Initial evaluation of a technique for complete cecal bypass in the horse.

Abstract

OBJECTIVE: To describe a novel stapling technique for creation of a complete cecal bypass, without ileal transection in horses. STUDY DESIGN: Experimental study. ANIMALS: Four adult horses. METHODS: Through a ventral median celiotomy, jejunocolostomy was made with an intraluminal anastomosis device (ILA-100) and oversewn with a Cushing pattern to reinforce the staple line. Immediately distal to the anastomosis, 4 rows of staples were applied using a thoracoabdominal stapling device (TA-90) to occlude the lumen of the distal jejunum and proximal ileum. Necropsy exams were performed at least 60 days after surgery. RESULTS: No intraoperative complications occurred. Cecal bypass was functional in all horses at necropsy. The most oral staple line across the ileum partially failed in 1 horse; however cecal bypass was functional. CONCLUSIONS: Complete cecal bypass without ileal transection is a viable alternative to traditional methods of complete cecal bypass. Two sets of staple lines across the ileum are recommended. Longer term follow-up is warranted before clinical use of this technique. CLINICAL RELEVANCE: Cecal bypass without ileal transection is technically simple and effectively bypasses the cecum. It also should intuitively require less time and have a reduced risk of contamination compared with complete cecal bypass with ileal transection.