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Kerby MD, Tobias KM, Monto T, Morandi F. Epiploic foramen entrapment in a dog. Vet Surg 2023; 52:1237-1244. [PMID: 37293954 DOI: 10.1111/vsu.13975] [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: 12/27/2022] [Revised: 04/07/2023] [Accepted: 05/20/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report small intestinal herniation through the epiploic foramen in a dog. ANIMALS Nine-year-old male castrated Shih Tzu. STUDY DESIGN Case report. METHODS The dog presented with an 8-year history of vomiting and regurgitation and acute onset of melena, lethargy, anorexia, anemia, and suspected gastrointestinal mass or obstruction on prereferral imaging. Abnormalities on abdominal radiographs included a large, midcaudal soft tissue structure and cranial displacement and segmental dilation of the small intestine. On abdominal ultrasound, severe gastric dilation, jejunal tortuosity and stacking, and peritoneal effusion were observed. Epiploic herniation of the small intestine and segmental jejunal devitalization was diagnosed on exploratory laparotomy, and the dog underwent hernia reduction, jejunal resection and anastomosis, and nasogastric tube placement. RESULTS Severe gastric distention and atony persisted 24 h after surgery, despite medical management. The dog was taken to surgery for decompressive gastrotomy and placement of gastrostomy and nasojejunostomy tubes for postoperative decompression and feeding, respectively. Three days after the original surgery, the dog developed a septic abdomen from anastomotic dehiscence and underwent jejunal resection and anastomosis and peritoneal drain placement. Gastric dysmotility gradually resolved with the administration of motility stimulants, removal of gastric residual volume, and nutritional support via nasojejunostomy tube feedings. Three months after discharge, the dog was clinically normal. CONCLUSION Epiploic foramen entrapment should be considered a type of herniation in dogs. Clinical suspicion should be raised in dogs with unresolving regurgitation and vomiting, visceral displacement, and stacking and distension of small intestine.
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Affiliation(s)
- Mary Douglass Kerby
- Department of Clinical Sciences at the University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Karen M Tobias
- Department of Clinical Sciences at the University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Thomas Monto
- Department of Clinical Sciences at the University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Federica Morandi
- Department of Clinical Sciences at the University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
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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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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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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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Culbertson TF, Smeak DD, Rao S. Volume of saline (0.9% NaCl) solution required to reach maximum peristaltic pressure in cadaveric intact jejunal specimens from dogs of various sizes. Am J Vet Res 2021; 82:988-995. [PMID: 34714768 DOI: 10.2460/ajvr.21.05.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the volume of saline (0.9% NaCl) solution required to reach a maximum intraluminal peristaltic pressure of 25 mm Hg in dogs of various sizes. SAMPLES 25 grossly normal jejunal segments from 6 canine cadavers < 20 kg (small dogs) and 25 segments from 5 cadavers ≥ 20 kg (large dogs). PROCEDURES Jejunal specimens were obtained within 1.5 hours after euthanasia. Harvested tissue was transected into 12-cm-long segments, mesentery was trimmed, and each segment was measured from the antimesenteric to mesenteric serosal edges. A 10-cm segment was isolated with Doyen forceps, securing a pressure sleeve within the lumen. Intraluminal saline was infused, and the volume was recorded when a pressure of > 25 mm Hg was achieved. Data were analyzed only from specimens in which the pressure remained between 24 and 26 mm Hg for > 5 seconds. RESULTS Mean ± SD intestinal measurement for large dogs (17.82 ± 1.44 mm) was greater than that for small dogs (12.38 ± 1.38 mm) as was the volume of saline solution infused (17.56 ± 7.17 mL vs 3.28 ± 1.41 mL, respectively). The volume infused increased by 1.31 mL (95% CI, 1.08 to 1.18) for every 1-mm increase in intestinal measurement and by 1.06 mL (95% CI, 1.052 to 1.068) for every 1-kg increase in body weight. CONCLUSIONS AND CLINICAL RELEVANCE The volume of saline solution used for intestinal leak testing should be determined on the basis of patient intestinal measurement or body weight. In vivo studies are necessary to establish the optimal volume for intestinal leak testing.
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Affiliation(s)
- Tricia F Culbertson
- From the Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523
| | - Daniel D Smeak
- From the Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523
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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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