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Miller AK, Regier PJ, Vilaplana Grosso FR, Daly EJ, Carroll BN, Colee JC. Cooled feline intestine and fresh intestine did not differ in enterotomy leak pressure testing or in gross wall thickness measurement. Vet Surg 2024; 53:926-935. [PMID: 38747077 DOI: 10.1111/vsu.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To report gross anatomical gastrointestinal measurements and compare enterotomy leak pressures between fresh and cooled feline cadavers. STUDY DESIGN Ex vivo, randomized study. ANIMALS Fresh feline cadavers (n = 20). METHODS Jejunal segments (8 cm) were harvested on the same day as euthanasia. From each cadaver, one segment was randomly assigned to control (C), fresh enterotomy (FE), and cooled enterotomy (CE) groups. Enterotomy construction and leak testing were performed within 12 h of euthanasia for the C and FE groups and after 17-29 h of cooling for the CE group. Initial leak pressure (ILP) and maximum intraluminal pressure (MIP) were compared. Gastrointestinal wall thickness and intraluminal diameter were measured on harvested applicable gastrointestinal divisions at up to three time points: day 1 fresh, day 2 cooled, and day 3 cooled. RESULTS The mean (± SD) ILPs for the C, FE, and CE constructs were 600 (± 0.0), 200.3 (± 114.7), and 131.3 (± 92.6) mmHg, respectively. The C ILP was higher (p < .001) than the FE and CE ILP. The ILP (p = .11) and the MIP (p = .21) did not differ between the FE and CE constructs. Wall thickness (measured in mm) did not differ between duodenum day 1 fresh and day 2 cooled groups (p = .18) or between any jejunum day groups (p = .86). The intraluminal diameters (mean ± SD) for the duodenum, jejunum, and ileum were 5.7 (± 0.7), 5.8 (± 0.8), and 7.2 (± 2.2) mm, respectively. CONCLUSION No difference was appreciated between FE and CE ILP and MIP. Wall thickness measurements did not differ between days for duodenum or jejunum. CLINICAL RELEVANCE Cadaveric feline intestine cooled for up to 29 h may be used for determining intestinal leak pressures.
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Affiliation(s)
- Annellie K Miller
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | | | - Edward J Daly
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - Bailey N Carroll
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - James C Colee
- Institute of Farm and Agricultural Sciences, Statistics Consulting Unit, University of Florida, Gainesville, Florida, USA
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Thompson JL, Miller L, Bowlt Blacklock K. Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies. Vet Surg 2024; 53:367-375. [PMID: 38071682 DOI: 10.1111/vsu.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To compare the intraluminal initial and maximal pressures of enterotomies closed using three different techniques (single-layer appositional continuous closure; closure with cyanoacrylate; a single-layer appositional closure augmented with cyanoacrylate) in a cooled canine cadaveric jejunal model and to report the initial leak location in all samples. STUDY DESIGN Experimental, ex-vivo study. SAMPLE POPULATION Grossly normal chilled small intestine segments from three canine cadavers. METHODS A total of 45 chilled jejunal segments (n = 15 segments/group) were assigned to a handsewn group (HSE), a cyanoacrylate only group (CE) and a handsewn and cyanoacrylate group (HS + CE). A 2 cm antimesenteric enterotomy was performed and closure with one of the above techniques. Initial leakage pressures (ILP), maximal intraluminal pressures (MIP) and initial leakage location were recorded by a single observer. RESULTS Handsewn enterotomies leaked at higher ILP when augmented with cyanoacrylate (83.3 ± 4.6 mmHg, p < .001) compared to both the HSE group (43.8 ± 5.3 mmHg) and the CE group (18.6 ± 3.5 mmHg). Those sealed with cyanoacrylate only leaked at a lower MIP compared with the other groups (p < .001). Maximal intraluminal pressures did not differ between handsewn enterotomies, whether augmented or not (p = .19). CONCLUSION Reinforcement of a sutured enterotomy closure with cyanoacrylate was easy to perform and resulted in significantly increased initial leak pressures in cadaveric jejunum. CLINICAL SIGNIFICANCE The increased leakage pressures achieved by reinforcing enterotomies with cyanoacrylate could consequently reduce the incidence of postoperative intestinal leakage following an enterotomy and may result in reduced patient morbidity or mortality.
