Ex vivo evaluation of a technique for equine jejunocecal anastomosis using radiofrequency thermofusion and a Cushing oversew

• Published in: Veterinary surgery Vol. 52; no. 4; pp. 545 - 553
• Main Authors: Gandini, Marco, Cerullo, Anna, Gallo, Livio, Iussich, Selina, Minoli, Lucia, Giusto, Gessica
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-05-2023; Blackwell Publishing Ltd
• Subjects: Adrenocorticotropic hormone; Anastomosis; Anastomosis, Surgical - methods; Anastomosis, Surgical - veterinary; Animals; Bursting pressure; Damage; Histology; Horses; Horses - surgery; Intestine; Intestine, Small; Intestines; Nervous system diseases; Pituitary; Population studies; Pressure; Radio frequency; Surgical Stapling - veterinary; Suture Techniques - veterinary; Sutures
• ISSN: 0161-3499; 1532-950X
• DOI: 10.1111/vsu.13946

Objective
To describe a technique for a side‐to‐side jejunocecal anastomosis in horses using radiofrequency thermofusion (TF) of the intestines supported by a Cushing oversew and to compare this anastomosis to handsewn and stapled techniques.
Study design
Ex vivo study.
Sample population
Intestinal tracts from 24 slaughtered horses.
Methods
A radiofrequency device was used to perform a jejunocecal anastomosis (Group RFA). The construction time and bursting pressure of this construct were compared with those of a hand‐sewn double layer (Group HS) and stapled anastomoses (Group ST) without oversew of the staple line. Histology was also performed for the TF anastomoses to evaluate the extent of the thermal damage.
Results
The median (range) construction time (min) for the TF (15.8 [14.4‐16.8]) was not significantly different from that for the HS (25.5 [24.2‐26.3]) and ST (10.8 [9.7‐12.5]) groups (p = .07). The construction time for ST was shorter than that for HS group (p < .001). The average (standard deviation) bursting pressure (mmHg) for HS (153.1 +/− 17.5) was higher than that for RFA (76 +/− 15) and ST groups (48 +/− 13; p < .001). The bursting pressure of the RFA was higher than that of the ST anastomoses (p = .001). The thermal damage caused by the device was within the suture oversew in the deeper layers, whereas it extended a few mm beyond the suture line in the serosa.
Conclusion
Radiofrequency assisted anastomoses provide similar construction times to current techniques and have a higher bursting pressure than ST anastomoses.
Clinical significance
Radiofrequency‐assisted anastomoses with a suture oversew demonstrated comparable bursting pressures to ST anastomoses. The use of the radiofrequency device on the intestine is extra label and causes serosal tissue damage, which may increase the risk of adhesions.