Ex vivo bursting pressure evaluation of three suture methods in equine small colon enterotomy

Small colon enterotomy is commonly performed to remove impactions caused by fecaliths, enteroliths or foreign bodies. A two-layer suture technique is frequently used; however, it may increase operative time and contribute to luminal restriction. The objective of this study is to evaluate three enterotomy closure techniques on the equine small colon, comparing time to completion, bursting pressure, luminal restriction and rupture location. Small colons from five slaughtered horses were obtained within six hours of death and divided into 40 cm segments. Two surgeons performed a 10 cm full thickness enterotomy on randomly assigned segments, which were closed using one of three techniques: 1-layer continuous Lembert, 1-layer interrupted Lembert or 2-layers simple continuous followed by Cushing, using 2 − 0 polydioxanone. Bursting pressure was evaluated using an arthroscopy pump at 1 L/min and a digital manometer. Methylene blue was infused until leakage or rupture was observed. Luminal restriction was assessed by measuring luminal width at the closure and at an adjacent unaffected site. Most segments (77%) ruptured at the taenia-serosal interface. No significant difference was found in bursting pressure (mmHg) or luminal restriction among experimental groups ( p = 0.97; p = 0.2). Time to completion was significantly different among groups ( p = 0.03), with the 1-layer continuous Lembert closure being significantly faster than both the interrupted Lembert and 2-layer closures. The single-layer continuous Lembert technique required less time than the other techniques while achieving comparable bursting pressure and luminal restriction under these ex vivo conditions. Further studies are required to determine whether these findings translate to clinical practice.