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Affiliation(s)
- Jamie-Leigh Thompson
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| | - Lucy Miller
- Department of Anesthesia and Analgesia, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| | - Kelly Bowlt Blacklock
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
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Williams EA, Monnet E. Clinical outcomes of the use of unidirectional barbed sutures in gastrointestinal surgery for dogs and cats: A retrospective study. Vet Surg 2023; 52:1009-1014. [PMID: 37332126 DOI: 10.1111/vsu.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/26/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To report the clinical outcomes of gastrointestinal surgery using unidirectional barbed sutures in single-layer appositional closure in dogs and cats. STUDY DESIGN Retrospective and descriptive study. SAMPLE POPULATION Twenty-six client-owned dogs; three client-owned cats. METHODS Medical records of dogs and cats that received gastrointestinal surgery closed with unidirectional barbed sutures were reviewed to collect information on signalment, physical examinations, diagnostics, surgical procedures, and complications. Short- and long-term follow-up information was collected from the medical records, the owners, or the referring veterinarians. RESULTS Six gastrotomies, 21 enterotomies, and nine enterectomies were closed with a simple continuous pattern with unidirectional barbed glycomer 631 sutures. Nine dogs had multiple surgical sites closed with unidirectional barbed sutures. None of the cases in the study developed leakage, dehiscence, or septic peritonitis during the 14-day short-term follow up. Long-term follow up information was collected for 19 patients. The median long-term follow-up time was 1076 days (range: 20-2179 days). Two dogs had intestinal obstruction due to strictures at the surgical site 20 and 27 days after surgery. Both were resolved with an enterectomy of the original surgical site. CONCLUSION Unidirectional barbed suture was not associated with a risk of leakage or dehiscence after gastrointestinal surgery in dogs and cats. However, strictures may develop in the long term. CLINICAL SIGNIFICANCE Unidirectional barbed sutures can be used during gastrointestinal surgery in client-owned dogs and cats. Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary.
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Affiliation(s)
- Evan A Williams
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Eric Monnet
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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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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Dobberstein REA, Oblak ML, Brisson BA, Singh A, Moens NMM, Ayoub S. Primary repair of nonsteroidal anti-inflammatory drug-associated full thickness gastrointestinal ulcers in 11 dogs. Vet Surg 2022; 51:1096-1105. [PMID: 35866930 DOI: 10.1111/vsu.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/01/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report the outcomes of dogs that underwent primary repair of gastroduodenal perforations associated with the administration of nonsteroidal anti-inflammatory drugs (NSAID). A secondary objective was to identify clinicopathological findings that predisposed dogs to postoperative death. STUDY DESIGN Retrospective study. ANIMALS Eleven dogs with complete gastric or duodenal perforation related to administration of an NSAID that underwent primary surgical repair. METHODS Medical records were reviewed for dogs that presented with peritonitis due to a complete gastroduodenal perforation while receiving NSAIDs between November, 2011 and January, 2021. Data collected included patient characteristics, clinical signs, clinicopathological results, surgical details, and postoperative management and outcome. RESULTS All dogs were large breeds (mean weight 42 kg; range 22-75 kg), with a mean age of 7.35 years. Nine dogs from a total of 11 (82 %) received a concurrent corticosteroid and NSAID, or a higher dose/frequency/length of NSAID administration than recommended by the manufacturer. All gastroduodenal perforations were found in the upper gastrointestinal tract. Eight of 11 (73%) dogs survived to discharge. The median postoperative duration of follow up was 444 days (range 2-1460 days). No association was detected between ulcer size or location and mortality. CONCLUSION Most dogs who underwent primary repair of complete gastroduodenal ulcers survived. Gastroduodenal perforations were generally due to the administration of higher or longer doses of NSAIDs, or concurrent administration of another NSAID or corticosteroid. CLINICAL SIGNIFICANCE Primary closure may be associated with a high success rate in dogs with full thickness gastroduodenal ulcers.
