgical procedure led us to design an experimental animal surgical programme. Material and method: NOTES was performed over a period of one year, in sows, following the European guidelines on the use of experimental animals. Ninety operations were performed with no animals surviving. The following aspects were assessed: 1. Access route complexity (transgastric, transvaginal, transesophageal and transumbilical). 2. Support measures for temporal/spatial orientation. 3. Technical possibilities for visceral orifice closure (clips, T-bars®, Obesco® clips and endoscopic suture). Resections of fallopian tubes, ovaries, gallbladder, mediastinal lymph nodes, tail of the pancreas and gastrojejunal derivations were performed with one or two endoscopes. Results: This experience enabled us to highlight a series of technical aspects essential for these techniques: 1. Pneumoperitoneum with CO2 is safer for entry. 2. Orifice size is important to limit contamination. 3. Puncture entry and guided dilation is safer. 4. Good gastric exit location makes it easier to approach viscera to be resected. 5. Intra-abdominal haemorrhage is difficult to control. 6. Leak-free closure cannot be guaranteed with clips, but t-bars® and Obesco® clips may be effective. 7. Endoscopes that permit triangulation may facilitate the dissection and endoscopic suture. Conclusions: NOTES requires a multidisciplinary team comprising laparoscopic and endoscopic surgeons. Pure NOTES is complex and hybrid forms or transumbilical route could be intermediate steps (AU)

Effects of mosapride on motility of the small intestine and caecum in normal horses after jejunocaecostomy

The purpose of the present study was to evaluate the prokinetic effects of mosapride with non-invasive assessment of myoelectrical activity in the small intestine and caecum of healthy horses after jejunocaecostomy. Six horses underwent celiotomy and jejunocaecostomy, and were treated with mosapride (treated group) at 1.5 mg/kg per osos once daily for 5 days after surgery. The other six horses did not receive treatment and were used as controls (non-treated group). The electrointestinography (EIG) maximum amplitude was used to measure intestinal motility. Motility significantly decreased following surgery. In the treated group, the EIG maximum amplitude of the small intestine was significantly higher than in the controls from day 6~31 after treatment. These findings clearly indicate that mosapride could overcome the decline of intestinal motility after jejunocaecostomy in normal horses.

Comparison of different tube materials and use of Chinese finger trap or four friction suture technique for securing gastrostomy, jejunostomy, and thoracostomy tubes in dogs.

OBJECTIVE: To compare Chinese finger trap (CFT) and 4 friction suture (FFS) techniques to secure gastrostomy (GT), jejunostomy (JT), and thoracostomy (TT) tubes of different materials. STUDY DESIGN: Prospective experimental study. ANIMALS: Canine cadavers (n=20). METHODS: Randomly, GT (n=20), JT (20), and TT (20) were inserted using 2 different suture techniques (10 for each tube type) and either silicone or another material (10 for each type). Axial distraction was applied to each tube until failure. Force and displacement to failure and failure mode were recorded and compared between techniques and materials for GT, JT, and TT. RESULTS: CFT failed most commonly by suture breakage whereas FFS failed mainly by tube slippage (P=.003). For GT, failure occurred more commonly by tube slippage (n=15; P<.001) whereas tube breakage was more common for JT (n=10; P<.001) and suture breakage for TT (n=14; P=.022). Silicone had higher force to failure than latex with GT, lower force to failure than red rubber with JT, and lower displacement to failure than polyvinylchloride with TT. CONCLUSIONS: Different failure modes occurred for CFT (suture breakage) and FFS (tube slippage) and among different tube types (tube slippage with GT, tube breakage with JT, and suture breakage with TT). Based on study results, CFT is preferred to FFS for anchoring silicone GT and TT. Silicone GT, red rubber JT, and polyvinylchloride TT were more secure than latex GT, silicone JT, and silicone TT, respectively. CLINICAL RELEVANCE: CFT should be preferred over FFS based on force and displacement to failure, but tube type and tissue reaction could influence anchoring strength.

