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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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Liu C, Wang Y, Zhao AR, Hu FA, Fan Q, Han G, Ding G, Fu T, Geng L, Yin H. An alternative asymmetric figure-of-eight single-layer suture technique for bowel anastomosis in an in vitro porcine model. Front Surg 2022; 9:896542. [PMID: 36248362 PMCID: PMC9554239 DOI: 10.3389/fsurg.2022.896542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Anastomotic techniques are of vital importance in restoring gastrointestinal continuity after resection. An alternative asymmetric figure-of-eight single-layer suture anastomotic technique was introduced and its effects were evaluated in an in vitro porcine model. Twelve 15-cm grossly healthy small intestine segments from a porcine cadaver were harvested and randomly divided into asymmetric figure-of-eight single-layer suture (figure-of-eight suture) and single-layer interrupted suture technique (interrupted suture) groups (n = 6 in each group). The anastomosed bowel was infused with methylene blue solution to test anastomotic leakage. Anastomosis construction time, leakage, and suture material cost were recorded and analyzed statistically using Fisher's exact test and Student's t-test. One anastomotic leakage occurred (16.67%) in the figure-of-eight suture group, and two (33.33%) in the interrupted suture group (p > 0.9999). The anastomosis construction time was relatively short in the figure-of-eight suture group, but the difference did not reach a statistically significant level between the two groups. The mean number of suture knots and the cost of suture material in the figure-of-eight suture group were significantly decreased in comparison to the interrupted suture group (15.67 ± 3.30 vs. 22.17 ± 2.03, 167.11 ± 35.20 vs. 236.45 ± 21.70 CNY, p < 0.01, respectively). Our results suggested that the alternative asymmetric figure-of-eight suture technique was safe and economic for intestinal anastomosis. An in vivo experiment is required to elucidate the effects of this suture technique on the physiological anastomotic healing process.
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Affiliation(s)
- Chen Liu
- The Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- The Department of Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yewen Wang
- The Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Ai-rong Zhao
- The Department of Pharmacy, Binzhou Medical University Hospital, Binzhou, China
| | - Feng-ai Hu
- The Clinical Laboratory, Binzhou Medical University Hospital, Binzhou, China
| | - Qizhong Fan
- The Department of Pharmacy, Binzhou Medical University Hospital, Binzhou, China
| | - Guoxiu Han
- The Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Guojian Ding
- The Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Tingliang Fu
- The Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Lei Geng
- The Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- Correspondence: Lei Geng Hongshan Yin
| | - Hongshan Yin
- The Department of Urology, Binzhou Medical University Hospital, Binzhou, China
- Correspondence: Lei Geng Hongshan Yin
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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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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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Simpson M, Hall JL. Transversus abdominis muscle as a gastric or intestinal on-lay flap in two dogs and one cat. J Small Anim Pract 2021; 62:918-923. [PMID: 33599994 DOI: 10.1111/jsap.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
Historically, omentalisation and serosal patching have been used to augment gastrointestinal wall defects or incisions where gastrointestinal viability is of concern. This report describes the novel use of a transversus abdominis muscle on-lay flap to augment and provide support to compromised intestine in three cases. The muscle flap was used to support: the ileum following reduction of an intussusception in a dog (case 1), the gastric wall following gastric strangulation, dilation and volvulus in a diaphragmatic rupture in a cat (case 2) and the jejunum following enterotomy and full-thickness ulcer resection with primary repair in a dog (case 3). All animals were discharged within 4 days postoperatively with no short- or long-term complications reported by either the referring veterinary surgeons on routine postoperative examination or on telephone follow-up with the owners (case 1: 10 months, case 2: 30 months, case 3: 6 weeks). The creation of a flap of the transversus abdominis muscle may provide a useful alternative or adjunct to previously described techniques for supporting the gastrointestinal tract when gastrointestinal tissue viability is questionable or resection is not feasible. Further prospective clinical evaluation studies would be indicated to determine whether the muscle flap remains viable or compare whether this technique should be recommended over conventional methods.
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Affiliation(s)
- M Simpson
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, EH25 9RG, UK
| | - J L Hall
- Wear Referrals Veterinary Hospital, Bradbury, Stockton-on-Tees, TS212ES, UK
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Lorange M, Smeak DD. 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. Am J Vet Res 2020; 81:985-991. [PMID: 33251840 DOI: 10.2460/ajvr.81.12.985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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).