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Affiliation(s)
- Rachel E A Dobberstein
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Michelle L Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Brigitte A Brisson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Noel M M Moens
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Sabrina Ayoub
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Duffy DJ, Chang YJ, Moore GE. Influence of barbed suture oversew of the transverse staple line during functional end-to-end stapled anastomosis in a canine jejunal enterectomy model. Vet Surg 2022; 51:801-808. [PMID: 35614547 PMCID: PMC9324082 DOI: 10.1111/vsu.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/14/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the influence of barbed suture oversew of the transverse staple line during functional end‐to‐end stapled anastomosis (FEESA) in dogs. Study design Randomized, experimental, ex vivo. Animals or sample population Grossly normal jejunal segments from 14 adult canine cadavers. Methods Ninety‐eight jejunal segments (n = 14/FEESA group, n = 14 controls) were harvested and randomly assigned to a control group, FEESA + monofilament suture oversew, FEESA + unidirectional barbed suture oversew or FEESA + bidirectional barbed suture oversew. Oversew techniques were performed using a Cushing suture pattern. Initial (ILP) and maximum leakage pressure (MLP), repair time (s), and location of observed leakage were recorded. Results No differences were detected in ILP (p = .439) or MLP (p = .644) respectively between experimental groups. Repairs times using barbed suture were ~ 18% faster (~25 s faster; p < .001) compared to monofilament suture. There was no difference between barbed suture types (p = .697). Mean ILP (p < .001) and MLP (p < .0001) were 6.6x and 5.1x greater respectively in the control group. Leakage location occurred predominately at the crotch of the FEESA in all groups. Conclusion FEESAs closed with a transverse staple line oversew using barbed suture, regardless of barb orientation, were completed faster and resulted in similar resistance to anastomotic leakage compared to monofilament suture. Clinical significance Oversewing the transverse staple line following FEESA using barbed suture offers similar resistance to anastomotic leakage, and may be associated with decreased surgical times in dogs compared to monofilament suture. Further studies are necessary to determine the benefits of barbed suture use in both open and laparoscopic gastrointestinal surgical applications following FEESA in dogs.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Quitzan JG, Singh A, Beaufrère H, Saleh TM. Influence of staple line number and configuration on the leakage of small intestinal functional end‐to‐end stapled anastomosis: An ex vivo study. Vet Surg 2022; 51:781-787. [DOI: 10.1111/vsu.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/23/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Juliany Gomes Quitzan
- School of Veterinary Medicine and Animal Science Sao Paulo State University Botucatu Sao Paulo Brazil
- Department of Clinical Studies, Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - Hugues Beaufrère
- Department of Clinical Studies, Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - Tarek M. Saleh
- Department of Biomedical Sciences, Ontario Veterinary College University of Guelph Guelph Ontario Canada
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Matz BM, Hlusko KC, Linden DS, Tillson DM, Hofmeister E. Ex vivo comparison of different thoracoabdominal stapler sizes for typhlectomy in canine cadavers. Vet Surg 2022; 51:682-687. [PMID: 35191557 DOI: 10.1111/vsu.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of staple size on leakage pressure of typhlectomy sites in canine cadavers. STUDY DESIGN Randomized, experimental cadaveric study. ANIMALS Twenty-four fresh canine cadavers. METHODS Ileocecocolic segments were exteriorized following right paracostal laparotomy after euthanasia. Cecal base length and wall thickness were measured. Each cecum was randomly assigned to 1 of 3 groups (TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm). The cecal base was stapled and the cecum was removed. A 10 cm segment including the stapled cecal excision site was tested for initial leak pressure. RESULTS The mean ± standard deviation body weights across the groups were 18.7 ± 6.1 kg, 16.2 ± 7.5 kg, and 14.2 ± 5.5 kg for the TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm groups, respectively (P = .48). There were no differences for mean cecal base length or wall thickness. Mean initial leak pressure (ILP) across groups was 182 ± 111 mmHg (TA 30 V3 2.5 mm), 112 ± 57 mmHg (TA 60 3.5 mm), and 77 ± 60 mmHg (TA 60 4.8 mm) (P = .78). CONCLUSION Each stapler size that was evaluated resulted in a mean ILP in excess of typical intraluminal pressures under normal circumstances. There were no differences among groups. CLINICAL SIGNIFICANCE The results of this cadaveric study support the use of any of the stapler sizes evaluated in similarly sized dogs. A prospective study is needed to be able to correlate stapler size and clinical outcome.