Evaluation of equine cecal motility by ausculation, ultrasonography and electrointestinography after jejunocecostomy.

OBJECTIVE: Horses often suffer reduced intestinal motility after jejunocecostomy. Therefore, accurate evaluation of intestinal motility is important for the prevention, diagnosis and treatment of this condition. The purpose of this study was to evaluate intestinal motility in horses after jejunocecostomy using three different methods, i.e. auscultation, ultrasonography and electrointestinography. ANIMALS: Six healthy thoroughbreds were used in this study. They were subjected to jejunocecostomy. PROCEDURE: Bowel sounds in the right paralumbar fossa were assigned a score of 0-3 for intestinal motility evaluation by auscultation, and the number of cecal contractions during a 3-min period were counted by ultrasonography. Electrointestinography (EIG) was used to measure percutaneous potential of the cecum. RESULTS: We identified three specific postoperative periods: the period of reduced intestinal motility (postoperative day 1 to day 2), in which intestinal motility declined, the unstable period (day 3 to day 7), in which intestinal motility partially recovered, and the full recovery period (day 8 to day 31), in which intestinal motility returned to preoperative state. Careful management was found to be especially important during the period of reduced intestinal motility and the unstable period. We found that, in healthy horses that underwent jejunocecostomy, it takes approximately one month for the cecum to return to normal motility patterns observed before surgery. CONCLUSION: We have shown in this study that evaluation of intestinal motility after jejunocecostomy in horses by EIG is more objective and provides more details than evaluation by auscultation or ultrasonography.

In vitro evaluation of a closed-bowel technique for one-layer hand-sewn inverting end-to-end jejunojejunosotomy in the horse.

OBJECTIVE: To report a technique for closed-bowel 1-layer inverting end-to-end jejunojejunal anastomosis in horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Fresh cadaveric jejunal segments from 12 horses. METHODS: For each bowel segment a 1-layer closed and a 2-layer inverting end-to-end jejunojejunosotomy was created. Anastomosis construction time and anastomotic bursting pressure were measured and compared. RESULTS: Closed-bowel anastomosis was significantly faster to create than a 2-layer technique. Luminal narrowing (<30%) was similar with both techniques and comparable with other inverting techniques. Bursting pressure was significantly higher for the 2-layer technique, although all anastomoses resisted pressures higher than those reported for other jejunojejunal anastomosis techniques. CONCLUSIONS: A 1-layer hand-sewn, closed, inverting jejunojejunosotomy using a modified Doyen clamp was easy and faster to perform, and resulted in functional characteristics similar to, a 2-layer hand-sewn inverting technique. CLINICAL RELEVANCE: A closed, 1-layer inverting technique could be considered for equine jejunal anastomosis but requires in vivo evaluation before recommendation for clinical use.

Use of laparoscopic-assisted jejunostomy for fecal diversion in the management of a rectocutaneous fistula in a dog.

A 2-year-old female Siberian Husky was referred for evaluation of a rectocutaneous fistula of unknown etiology. On evaluation, a rectal tear and an associated perivulvar abscess and draining tract were identified. Several attempts were made to repair the rectocutaneous fistula and associated rectal tear. Primary repair and fascia lata graft repair failed. Successful management was achieved via a laparoscopic-assisted end-on jejunostomy for fecal diversion, and the wound healed readily by second intention. During the period of hospitalization, the dog lost a considerable amount of weight. Particular care should be taken regarding fluid therapy, administration of antimicrobials, and adequate nutrition in patients with rectocutaneous fistulas. Overall, the use of laparoscopic-assisted end-on jejunostomy for fecal diversion in the management of rectocutaneous fistulas in dogs appears to be feasible; end-on or loop jejunostomy may also be an option for the treatment of other diseases of the distal portion of the gastrointestinal tract.

Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs.

OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.