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Regier PJ, Fealey MJ, Kim SE, Case JB, Garcia-Pereira F. Comparison of intestinal leak pressure between cadaveric canine and commercial synthetic intestinal tissue that did and did not undergo enterotomy. Am J Vet Res 2020; 81:827-831. [PMID: 32969730 DOI: 10.2460/ajvr.81.10.827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare initial leak pressure (ILP) between cadaveric canine and synthetic small intestinal segments that did and did not undergo enterotomy. SAMPLE Eight 8-cm grossly normal jejunal segments from 1 canine cadaver and eight 8-cm synthetic small intestinal segments. PROCEDURES Intestinal segments were randomly assigned to undergo enterotomy (6 cadaveric and 6 synthetic segments) or serve as untreated controls (2 cadaveric and 2 synthetic segments). For segments designated for enterotomy, a 2-cm full-thickness incision was created along the antimesenteric border. The incision was closed in a single layer with 4-0 suture in a simple continuous pattern. Leak testing was performed with intestinal segments occluded at both ends and infused with dilute dye solution (999 mL/h) until the solution was observed leaking from the suture line or serosal tearing occurred. Intraluminal pressure was continuously monitored. The ILP at construct failure was compared between cadaveric and synthetic control segments and between cadaveric and synthetic enterotomy segments. RESULTS Mean ± SD ILP did not differ significantly between cadaveric (345.11 ± 2.15 mm Hg) and synthetic (329.04 ± 24.69 mm Hg) control segments but was significantly greater for cadaveric enterotomy segments (60.77 ± 15.81 mm Hg), compared with synthetic enterotomy segments (15.03 ± 6.41 mm Hg). CONCLUSIONS AND CLINICAL RELEVANCE Leak testing should not be used to assess the accuracy or security of enterotomy suture lines in synthetic intestinal tissue. Synthetic intestinal tissue is best used for students to gain confidence and proficiency in performing enterotomies before performing the procedure on live animals.
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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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12
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Duffy DJ, Chang YJ, Balko JA, Moore GE. Effect of presurgical storage conditions on leakage pressures of enterotomy sites closed with unidirectional barbed suture material in fresh, chilled, and frozen-thawed cadaveric canine jejunal specimens. Am J Vet Res 2020; 81:220-226. [PMID: 32101038 DOI: 10.2460/ajvr.81.3.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of presurgical storage conditions on leakage pressures of enterotomy sites closed with unidirectional barbed suture material in fresh, chilled, and frozen-thawed cadaveric canine jejunal specimens. SAMPLE 36 grossly normal jejunal segments obtained from 4 dog cadavers. PROCEDURES 9 jejunal segments were harvested immediately from each euthanized dog and randomly assigned to be tested within 4 hours after collection (fresh segments), stored at 4°C for 24 hours before testing (chilled segments), or stored at -20°C for 7 days and thawed at 21°C for 6 hours before testing (frozen-thawed segments). For leakage pressure testing, a 3-cm-long antimesenteric enterotomy was performed and repaired with 3-0 unidirectional barbed suture material in a simple continuous pattern in each segment. Time to complete the enterotomy, initial leakage pressure, maximum intraluminal pressure, and leakage location were recorded for each segment. RESULTS Mean ± SD initial leakage pressure for fresh, chilled, and frozen-thawed segments was 52.8 ± 14.9 mm Hg, 51.8 ± 11.9 mm Hg, and 33.3 ± 7.7 mm Hg, respectively. Frozen-thawed segments had significantly lower mean initial leakage pressure, compared with findings for fresh or chilled segments. Time to complete the enterotomy, maximum intraluminal pressure, and leakage location did not differ among groups. CONCLUSIONS AND CLINICAL RELEVANCE Leak pressure testing of cadaveric jejunal segments that are fresh or chilled at 4°C for 24 hours is recommended for enterotomy studies involving barbed suture material in dogs. Freezing and thawing of cadaveric jejunal tissues prior to investigative use is not recommended because leak pressure data may be falsely low.
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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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15
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Chu KL, Duffy DJ, Vieson MD, Moore GE. Ex vivo comparison of leakage pressures and leakage location with a novel technique for creation of functional side-to-side canine small intestinal anastomoses. Vet Surg 2020; 49:1024-1034. [PMID: 32255208 DOI: 10.1111/vsu.13408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/08/2019] [Accepted: 05/19/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage. STUDY DESIGN Experimental, ex vivo. SAMPLE POPULATION Jejunal segments (n = 130) from 10 healthy canine cadavers. METHODS Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically. RESULTS Initial leakage pressure was greater in group D than in groups A, B, and C (P < .011). There was a difference in ILL among groups (P = .003). Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D. Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P < .004). Histological examination was consistent with collagenous fusion without cavitation defects. CONCLUSION Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses. CLINICAL SIGNIFICANCE Despite the success and feasibility of creating an FSS-SIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.
