Effect of extensive ileal resection with a large resulting mesenteric defect and stapled ileal stump in horses with a jejunocaecostomy: a comparison with other anastomotic techniques

Extensive resection of the ileum of the horse, using automated stapling equipment followed by a stapled jejunocaecostomy, without closure of the mesenteric defect, was evaluated prospectively as a surgical treatment for lesions involving the distal small intestine. Of 153 horses treated surgically for colic, 10 horses with strangulating lesions involving the distal ileum were treated by extensive resection and jejunocaecal anastomosis leaving a residual mesenteric defect. These were compared with 12 horses with jejunoileal lesions treated by jejunocaecal anastomosis with closure of the mesentery, and 19 horses with distal jejunal lesions treated with an end-to-end jejunojejunal anastomosis and mesenteric closure. Long-term (> 7 months) and short-term survival, duration of surgery, length of intestine resected, time from completion of surgery until the horse first defaecated and the highest recorded postoperative plasma fibrinogen level were assessed. There were no significant differences between the surgical techniques for any of the assessed parameters, but there was a trend to significance with a higher death rate following discharge from the hospital when cases of jejunocaecal anastomosis with a residual mesenteric defect were compared to cases of end-to-end jejunojejunal anastomosis with closure of the mesentery (P = 0.06). This study suggests that a stapled distal ileal resection and jejunocaecal anastomosis leaving a residual mesenteric defect is a satisfactory technique when pathological changes necessitate resection of the distal ileum. However, in this study, jejunocaecal anastomosis with or without mesenteric closure produced inferior results compared to jejunojejunal anastomosis.