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Affiliation(s)
- Brad M Matz
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Katelyn C Hlusko
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Daniel S Linden
- First Coast Veterinary Specialists, Jacksonville, Florida, USA
| | - D Michael Tillson
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Erik Hofmeister
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
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Duffy DJ, Chang YJ, Moore GE. Influence of crotch suture augmentation on leakage pressure and leakage location during functional end-to-end stapled anastomoses in dogs. Vet Surg 2022; 51:697-705. [PMID: 35020207 DOI: 10.1111/vsu.13764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/05/2021] [Accepted: 12/18/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the influence of anastomotic crotch suture augmentation on leakage pressures and leakage location following intestinal functional end-to-end stapled anastomosis (FEESA) in dogs. STUDY DESIGN Ex vivo, randomized, experimental. SAMPLE POPULATION Chilled jejunal segments from 3 adult dogs. METHODS Jejunal specimens were tested within 24 hours of collection. A FEESA was performed and randomly assigned to 1 of 4 treatment groups (n = 12/group): (1) no crotch suture (NCS); (2) simple interrupted crotch suture (SICS); (3) two simple interrupted crotch sutures (TCS) placed laterally on opposing jejunal limbs; (4) simple continuous crotch suture (SCCS) augmentation. Crotch sutures were performed using 3-0 USP polydioxanone. Initial (ILP) and maximal (MLP) leakage pressures (Mean ± SD mm Hg) and leakage location were recorded and compared between groups. RESULTS Initial leakage pressure was greater after placement of TCS (37.8 ± 6.4, P < .039) and SCCS (47.6 ± 11.0, P < .002) than NCS (27.1 ± 2.5) and SICS (33.0 ± 6.0). Maximal leakage pressure was greater in specimens including SICS, TCS, and SCCS than those without crotch suture augmentation (P < .043). Leakage occurred at the anastomotic crotch in 8/12 NCS, 6/12 SICS, 11/12 TCS, and 12/12 SCCS constructs (P < .001). CONCLUSION Augmentation of FEESA with TCS and SCCS increased ILP and decreased the occurrence of leakage from the anastomotic crotch, while all methods of anastomotic crotch augmentation increased MLP. CLINICAL SIGNIFICANCE Augmenting the FEESA with crotch suture(s) improved the resistance of the jejunal anastomosis to leakage in normal cadaveric segments. Placing 2 crotch sutures or use of a simple continuous pattern for anastomotic augmentation appeared to be superior to the placement of a single suture.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Regier PJ. Current Concepts in Small Animal Gastrointestinal Surgery. Vet Clin North Am Small Anim Pract 2022; 52:437-454. [DOI: 10.1016/j.cvsm.2021.11.002] [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]
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Chang YJ, Duffy DJ, Moore GE. Influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure. Vet Surg 2021; 50:1502-1509. [PMID: 34405426 DOI: 10.1111/vsu.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/12/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure. STUDY DESIGN Randomized, experimental, cadaveric. ANIMALS OR SAMPLE POPULATION Grossly normal jejunal segments from three canine cadavers. METHODS Jejunal segments were harvested and randomly assigned based upon effector loop location from the beginning of the incisional line. Groups (n = 12/group) included 0 mm, 5 mm, 10 mm, 15 mm, and intact controls (n = 6/group), repaired using a 3-0 unidirectional barbed suture in a simple continuous pattern. Initial leakage pressure (ILP), maximum intraluminal pressure (MIP), repair time, and leakage location were recorded. RESULTS Mean ILP for 0 mm group (24.42 ± 8.43 mmHg) was lower (p ≤ .001) compared to all experimental groups with ILP ~40% lower. There was no difference in MIP among experimental groups (p = .239). Repair time increased (p < .0001) as the distance of the effector loop increased ≥5 mm from the beginning of the incisional line. Leakage location differed among groups (p < .001) with leakage in the 0 mm group from the incisional line (75%), compared to leakage from predominantly from the suture holes in other groups, respectively. CONCLUSION Effector loop location influenced ILP and leakage location. Effector loops placed at the beginning of the incisional line (0 mm) decreased ILP compared to loops placed at 5, 10, and 15 mm. CLINICAL SIGNIFICANCE Effector loop location using a unidirectional barbed suture should be placed ≥5 mm from beginning of the incisional line for enterotomy closure. Further in vivo studies are necessary to determine the clinical significance of these findings.