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Affiliation(s)
- Kyle L Chu
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Miranda D Vieson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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16
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Duffy DJ, Chang YJ, Moore GE. Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model. Vet Surg 2020; 49:1213-1220. [PMID: 32255202 DOI: 10.1111/vsu.13405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the influence of three closure techniques on leakage pressures of canine typhlectomies. STUDY DESIGN Experimental, ex vivo. SAMPLE POPULATION Grossly normal cecal segments from 24 adult canine cadavers. METHODS Typhlectomies were assigned to one of three closure techniques: simple continuous closure with a Parker-Kerr pattern with 4-0 polydioxanone (group 1), closure with a 60-mm gastrointestinal stapler loaded with a 3.8-mm staple cartridge (group 2), and placement of a Cushing suture to augment the stapled closure (group 3). The median (range) of initial leakage pressure (ILP) and maximum leakage pressure (MLP) was compared between groups along with leakage location. RESULTS Typhlectomies in group 3 leaked at higher ILP (310 mm Hg; 188-310) than those in groups 1 (43 mm Hg; 31-80) and 2 (109.5 mm Hg; 68-173; P < .0001). Maximum leakage pressure were greater in group 3 than in other groups (P < .0001). Leakage was detected in 20 of 24 (83%) typhlectomies, located at the incisional line in 13 of 24 (54%) specimens and from suture holes in seven of 24 (29%) specimens. CONCLUSION Placement of a Cushing suture pattern to augment stapled incisions improved the ability of typhlectomies to sustain pressure compared with sutured or stapled cadaveric specimens alone. CLINICAL SIGNIFICANCE These results provide evidence to support placement of a Cushing suture pattern to augment the staple line for typhlectomies in dogs, although in vivo studies are required to determine the clinical significance of these findings.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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17
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Fealey MJ, Regier PJ, Steadman Bs C, Brad Case J, Garcia-Pereira F. Initial leak pressures of four anastomosis techniques in cooled cadaveric canine jejunum. Vet Surg 2020; 49:480-486. [PMID: 32034924 DOI: 10.1111/vsu.13392] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/10/2019] [Accepted: 01/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the effectiveness of four different intestinal anastomosis techniques at preventing leakage after enterectomy. STUDY DESIGN Experimental study. SAMPLE POPULATION Grossly normal jejunal segments (N = 70) from three fresh canine cadavers. METHODS Eight-centimeter cooled canine cadaveric jejunal segments were randomly assigned to a control group (six segments) and four treatment groups (16 segments each [two segments/anastomotic construct]): (1) handsewn anastomosis (HSA), (2) barbed suture anastomosis (B-HSA), (3) stapled functional end-to-end anastomosis (SFEEA), and (4) stapled functional end-to-end anastomosis with an oversew (SFEEA-O). Control segments and anastomotic constructs were infused intraluminally to the point of leakage. Initial leak pressures were recorded and compared. RESULTS Initial leak pressures (median + range) for jejunal control segments, HSA, B-HSA, SFEEA, and SFEEA-O were 331.88 mmHg (range, 315.34-346.64), 35.17 (20.29-56.24), 24.99 (6.08-38.64), 28.77 (18.80-85.09), and 35.92 (12.05-80.71), respectively. No difference was detected between leak pressures of anastomosed segments (P = .35), all of which were more variable and lower than those of intact segments. CONCLUSION No difference in initial leak pressures was detected between the four anastomosis techniques tested in cooled canine cadaveric jejunum. CLINICAL SIGNIFICANCE All four anastomosis techniques evaluated in this study may be suitable in dogs.
