Suture anastomosis. An experimental study using limited suturing of the small bowel in the dog

Intestinal surgery in small animals: historical foundations, current thinking, and future horizons

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra-abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.

Técnicas de sutura do tubo digestivo em plano único total, em jejuno de cães: pontos de Gambee com nós atados na serosa versus pontos totais atados no lume, sobre a mucosa

OBJETIVO: Comparar a sutura do tubo digestivo em plano único com pontos totais simples versus pontos especiais de Gambee. MÉTODOS: Foram operados seis cães machos, sem raça definida, pesando entre 7 e 12 kg, anestesiados com pentobarbital sódico a 30 mg/kg. Foi realizada secção transversa do jejuno, a 30 cm da flexura duodenojejunal, seguida de anastomose término-terminal com a técnica de sutura em plano único total descrita por Gambee, sendo a metade anterior da anastomose suturada com nós atados na superfície serosa e a metade posterior com nós atados sobre a camada mucosa, no lume do órgão. Foram utilizados pontos simples separados de polipropileno monofilamentar azul 4-0, pré-montados em agulha de 2 cm (3/8 de círculo), intervalados de 3 mm. No 7º dia pós-operatório os animais foram sacrificados e necropsiados. Foram analisadas as aderências na linha de sutura mediante um escore e feita análise macroscópica e microscópica , inclusive histometria. RESULTADOS: As aderências peritoneais se equivaleram em ambas as faces da anastomose.O exame macroscópico da linha de sutura mostrou boa regeneração serosa. Na microscopia observava-se permanência de fenômenos inflamatórios agudos em ambas as suturas. O realinhamento, a reestruturação e a regeneração das camadas foram adequadas em todo o perímetro da anastomose. Na morfometria, os polimorfonucleares, os macrófagos, os fibroblastos e as fibras colágenas se equivaleram nas duas metades comparadas da anastomose. CONCLUSÃO: A reparação do tubo digestivo na região anastomótica em plano único total pela técnica de Gambee se faz de forma similar, quer tenham sido utilizados pontos de sutura especiais de Gambee ou pontos totais simples. Dessa forma, é indiferente a utilização de um ou de outro tipo de sutura aqui estudado, dependendo exclusivamente da preferência do cirurgião.

Non-suture anastomosis: the historical development

A wide range of devices for uniting the bowel has been invented. These are ligatures, prostheses, adhesives and staples. Denans' rings and Henroz' articulated rings were described in 1826, and Murphy's anastomosis button in 1892. Modern stapling began with Hültl in 1908 and Petz in 1924. Sophisticated stapling instruments were invented in Moscow by Androsov and others between 1950 and 1960. These were modified by Ravitch to produce, in 1967, a safe, disposable, presterilized, preloaded, interchangeable cartridge in a light instrument. The value of stapling is now beyond dispute.

A view of the development of intestinal suture. Part II. Principles and techniques

During the 19th century, the principles of suturing and operating upon the bowel were developed. Lembert published his technique, emphasizing the importance of the serosa in 1826. This brought about sudden transition from the ancient methods of intestinal surgery. Considerable controversy followed. Dieffenbach reported the first clinical success with this suture in 1836. Lister introduced aseptic sutures and the principles of antisepsis to the intestine which allowed the subsequent developments. The importance of the submucosa in anchoring a stitch, so that divided surfaces could stay opposed, was drawn to surgeons' attention by Gross and by Halsted. Mall described the histologic changes and pointed out that necrosis would occur if sutures were too close or too tight. More than 200 modifications were described by the beginning of the 20th century. During the 1950s, everting suture was compared with inverting anastomoses, and the safety of this method was realized.