Comparison between Gallbladder Serosal and Mucosal Patch in Duodenal Injuries Repair in Dogs

Management of the complex duodenal injury

INTRODUCTION

Complex duodenal trauma is a rare injury with an incidence of 1-4.7% of all abdominal trauma. Historically, varied approaches have been used in the management of these complex injuries and the prevention of complications. This is a review of the current management methodology of complex duodenal injury.

METHODS

A review of the medical literature to include the past and current management of duodenal trauma was performed. Google scholar (1970-2022) and PubMed (1970-2022) were searched using the keywords: complex duodenal trauma, surgical management, and duodenal complications.

DISCUSSION

Complex duodenal trauma can be classified using the AAST grading scale as those encompassing grades III-V. Multiple studies and review articles characterize the difficulty in managing complex duodenal injuries. The tenets of operative management of duodenal trauma include the decision for damage control, resection of non-viable tissue, restoring gastrointestinal continuity, diversion of gastrointestinal contents, bile and pancreatic enzymes, allowing the repair to heal, and providing feeding access. The variety of both historic and current approaches attempt to address these tenets. The incidence of complications are as high as 65% with the most common complications including abscess formation, suture line dehiscence and fistula formation. The overall mortality ranges from 5 to 30%.

CONCLUSIONS

Many different approaches and strategies have been proposed to repair complex duodenal injuries, all of which address important tenets of its management. The risk of complications remains high, therefore, it is vital to have a thoughtful and multidisciplinary approach when treating these injuries.

Comparison of a simple continuous versus simple interrupted suture pattern for the repair of a large, open duodenal defect with a jejunal serosal patch in a canine cadaveric model

OBJECTIVE

To determine whether jejunal serosal patches could securely seal large, open defects in duodenal segments harvested from canine cadavers and to compare intraluminal pressures at which leakage first occurred and maximal intraluminal pressures for repaired duodenal segments between 2 suture patterns.

SAMPLE

Duodenal and jejunal segments from 9 canine cadavers.

PROCEDURES

20 constructs were created through repair of large, open duodenal defects with circumferential suturing of an intact jejunal segment (jejunal serosal patch). Constructs were randomly assigned to have the serosal patch anastomosed to the duodenal segment by a simple continuous or simple interrupted suture pattern. The pressure at which the first leakage was observed and the maximum pressure obtained during testing were recorded and compared between suture patterns.

RESULTS

Initial leakage pressure was significantly higher with the simple interrupted pattern (mean ± SD, 68.89 ± 5.62 mm Hg), compared with the simple continuous pattern (59.8 ± 20.03 mm Hg). Maximum intraluminal pressures did not significantly differ between the simple interrupted (91 ± 8.27 mm Hg) and simple continuous patterns (90.7 ± 16.91 mm Hg). All constructs, regardless of suture pattern, withstood supraphysiologic pressures.

CONCLUSIONS AND CLINICAL RELEVANCE

Jejunal serosal patches adequately sealed large, open duodenal defects and prevented leakage in these constructs. Constructs with simple continuous or simple interrupted suture patterns withstood physiologic and supraphysiologic intraluminal pressures, although constructs with a simple interrupted suture pattern initially leaked at higher pressures. (Am J Vet Res 2020;81:985-991).

Successful vascularized jejunal patch graft to treat severe orad duodenal injury secondary to foreign body obstruction in a dog

OBJECTIVE

To report the surgical treatment and outcome of an adult dog with a duodenal perforation treated with a vascularized jejunal patch graft.

STUDY DESIGN

Case report.

ANIMAL

A 1-year-old castrated male boxer dog.

METHODS

Damage to a duodenal segment containing the major and minor papillae was repaired with a vascularized jejunal graft. A segment of healthy jejunum was mobilized maintaining the jejunal vessels, and a donor site anastomosis was performed. The vascularized jejunal graft was incised on the antimesenteric border creating a rectangular segment, which was trimmed and sutured to the duodenal recipient site as a patch graft to repair the defect.

RESULTS

The dog recovered well without major complications. Within 2 weeks, appetite and bowel movements were normal, with no episodes of vomiting. Infrequent regurgitation resolved without medical therapy.

CONCLUSION

A vascularized jejunal patch graft is a feasible option for successful surgical repair of duodenal injury in the dog.

CLINICAL SIGNIFICANCE

This report describes a novel surgical repair technique for treatment of gastrointestinal injuries.

