Equine intestinal anastomotic techniques

The focus of this presentation will be anastomotic techniques in the small intestine, as these are the most frequently used by most equine surgeons. There are numerous different techniques that can be used, with advantages of some including greater bursting strength or a more rapid technique. However, by far the most important factor is to become comfortable with a specific technique and to use that technique consistently. This includes knowledge of the weaknesses of the chosen technique so that postoperative complications can be avoided.

Small intestinal resection
The initial consideration is the method used to resect the small intestine. This should include an organized approach to exploring the length of the small intestine, how to correct the strangulation, and how to decompress the small intestine. Whenever possible, the small intestine should always be explored from the ileocolic ligament proximally to the duodenocolic fold. As the strangulating lesion is encountered working up from the ileum, such as a strangulating lipoma or entrapment within the epiploic foramen, it is corrected followed by continued exploration of the small intestine. The most difficult lesions to work with are those directly involving the ileum, including ileocecal intussusceptions in which the ileum is not available for exploration. This will necessitate freeing the ileum from the strangulating lesion, or in the case of an intussusception, exploring the remainder of the small intestine in preparation for decompression. The small intestine can be decompressed in two general ways: 1) decompression along the length of the small intestine into the cecum or 2) decompression though an enterotomy. If the small bowel is to be decompressed into the cecum, the surgeon should make sure that there is only a limited quantity of fluid or that the majority of the distension is gas. This is because an overly full cecum is problematic to work with, particularly considering jejunocecal anastomosis. Therefore, one of the simplest options is to decompress the small intestine through the site of the resection, making sure to support the bowel at the site of decompression so that it does not put excessive tension on the mesentery.  [...]