An ex vivo comparison of jejunal transection angles and the effect on lumen diameter following end-to-end jejunojejunal anastomoses.

Abstract

Objective: To evaluate three different jejunal transection angles for end-to-end jejunojejunostomies, comparing construction time, lumen size, and suture number.

Study design: Ex vivo cadaver study.

Sample population: Eight euthanized horses each had three mid-jejunal specimens harvested.

Methods: Jejunal segments were assigned to one of three groups (A30, A45, and A60) and transected at 30, 45, or 60°, respectively. Following transection, a standardized handsewn single-layer interrupted modified Lembert anastomosis was performed, and construction time and number of sutures placed were recorded. Anastomotic index (AI) was calculated. Statistical analysis was performed using a one-way ANOVA. Statistical significance was set at p < .05.

Results: Transected jejunal lengths increased as the transection angle decreased (p < .001). Anastomoses construction time was not different between groups (p = .301). The number of sutures required to complete the anastomosis was higher (p = .026) for A30 compared to A60 but was not different between A60 and A45 or A45 and A30 (p > .333). Mean AI were 93.37, 114.29, and 135.07 for groups A60, A45, and A30 and the AI increased as the transection angle decreased (p < .001).

Conclusion: A 60° transection angle reduced lumen size at the anastomosis but a 45 and 30° transection angle resulted in an increased lumen size at the anastomosis. The 45° angle did not increase the number of sutures required. The 30° angle significantly increased the number of sutures required.

Clinical significance: A 45° angle of transection does not result in increased surgical time or number of sutures placed. Further investigation is required to determine the ideal angle of transection.