Two cases of laparoscopic direct spiral closure of large defects in the second portion of the duodenum after laparoscopic endoscopic co-operative surgery

Curative endoscopic resection of non-ampullary duodenal lesions, although possible, is challenging. In recent years, although a novel surgical technique named laparoscopic-endoscopic cooperative surgery (LECS), which combines laparoscopic and endoscopic techniques, has made the resection of nonampullary duodenal lesions relatively easier, closure of the defect is still controversial. We report two cases of the duodenal lesion which were closed using a novel technique for primary closure utilising the free wall of the duodenum. Two cases of the duodenal lesion in the second portion of the duodenum were undergone full thickness resection using the LECS technique. The defect is designed spirally to ensure maximum use of the free wall of the duodenum. The mucosal layer is closed using a running suture, and the seromuscular layer is closed using interrupted sutures. The suture line is then reinforced with omentum. There were no intraoperative complications and had uneventful post-operative courses with no leakage, stenosis, or relapse.

Evaluation of intraluminal pressure in cystorrhaphies with and without intestinal serosal patch supplementation from canine cadavers

PURPOSE

To evaluate the maximal intraluminal pressure (MIP) supported by canine cadaveric urinary bladders that underwent cystotomy followed by cystorraphy, with and without serosal patching-supplementation.

METHODS

Two groups (n=8 each) were formed, and in one (conventional) the cystotomy was closed with cushing pattern. In the other group (serosal), the same procedure was performed, and a piece of jejunum was used for the construction of the serosal patching over the cystorraphy. MIP was measured by means of an invasive blood pressure transducer with closed stopcock attached to a multiparameter monitor. At the end of each measurement, the bladder body circumference was assessed.

RESULTS

Mean ± SD MIP sustained for the conventional and serosal groups were 28.88 ± 5.08 and 65.38 ± 10.99 mmHg, respectively (p < 0.0001). Bladder circumference did not change significantly between groups (p = 0.35) and did not correlate with MIP assessed in conventional (p = 0.27; r = 0.4379) and serosal groups (p = 0.37; r = -0.3637).

CONCLUSION

Serosal patch-supplemented cystorraphies were able to sustain intraluminal pressures 55.8% higher, than nonsupplemented cystorraphies in specimens from canine cadavers.

Evaluation of repair in duodenal perforation with human amniotic membrane: An animal model (dog)

Background:

There is a growing tendency toward application of human amniotic membrane (HAM) as a biologic substitute in various tissue injuries where a significant tissue loss is a matter of concern. In gastrointestinal injuries especially duodenal ones, some potential limitations in current surgical techniques contribute to not fully acceptable healing outcomes. Thus, this study was carried out to assess repair with HAM patch for duodenal defect in comparison with simple duodenoraphy in an animal model (dog).

Materials and Methods:

A total of 15 male German shepherd dogs weighing 23-27 kg were randomly divided into two groups. Group A with 10 dogs, which were a candidate for duodenal repair by amniotic membrane patch and Group B consisted of 5 dogs perform simple duodenorraphy. A precise control was made to match all conditions except surgical technique. Macroscopic and microscopic features of the healed duodenal lumen in both groups were recorded.

Results:

Gross evaluation revealed no difference in luminal diameter in both groups. Statistical analysis of duodenal diameter between both groups after operation also showed no significant difference (P_v = 0.789). Histological assessment indicated less inflammation with better wound healing in Group A.

Conclusion:

It seems that repairing duodenal wall defect with HAM would result in better histological outcomes compared with what is seen in simple duodenoraphy in animal models. However, there is no significant difference regarding surgical findings.

Efficacy of Serosal Patching in Dogs with Septic Peritonitis

The objective of this study was to evaluate the correlation of serosal patching in dogs with existing septic peritonitis with continued postoperative septic peritonitis and death. Records were collected from dogs that underwent intestinal surgery from 1998 to 2007 at four veterinary teaching hospitals and one private referral clinic. Dogs were included if they were diagnosed with septic peritonitis and had subsequent surgery of either the small intestine or cecum. Eighty-two surgeries were evaluated. Eighteen dogs (22%) received a serosal patch during surgery. Of those, three dogs (16.7%) had septic peritonitis postoperatively. Sixty-four dogs (78%) did not receive a serosal patch, and 19 of those dogs (29.7%) had postoperative septic peritonitis (P = 0.27). Of the 18 cases with serosal patching, 6 (33.3%) died prior to discharge. Of the 63 cases that did not receive a patch and had information regarding survival, 14 (22.2%) died prior to discharge (P = 0.34). Use of a serosal patch did not protect dogs from either postoperative septic peritonitis or failure to survive.

Management of duodenal injuries

Injuries to the duodenum pose a diagnostic and therapeutic challenge to the surgeon. Due to the intra- and extra-peritoneal location of the duodenum, the presentation can be overt or occult, and delay in diagnosis is associated with an increased mortality rate. A range of interventions have been described and this article reviews the relevant literature, highlights the salient points and suggests a treatment algorithm.