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Affiliation(s)
- Mark J Fealey
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Charles Steadman Bs
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Fernando Garcia-Pereira
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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18
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Duffy DJ, Chang YJ, Balko JA, Moore GE. Ex vivo comparison of the effect of storage temperature on canine intestinal leakage pressures. Vet Surg 2019; 49:496-501. [PMID: 31721267 DOI: 10.1111/vsu.13339] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/11/2019] [Accepted: 09/12/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the effect of storage temperature on cadaveric small intestinal leakage pressures after enterotomy. STUDY DESIGN Experimental ex vivo study. ANIMALS Grossly normal jejunal segments from four canine cadavers. METHODS Thirty-six jejunal segments (n = 12 segments/group) were harvested immediately after euthanasia and assigned to a fresh group (tested within 4 hours), chilled group (stored for 24 hours at 4°C before testing), or freeze-thaw group (frozen at -20°C for 7 days and thawed at 21°C for 6 hours before testing). A 2-cm antimesenteric enterotomy was performed and repaired with 4-0 monofilament suture in a simple-continuous pattern. Initial leakage pressure (ILP), maximal intraluminal pressure (MIP), and leakage location were recorded, with testing performed at room temperature. RESULTS Mean ± SD ILP for fresh, chilled, and frozen-thawed specimens was 52.9 ± 8.4, 51.8 ± 11.9 and 29.8 ± 4.4 mm Hg, respectively. There was a difference in ILP among groups (P < .003), with freeze-thaw samples demonstrating lower ILP compared with other groups. There was no difference in MIP between groups (P = .186) There was a difference in leakage location among groups (P = .004), with the majority of chilled and freeze-thaw samples leaking at the suture holes compared with the incisional line in fresh samples. CONCLUSION Freezing and subsequent thawing prior to specimen testing reduced ILP compared with use of fresh and chilled specimens but did not affect MIP among experimental groups. CLINICAL SIGNIFICANCE Cadaveric canine intestinal specimens tested immediately after collection or after chilling for 24 hours should be recommended for ex vivo burst pressure assessment in dogs. Additional studies to evaluate loss in testing viability of chilled intestinal specimens are warranted to help govern experimental methodologies.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Julie A Balko
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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Ellison GW, Case JB, Regier PJ. Intestinal surgery in small animals: historical foundations, current thinking, and future horizons. Vet Surg 2019; 48:1171-1180. [PMID: 31286544 DOI: 10.1111/vsu.13275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/23/2019] [Accepted: 06/01/2019] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Gary W Ellison
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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Sumner SM, Regier PJ, Case JB, Ellison GW. Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008-2018). Vet Surg 2019; 48:1188-1193. [PMID: 31270826 DOI: 10.1111/vsu.13274] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/08/2019] [Accepted: 06/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the influence of oversewing a transverse staple line in functional end-to-end stapled intestinal anastomoses (FEESA) in dogs. STUDY DESIGN Retrospective observational study. SAMPLE POPULATION Seventy-seven client-owned dogs that underwent 78 FEESA reinforced (n = 30) or not reinforced (n = 48) with suture at the transverse staple line. METHODS The medical records database was searched and reviewed for dogs that had undergone a FEESA between January 2008 and September 2018. Data were collected regarding signalment, body weight, clinical presentation, indication for surgery, serum albumin, presence of septic peritonitis, previous surgeries, surgical techniques (ie, oversew, crotch suture, omental wrap, omental patch, serosal patch), histopathology results, and postoperative outcome. RESULTS The only differences identified between groups consisted of higher preoperative albumin (2.89 ± 0.56 vs 2.34 ± 0.62 g/dL; P = .006) and lower postoperative dehiscence rate (0/30 vs 7/48; P = .028) in dogs with an oversewn FEESA. Oversewing the FEESA was identified as the significant factor in a model with oversewing and preoperative albumin fit to the outcome of dehiscence (oversew P = .010, albumin P = .761). The location of the dehiscence was specified in four of seven dogs, all along the transverse staple line. Patterns used for oversew were unspecified (n = 11), simple continuous (8), Cushing (4), simple interrupted (2), cruciate (1), interrupted horizontal mattress (1), and Lembert (1). CONCLUSION Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence. CLINICAL SIGNIFICANCE Our results provide evidence to support additional investigation of suture reinforcement (oversewing) at the transverse staple line of FEESA to reduce postoperative dehiscence.
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Affiliation(s)
- Scarlett M Sumner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Gary W Ellison
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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Mutascio LM, Breur GJ, Moore GE, Simons MC. Effects of a surgical sealant on leakage pressure and circumference of fresh canine cadaver small intestinal anastomoses. Am J Vet Res 2018; 79:1335-1340. [DOI: 10.2460/ajvr.79.12.1335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Aeschlimann KA, Mann FA, Middleton JR, Belter RC. Comparison of enterotomy leak pressure among fresh, cooled, and frozen-thawed porcine jejunal segments. Am J Vet Res 2018; 79:576-580. [DOI: 10.2460/ajvr.79.5.576] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jones CT, Chen CY, Campbell BG, Fransson BA. Assessment of leakage pressure following enterotomy closure reinforced by tissue adhesive in a caprine cadaver model. N Z Vet J 2017. [DOI: 10.1080/00480169.2017.1344586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- CT Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| | - CY Chen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
- Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - BG Campbell
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| | - BA Fransson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
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Spiller PR, Gomes LG, Monzem S, Ducatti KR, Dower NMB, Pizzinatto FD, Ribeiro AP, Souza RLD. Evaluation of intraluminal pressure in cystorrhaphies with and without intestinal serosal patch supplementation from canine cadavers. Acta Cir Bras 2015; 30:704-8. [PMID: 26560429 DOI: 10.1590/s0102-865020150100000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Hansen LA, Smeak DD. In vitro comparison of leakage pressure and leakage location for various staple line offset configurations in functional end-to-end stapled small intestinal anastomoses of canine tissues. Am J Vet Res 2015; 76:644-8. [DOI: 10.2460/ajvr.76.7.644] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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