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Affiliation(s)
- Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Culbertson TF, Smeak DD, Pogue JM, Vitt MA, Downey AC. Intraoperative surgeon probe inspection compared to leak testing for detecting gaps in canine jejunal continuous anastomoses: A cadaveric study. Vet Surg 2021; 50:1472-1482. [PMID: 34374997 DOI: 10.1111/vsu.13708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the detection of gaps in jejunal continuous anastomoses by probing (PT) versus leak testing (LT). STUDY DESIGN Experimental study. ANIMALS Normal jejunal segments (n = 24) from two fresh canine cadavers. METHODS Intestinal segments were randomly selected by four volunteers who created six simple continuous anastomoses: two constructs using standard technique with 2-3 mm suture spacing (ST, 8 total), and four constructs with one 4-mm gap (IG, 16 total). All 24 anastomoses were examined with PT (1 volunteer) prior to LT (3 volunteers). LT was performed within a maximal peristaltic pressure range (34-54 cmH2 O). The presence and location of anastomotic leaks (LA ) detected with LT were compared with gaps detected with PT. RESULTS Nineteen out of twenty-four (79.2%) samples had at least one probe drop, and four out of twenty-three (17.4%) samples leaked. LT results from one sample were excluded due to iatrogenic suture failure. PT was 100% sensitive (95% CI: 51.01, 100%) with a 100% negative predictive value (95% CI: 56.55, 100%) at detecting gaps compared with LT. The location of all LA was accurately identified with PT and confirmed during LT. CONCLUSION PT was highly sensitive at detecting gaps compared with LT. All LA were accurately detected by PT. None of the segments negative during PT leaked. CLINICAL SIGNIFICANCE The diagnostic value of PT appears adequate to recognize gaps in cadaveric small intestinal anastomoses. PT offers surgeons an alternative to detect suture gaps that may contribute to postoperative dehiscence of intestinal anastomoses.
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Affiliation(s)
- Tricia F Culbertson
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Daniel D Smeak
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Joanna M Pogue
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Molly A Vitt
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Amy C Downey
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Sapora JA, Hafez A, Monnet E. Ex vivo comparison of hand-sutured versus circular stapled anastomosis in canine large intestine. Vet Surg 2021; 50:1495-1501. [PMID: 34355807 DOI: 10.1111/vsu.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/29/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand-sewn techniques in dogs. STUDY DESIGN Ex-vivo study. ANIMALS Colon from 11 canine cadavers. METHODS Thirty-two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and 4-0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End-to-End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye-containing solution was first observed to leak from the anastomosis site. RESULTS Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p = .0313, C4.8mm-BG p = .0131, C3.5mm-G p = .0469, C3.5mm-BG p = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg. CONCLUSION End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. CLINICAL SIGNIFICANCE These results provide evidence to support hand-suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.
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Affiliation(s)
- Joseph A Sapora
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Ahmed Hafez
- Faculty of Veterinary Medicine, Department of Surgery, Anesthesiology, and Radiology, Beni-Suef University, Beni-Suef, Egypt
| | - Eric Monnet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Mullen KM, Regier PJ, Waln M, Fox-Alvarez WA, Colee J. Gastrointestinal thickness, duration, and leak pressure of six intestinal anastomoses in dogs. Vet Surg 2020; 49:1315-1325. [PMID: 32697359 DOI: 10.1111/vsu.13490] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/17/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare leak pressures and construct completion time of six intestinal anastomoses and report normal canine gastrointestinal thickness. STUDY DESIGN Experimental study. ANIMALS Grossly normal jejunal segments (n = 140) from 10 fresh canine cadavers. METHODS Gastrointestinal thickness was recorded. Eight-centimeter cooled canine cadaveric jejunal segments were randomly assigned to a control group (20 segments) and six treatment groups (20 segments/group [10 constructs/group]): (1) handsewn anastomosis (HSA), (2) functional end-to-end stapled anastomosis (FEESA)-blue thoracoabdominal (TA; FEESA-TAB), (3) FEESA-green TA (FEESA-TAG), (4) FEESA TA-gastrointestinal anastomosis (GIA), (5) FEESA with suture oversew (FEESA-O), and (6) skin staples (SS). Construct assembly time, initial leak pressure (ILP), maximum intraluminal pressure (MIP), and leakage location were compared. RESULTS Initial leak pressures (mean ± SD) for control (308.38 ± 115.91 mm Hg), HSA (41.96 ± 15.97), FEESA-TAB (31.71 ± 15.71), FEESA-TAG (27.24 ± 14.11), FEESA-GIA (25.62 ± 11.22), FEESA-O (31.01 ± 17.38), and SS (44.42 ± 28.88) groups were compared. No difference in ILP (P > .24) or MIP (P > .17) was detected between treatment groups. Sutured anastomoses took up to 10 times longer to complete (P = .0025). The stomach, duodenum, jejunum, and ileum mural thicknesses (mean ± SD) were 3.99 ± 0.44 mm, 2.34 ± 0.16, 2.49 ± 0.28, and 2.30 ± 0.31, respectively. CONCLUSION The ILP of all anastomoses exceeded maximum intraluminal peristaltic pressures. Stapled anastomoses were faster to complete. CLINICAL SIGNIFICANCE All anastomoses may be considered when performing an intestinal resection and anastomosis, with stapled anastomoses resulting in a shorter surgical time. Canine intestinal thickness may warrant use of a larger staple size.
