title: Clinical comparison between a continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane with an interrupted Lembert pattern for one-layer jejunojejunostomy in horses.
abstract: BACKGROUND
  Although experimental studies have demonstrated differences in performance between methods for handsewn jejunojejunostomy in horses, information on clinical results after different methods of anastomosis are rare.
  
  
  OBJECTIVE
  A continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane would perform better than an interrupted Lembert pattern for jejunojejunostomy in horses.
  
  
  METHODS
  Data was reviewed on 32 horses that underwent jejunojejunostomy from 1993-2002. Kaplan-Meier analyses and rates for post operative colic and death were used to compare outcomes after an interrupted Lembert pattern (15 horses with strangulating lesions and 5 horses with nonstrangulating lesions) and a continuous Lembert pattern with membrane (12 horses with strangulating diseases).
  
  
  RESULTS
  None of the 32 horses had post operative ileus or post operative endotoxaemia. One horse with a continuous pattern required a repeat celiotomy for anastomotic impaction. Short-term survivals for the interrupted Lembert were 100% (nonstrangulating lesions) and 93% (strangulating lesions) and for the continuous pattern 92% (all strangulating). Long-term rates for mortality and colic episodes were less for the continuous Lembert pattern with membrane compared with the interrupted Lembert for strangulating lesions (P<0.05) and were less for strangulating lesions than for nonstrangulating lesions (P<0.05). For strangulating lesions, Kaplan-Meier analyses yielded a survival probability of 70% for up to 9 years after the interrupted Lembert pattern and 80% for up to 5 years for the continuous Lembert pattern.
  
  
  CONCLUSIONS
  Both Lembert patterns performed well in clinical use, although the continuous pattern with the carboxymethylcellulose and hyaluronate membrane had superior long-term outcomes with less colic and mortality from colic.
authors.affiliation: Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, FL, USA. freemand@ufl.edu
authors.forename: D E
authors.initials: DE
authors.lastname: Freeman
authors.forename: D J
authors.initials: DJ
authors.lastname: Schaeffer
mesh_terms: D000375:Aging; D000818:Animals; D002266:Carboxymethylcellulose Sodium; D005767:Gastrointestinal Diseases / Q000601:surgery / Q000662:veterinary; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses; D006820:Hyaluronic Acid; D007582:Jejunostomy / Q000379:methods / Q000662:veterinary*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000662:veterinary*
chemical_list: D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium