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Freeman DE, Bauck AG. Repeat Celiotomy-Current Status. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00024-X. [PMID: 37121783 DOI: 10.1016/j.cveq.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Repeat celiotomy can be lifesaving in horses with a surgically treatable postoperative obstruction, although guidelines for its use are lacking, except for uncontrollable postoperative pain. Overdiagnosis of ileus as the cause of postoperative obstruction could delay a second surgery so the disease progresses beyond a manageable level of severity. Although many horses respond favorably to repeat celiotomy, complications can be severe and life threatening, such as incisional infection and adhesions. Repeat celiotomy does not seem to exacerbate postoperative ileus, despite additional surgical manipulation. An important benefit of repeat celiotomy is termination of hopeless cases, thereby reducing cost and suffering.
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Affiliation(s)
- David E Freeman
- University of Florida, College of Veterinary Medicine, Gainesville, FL, USA.
| | - Anje G Bauck
- University of Florida, College of Veterinary Medicine, Gainesville, FL, USA
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Suzuki Y, Nomura K, Matsui A, Kikuchi D, Hoteya S. Utility and Feasibility of Removing Surgical Staples from the Remnant Stomach or Gastric Conduit during Endoscopic Submucosal Dissection. Intern Med 2023; 62:963-972. [PMID: 36047114 PMCID: PMC10125828 DOI: 10.2169/internalmedicine.9759-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Endoscopic submucosal dissection (ESD) for gastric cancer in the remnant stomach poses some specific technical difficulties due to severe fibrosis and the presence of surgical staples. Therefore, we clarified the feasibility and safety of removing staples. Methods We retrospectively analyzed ESD outcomes of cases of gastric cancer in the remnant stomach. Materials This study reviewed 227 patients who underwent ESD for gastric cancer in the remnant stomach or gastric conduit. Patients were divided into those in whom resection extended to the anastomotic site or suture line (AS group; n=90) and those without such extension (non-AS group; n=137). The AS group was further divided into cases in which staples were removed (staple group; n=22) and those in which they were not (control group; n=68). Results The rates of specimen damage and curative resection and the duration and speed of the procedure were significantly worse in the AS group than the non-AS group. There were no significant differences between the staple group and the control group in the curative or complete resection rates, and no complications occurred in the staple group. In a propensity score-matched analysis, the rate of specimen damage was significantly lower in the staple group than in the control group (p=0.002), and the procedure speed tended to be faster (p=0.077). Conclusion Staple removal may improve the outcomes of ESD in patients with gastric cancer in the remnant stomach or gastric conduit by reducing the risk of specimen damage and increasing the procedure speed without complications.
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Affiliation(s)
- Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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Seitz-Cherner E, Bauck AG, Denagamage T, Freeman DE. Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses. Vet Surg 2023; 52:407-415. [PMID: 36084150 DOI: 10.1111/vsu.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare single-layer anastomoses (modified continuous Lembert [mod-CL] and modified-interrupted Lembert [mod-IL]) and a 2-layer simple continuous anastomosis (2 L; seromuscular and mucosal) for jejunojejunal anastomoses in equine cadavers and to compare ex vivo to in vivo time to complete the anastomosis and stoma size with a mod-IL pattern. STUDY DESIGN Measurements in jejunum from cadaver and anesthetized horses. ANIMALS Ten live horses and 18 equine cadavers. METHODS Time to complete anastomosis, bursting pressures (BP), leakage sites, and anastomotic index (size ratio of anastomotic lumen to control lumen) were recorded. Time to completion and lumen size were compared between in vivo and ex vivo mod-IL patterns. RESULTS The mod-CL pattern was fastest (8.44 ± 1.30 min, p < .05), and the 2 L pattern was slower (17.07 ± 2.0 min) than the mod-CL and mod-IL (p < .05). The anastomotic index exceeded 100 and did not differ between patterns. Segments reached higher bursting pressures when anastomosed with mod-IL (145.94 ± 24.18 mm Hg) than mod-CL (p < .05). In vivo closure was approximately 8 minutes slower than ex vivo, and with a smaller anastomotic index. CONCLUSIONS All anastomoses increased lumen size over control segments ex vivo. Lumen size after placement of a mod-IL was greater ex vivo than in vivo, and completion was slower in vivo than ex vivo. [Corrections added on 26 Dec 2022, after online publication: added "ex vivo" to the first line of Conclusions in the Abstract.] CLINICAL SIGNIFICANCE: Slower and smaller anastomoses should be anticipated in vivo compared to ex vivo results. Anastomoses with a mod-IL pattern appear clinically advantageous, producing a comparable lumen size in less time than 2 L.
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Affiliation(s)
| | - Anje G Bauck
- Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas Denagamage
- Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - David E Freeman
- Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Roessner HA, Hurcombe SD, Klein CE, Hopster K, Engiles JB. Comparison of one-layer Utrecht pattern with two-layer (simple continuous/Cushing) pattern for jejunojejunostomy in healthy horses in vivo. Vet Surg 2021; 50:1483-1494. [PMID: 34245462 DOI: 10.1111/vsu.13679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/15/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare end-to-end jejunal anastomoses with a one-layer (Utrecht) and two-layer (simple continuous/Cushing) patterns. STUDY DESIGN Experimental study. ANIMALS Eight healthy adult horses. METHODS Jejunal end-to-end anastomoses were performed in randomly assigned one-layer or two-layer patterns. Horses were recovered from surgery and monitored for complications. At 14 days, the opposite pattern was performed (cross-over design) prior to euthanasia. Duration of closures was compared between patterns. Serosal width was measured before harvesting anastomotic sites from the first procedure. Luminal diameter was measured, and sections were collected for histological evaluation of heating after routine and immunohistochemical staining. RESULTS One-layer closure was faster (716 ± 86 s) than two-layer closures (1136 ± 111 s). Postoperative complications were minimal. No difference was detected in lumen size between groups. The lumen was reduced by 18% after one-layer and 15% after two-layer closures (p = .34). Serosal adhesions to the mesentery without clinical evidence of obstruction were observed in two horses with two-layer closure. Histopathological scores for inflammation, infection, and healing did not differ between groups. CONCLUSION Jejunal anastomosis with one-layer Utrecht technique was about 7 min faster and led to similar luminal reduction and histological healing scores as two-layer jejunojejunostomies. CLINICAL SIGNIFICANCE The outcomes of one-layer Utrecht jejunojejunostomies in healthy horses justify clinical evaluation of this technique.
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Affiliation(s)
- Holly A Roessner
- New Bolton Center, Department of Clinical Sciences, The University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Samuel D Hurcombe
- New Bolton Center, Department of Clinical Sciences, The University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Chelsea E Klein
- New Bolton Center, Department of Clinical Sciences, The University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Klaus Hopster
- New Bolton Center, Department of Clinical Sciences, The University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Julie B Engiles
- New Bolton Center, Department of Clinical Sciences, The University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Freeman DE. Letter to the Editor: Response to Dr Blikslager's letter on post‐operative reflux. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
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Affiliation(s)
- S. Miles
- Palm Beach Equine Clinic Wellington Florida USA
| | - W. Davis
- Palm Beach Equine Clinic Wellington Florida USA
| | - W. F. Craft
- Department of Comparative, Diagnostic, and Population Medicine College of Veterinary Medicine University of Florida Veterinary School Gainesville Florida USA
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Freeman DE. Is There Still a Place for Lidocaine in the (Postoperative) Management of Colics? Vet Clin North Am Equine Pract 2019; 35:275-288. [PMID: 31076222 DOI: 10.1016/j.cveq.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intravenous lidocaine is widely used to prevent or treat postoperative ileus in horses. Clinical studies that support this approach are flawed and contradicted by others. Also, physical obstruction could be more important in causing postoperative reflux than postoperative ileus in the horse. The antiinflammatory properties of lidocaine and the role of inflammation from intestinal handling in the genesis of postoperative reflux are questionable. Because of cost and questionable efficacy of lidocaine, a well-designed clinical trial is required to support its continued use. However, lidocaine could be given to provide or enhance analgesia in selected cases with postoperative colic.
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Affiliation(s)
- David E Freeman
- Equine Surgery, University of Florida, College of Veterinary Medicine, Large Animal Clinical Sciences, PO Box 100136, Gainesville, FL 32610, USA.
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Small intestinal herniation through the broad ligament in a mare outside of the gestation period – a case report. ACTA VET BRNO 2019. [DOI: 10.2754/avb201887040331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A Furioso-North Star mare, aged 8 years, was examined for colic signs. The mare had a history of dystocia and post partum vaginal lacerations, acute endometritis and laminitis approximately one year before the admission for colic. Signs of persistent abdominal pain, moderate distended abdomen, non-passage of manure, fever, tachycardia, tachypnoea, congested mucus membranes, and “toxic line” were recorded. No intestinal borborygmi were present in the four quarters of the abdomen. On rectal examination, the colon, the ventral band of the caecum, the right ovary and the uterine horn were palpated on the right side of the abdomen. The spleen, the nephrosplenic ligament, the left ovary and a firm, distended and painful small intestine (SI) loop were palpated on the left side. The left uterine horn and the adjacent broad ligament were not detectable. Percutaneous abdominal ultrasound evaluation revealed a large amount of fluid in the abdominal cavity, SI distention and absence of peristalsis. Abdominocentesis yielded approximately 20 ml of red-tinged peritoneal fluid with increased mean protein concentration (5.2 mg/dl), white blood cell count (12,550 cells/μl), and lactate (14 mmol/dl). A presumptive diagnosis of SI strangulation was made. Surgical resection of the affected intestinal loops was recommended. Due to poor prognosis and financial limitations, the mare was euthanized. Post mortem macroscopic diagnosis was a herniation of 3 metres of the mid-jejunum through the left mesometrium, resulting in a complete and complicated strangulation. To prevent this type of SI strangulation, we recommend transrectal palpation of the urogenital tract (including the broad ligament) after foaling. If a defect is identified, we recommend flank laparoscopy for correction.
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Steward SK, Bauck AG, Zoll W, Conway JA, Freeman DE. Small intestinal strangulation in a tear in the mesometrium of a nonpregnant mare. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. K. Steward
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville USA
| | - A. G. Bauck
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville USA
| | - W. Zoll
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville USA
| | - J. A. Conway
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville USA
| | - D. E. Freeman
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville USA
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Freeman DE. Fifty years of colic surgery. Equine Vet J 2018; 50:423-435. [DOI: 10.1111/evj.12817] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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Troy JR, Holcombe SJ, Fogle CA, Epstein KL, Woodie JB. Effects of hyaluronate-carboxymethylcellulose membranes on the clinical outcome of horses undergoing emergency exploratory celiotomy. Vet Surg 2018; 47:385-391. [PMID: 29460952 DOI: 10.1111/vsu.12777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 07/13/2017] [Accepted: 07/28/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the influence of hyaluronate-carboxymethylcellulose (HA-CMC) membranes applied to intestinal anastomoses or enterotomies on postoperative complications after emergency exploratory celiotomy. STUDY DESIGN Multicenter retrospective case-controlled series. ANIMALS Adult horses (59 in the HA-CMC group and 91 controls). METHODS Medical records from 4 referral hospitals were searched for horses ≥1 year of age, treated between 2008 and 2014 with emergency exploratory celiotomy, and surviving at least 24 hours postoperatively. Horses receiving repeat celiotomy during the same hospitalization were excluded. Horses who received HA-CMC were matched with controls who did not receive HA-CMC but had similar intestinal lesions and procedures at the same referral hospital. Postoperative complications (colic, nasogastric reflux, fever, incisional infection, and septic peritonitis), duration of hospitalization, and survival were compared between groups. Data were compared between horses by t test, Wilcoxon signed rank test, and χ2 test. RESULTS The volume of nasogastric reflux at admission (P = .02) and the duration of administration of lidocaine after surgery (P = .02) were greater in horses with HA-CMC membranes than in controls. No difference in postoperative complications or survival was detected between groups: 48 of 59 (81%) horses treated with HA-CMC survived until discharge from the hospital compared with 80 of 91 (88%) horses in the control group (P = .27). Fifteen of 21 horses treated with HA-CMC and 30 of 43 horses in the control group survived >12 months after hospital discharge. CONCLUSION Application of HA-CMC membranes to anastomoses or intestinal incisions did not influence postoperative complications or survival after emergency celiotomy compared with controls. CLINICAL SIGNIFICANCE The safety and efficacy of HA-CMC membrane application to intestinal sites during colic surgery in horses is equivocal.
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Affiliation(s)
- Jarrod R Troy
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Susan J Holcombe
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Callie A Fogle
- Department of Large Animal Medicine, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Kira L Epstein
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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Bauck AG, Easley JT, Cleary OB, Graham S, Morton AJ, Rötting AK, Schaeffer DJ, Smith AD, Freeman DE. Response to early repeat celiotomy in horses after a surgical treatment of jejunal strangulation. Vet Surg 2017; 46:843-850. [DOI: 10.1111/vsu.12670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/23/2016] [Accepted: 02/03/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Anje G. Bauck
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Jeremiah T. Easley
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Orlaith B. Cleary
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Sarah Graham
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Alison J. Morton
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Anna K. Rötting
- Department of Comparative Biosciences; University of Illinois, College of Veterinary Medicine; Urbana Illinois
| | - David J. Schaeffer
- Department of Comparative Biosciences; University of Illinois, College of Veterinary Medicine; Urbana Illinois
| | - Andrew D. Smith
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - David E. Freeman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
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Affiliation(s)
- D. Freeman
- College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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Salem SE, Proudman CJ, Archer DC. Prevention of post operative complications following surgical treatment of equine colic: Current evidence. Equine Vet J 2015; 48:143-51. [PMID: 26440916 DOI: 10.1111/evj.12517] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
Abstract
Changes in management of the surgical colic patient over the last 30 years have resulted in considerable improvement in post operative survival rates. However, post operative complications remain common and these impact negatively on horse welfare, probability of survival, return to previous use and the costs of treatment. Multiple studies have investigated risk factors for post operative complications following surgical management of colic and interventions that might be effective in reducing the likelihood of these occurring. The findings from these studies are frequently contradictory and the evidence for many interventions is lacking or inconclusive. This review discusses the current available evidence and identifies areas where further studies are necessary and factors that should be taken into consideration in study design.
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Affiliation(s)
- S E Salem
- Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - C J Proudman
- Faculty of Health and Medical Sciences, School of Veterinary Medicine, Guildford, Surrey, UK
| | - D C Archer
- Institute of Infection and Global Health and School of Veterinary Sciences, University of Liverpool, Leahurst, Neston, UK
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Freeman DE. Skin staples for end-to-end anastomosis with mesenteric onlay flap in horses. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D. E. Freeman
- University of Florida College of Veterinary Medicine; Gainesville Florida USA
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Freeman DE. Letter to the Editor. Equine Vet J 2015; 47:249. [DOI: 10.1111/evj.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aristizabal FA, Lopes MA, Silva A, Avanza MF, Nieto JE. Evaluation of the Effect of Onlay Mesenteric Flaps on End-To-End Jejunojejunostomy Healing in Horses. Vet Surg 2014; 43:479-86. [DOI: 10.1111/j.1532-950x.2014.12120.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio A. Aristizabal
- Departamento de Médicina Veterinária; Universidade Federal de Viçosa; Viçosa MG Brazil
| | - Marco Aurélio Lopes
- Departamento de Médicina Veterinária; Universidade Federal de Viçosa; Viçosa MG Brazil
| | - Adriana Silva
- Departamento de Médicina Veterinária; Universidade Federal de Viçosa; Viçosa MG Brazil
| | | | - Jorge E. Nieto
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine University of California-Davis; Davis California
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Close K, Epstein KL, Sherlock CE. A Retrospective Study Comparing the Outcome of Horses Undergoing Small Intestinal Resection and Anastomosis With A Single Layer (Lembert) or Double Layer (Simple Continuous and Cushing) Technique. Vet Surg 2014; 43:471-8. [DOI: 10.1111/j.1532-950x.2014.12143.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 06/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Kristyn Close
- College of Veterinary Medicine; Department of Large Animal Medicine; University of Georgia; Athens Georgia
| | - Kira L. Epstein
- College of Veterinary Medicine; Department of Large Animal Medicine; University of Georgia; Athens Georgia
| | - Ceri E. Sherlock
- College of Veterinary Medicine; Department of Large Animal Medicine; University of Georgia; Athens Georgia
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Freeman DE, Schaeffer DJ, Cleary OB. Long-term survival in horses with strangulating obstruction of the small intestine managed without resection. Equine Vet J 2014; 46:711-7. [PMID: 24237247 DOI: 10.1111/evj.12216] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022]
Abstract
REASONS FOR PERFORMING STUDY Although many studies have described results after small intestinal resection and anastomosis in horses, few have described the outcome in horses with strangulating lesions managed without resection. OBJECTIVES To examine short- and long-term recoveries in horses with strangulated small intestine that was judged to be viable during surgery and not resected. STUDY DESIGN Retrospective analysis of case records. METHODS Data were reviewed from all cases (35 horses) with colic caused by small intestinal strangulation that underwent surgery between 1996 and 2011 at 2 university hospitals and that were managed without resection by 2 surgeons who used a clinical grading system to assess intestinal viability. Kaplan-Meier analyses were used to examine long-term survival. RESULTS Survival to discharge from the hospital was 100%, and post operative complications developed in 11 horses (31%). Three horses (8.6%) required repeat coeliotomy because of persistent pain with or without reflux, and they responded favourably to decompression of distended intestine. Ten horses died after discharge, and 12 were still alive at follow-up from 20 to 192 months after surgery. Information was available on 13 horses after discharge, but these were eventually lost to follow-up. Kaplan-Meier analyses yielded a median survival probability of 120 months. CONCLUSIONS A subjective method of assessing small intestinal viability in strangulated small intestine in horses, as used in this study, could reduce the need for resection and anastomosis, with the associated complications and costs. Also, the favourable post operative course in these horses provides strong evidence that early referral could avoid the need for resection and improve survival. The numbers of horses with the most severe changes that were not resected were too small to allow a conclusion that such segments should be left in place, and additional criteria might be needed to guide that decision in such cases.
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Affiliation(s)
- D E Freeman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, USA
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Nonaka S, Oda I, Makazu M, Haruyama S, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Kushima R, Saito Y. Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. Gastrointest Endosc 2013; 78:63-72. [PMID: 23566640 DOI: 10.1016/j.gie.2013.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 02/04/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. OBJECTIVE We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy. DESIGN Retrospective study. SETTING National Cancer Center Hospital, Tokyo, Japan. PATIENTS We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011. INTERVENTION ESD MAIN OUTCOME MEASUREMENTS We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival. RESULTS A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from EGC in the remnant stomach. LIMITATIONS Single-center, retrospective study. CONCLUSION ESD for EGC in the remnant stomach of patients after gastrectomy was a feasible and effective therapeutic method and should become the standard treatment in such cases, based on the favorable long-term outcomes.
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Affiliation(s)
- Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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WRIGHT S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2011. [DOI: 10.1111/j.2042-3292.2011.00356.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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