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Affiliation(s)
- Kaitlyn M Mullen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Florida, USA
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Florida, USA
| | - Monica Waln
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Florida, USA
| | - W Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Florida, USA
| | - James Colee
- Department of Statistics, College of Liberal Arts and Sciences University of Florida, Florida, USA
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15
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Mullen KM, Regier PJ, Ellison GW, Londoño L. A Review of Normal Intestinal Healing, Intestinal Anastomosis, and the Pathophysiology and Treatment of Intestinal Dehiscence in Foreign Body Obstructions in Dogs. Top Companion Anim Med 2020; 41:100457. [PMID: 32823156 DOI: 10.1016/j.tcam.2020.100457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
Small intestinal anastomoses are commonly performed in veterinary medicine following resection of diseased or devitalized intestinal tissue. Traditionally, suture has been employed to anastomose intestinal ends. However, use of intestinal staplers has become increasingly popular due to the ability to produce a rapid anastomosis with purported superior healing properties. Under normal conditions, intestinal healing occurs in three phases: inflammatory, proliferative, and maturation. Dehiscence, a devastating consequence of intestinal anastomosis surgery, most often occurs during the inflammatory phase of healing where the biomechanical strength of the anastomosis is almost entirely dependent on the anastomotic technique (suture or staple line). The resulting septic peritonitis is associated with a staggering morbidity rate upwards of 85% secondary to the severe systemic aberrations and financial burden induced by septic peritonitis and requirement of a second surgery, respectively. Intraoperative and postoperative consideration of the multifactorial nature of dehiscence is required for successful patient management to mitigate recurrence. Moreover, intensive postoperative critical care management is necessitated and includes antibiotic and fluid therapy, vasopressor or colloidal support, and monitoring of the patient's fluid balance and cardiovascular status. An understanding of anastomotic techniques and their relation to intestinal healing will facilitate intraoperative decision-making and may minimize the occurrence of postoperative dehiscence.
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Affiliation(s)
- Kaitlyn M Mullen
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA.
| | - Gary W Ellison
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Leonel Londoño
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
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Duffy DJ, Moore GE. Influence of oversewing the transverse staple line during functional end-to-end stapled intestinal anastomoses in dogs. Vet Surg 2020; 49:1221-1229. [PMID: 32502297 DOI: 10.1111/vsu.13451] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/16/2020] [Accepted: 05/02/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the effect of oversewing the transverse staple line after functional end-to-end stapled intestinal anastomoses (FEESA) on canine jejunal leakage pressures. STUDY DESIGN Experimental, ex vivo, randomized study. SAMPLE POPULATION Jejunal segments from three adult canine cadavers. METHODS Jejunal segments were harvested within 2 hours of euthanasia and anastomosed (24 jejunal segments per group, consisting of two segments per construct with n = 12/ group). Constructs were then randomly assigned to receive FEESA alone, FEESA + Cushing oversew, or FEESA + simple-continuous oversew of the transverse staple line with 3-0 polydioxanone. Results for initial leakage pressure (ILP) and maximal leakage pressure (MLP) and initial leakage location (LL) were compared between groups. RESULTS Mean ILP was 1.8-fold higher for FEESA + Cushing oversew (62.4 ± 7.8 mm Hg) compared with FEESA alone and FEESA + simple-continuous oversew (P < .001). Mean MLP were higher for both oversewn techniques compared with FEESA alone (P < .001). Oversewing the transverse staple line with either pattern increased mean MLP by 1.4-fold compared with FEESA alone. Leakage occurred at the level of the transverse staple line in nonoversewn constructs (P < .001). CONCLUSION Oversewing the transverse staple line after FEESA increased MLP and decreased the occurrence of leakage at this location. Oversewing with a Cushing pattern increased ILP compared with oversew with a simple-continuous pattern. CLINICAL SIGNIFICANCE Our results provide evidence to support oversewing the transverse staple line after FEESA. Doing so may reduce the occurrence of postoperative dehiscence. These findings warrant additional focused investigation in vivo through a prospective randomized clinical trial.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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