Placement of jejunal feeding tubes for post-gastric feeding.

In veterinary patients, postgastric feeding is indicated for uncontrollable gastric vomiting, gastroparesis, biliary tract disease, pancreatitis, and for patients at increased risk for aspirating secondary to decreased mentation, prolonged recumbency, or an unprotected airway. Postgastric feeding may be implemented via the placement of a jejunal feeding tube. These tubes can be placed surgically (jejunostomy tubes) or with fluoroscopic or endoscopic guidance. This article will focus on methods of jejunal feeding-tube placement, advantages and disadvantages of the methods described, and complications associated with jejunal feeding.

A comparison of the mechanical strength of two stapled anastomosis techniques for equine small intestine.

OBJECTIVE: To compare bursting strength, time of construction, and cost of a closed one-stage, stapled functional end-to-end jejunojejunostomy (FEE) with a stapled side-to-side jejunojejunostomy (STS). STUDY DESIGN: Experimental, randomized block design. ANIMALS: Seven adult horses without gastrointestinal disease. METHODS: The jejunum was isolated, and three FEE, three STS, and three control segments were created in each horse using a randomized block design. Anastomosis time was recorded. The intraluminal pressure at failure and mode of failure were recorded. Length at failure was measured on digitized images. Bursting pressure (BP), bursting wall tension (BWT), anastomosis time, and cost were compared. RESULTS: Control jejunal segments were stronger (P < or = .0001) in bursting strength and bursting wall tension (P < or = .0001) than either anastomosis type; no difference was found between anastomosis types for either variable. Functional end-to-end jejunojejunostomy was significantly quicker and less costly than STS (P < or = .0001). CONCLUSIONS: Mechanically there were no significant differences between the FEE and STS techniques. The FEE technique maintained the physiologic direction of peristalsis of the segments, required less tissue manipulation, and was faster and more economical to create. CLINICAL RELEVANCE: The FEE is a clinically viable technique.

Treatment of irreducible caecocolic intussusception in horses by jejuno(ileo)colostomy.

Six of eight horses with caecocolic intussusception were treated successfully by jejuno- or ileocolostomy. The other two horses were euthanased during surgery. Four of the six horses survived long term, but two died within two-and-a-half months, of problems related to the surgery. Compared with other techniques for treating caecocolic intussusception, jejuno- or ileocolostomy reduces surgical time and decreases the risk of abdominal contamination.

Successful treatment of feline pancreatitis using an endoscopically placed gastrojejunostomy tube.

A cat with pancreatitis, diagnosed using abdominal ultrasonography, fine-needle aspirate cytopathology, and increased concentration of serum trypsin-like immunoreactive substance, was treated successfully using jejunal alimentation provided through a percutaneous gastrojejunostomy tube. This method of jejunal feeding is less technically difficult, less stressful for the patient, and has fewer complications than surgically placed jejunostomy tubes. Nutritional support with jejunal feeding is superior to total parenteral nutrition, as it maintains gut integrity, decreases septic complications, and may reduce exogenous insulin requirements. The methods of tube insertion and maintenance, and the physiological advantages over other feeding methods are described.

Interlocking box jejunostomy: a new technique for enteral feeding.

A new jejunostomy tube placement technique is described and compared to traditional methods. The interlocking box technique was compared to a simple purse-string with jejunopexy and an inverting serosal tunnel (Witzel technique) with jejunopexy. Procedures performed in fresh canine cadavers were fluid pressure tested following tube removal. Mean+/-standard deviation (SD) intraluminal pressure necessary to induce leakage at the jejunopexy site of the interlocking box group (87.63+/-40.56 cm H2O) was significantly greater (p less than 0.001) than the simple purse-string (43.17+/-31.69 cm H2O) and serosal tunnel (46.33+/-23.60 cm H2O) groups. Significant differences were not identified between the latter groups. The interlocking box technique resisted leakage following acute removal better than conventional techniques and should be tested clinically.