The use of disposable skin staples for intestinal resection and anastomosis in 63 dogs: 2000 to 2014

OBJECTIVE

To describe the use of disposable skin staples for intestinal resection and anastomosis in dogs and report associated dehiscence and mortality rates.

METHODS

Retrospective evaluation of medical records of dogs that underwent intestinal resection and anastomosis using disposable skin staples between 2000 and 2014. Data regarding patient signalment, indication for surgery, location of the resection and anastomosis, number of procedures performed, evidence of peritonitis at the time of surgery, surgeon qualifications, dehiscence, and mortality were obtained from the medical records. Mortality was defined as failure to survive beyond 10 days following resection and anastomosis.

RESULTS

The overall mortality rate of patients undergoing intestinal resection and anastomosis was 12·7% (8/63). The most common indication for resection and anastomosis was neoplasia (20/63 [31·7%]), followed by foreign body removal (19/63 [30·2%]). The overall dehiscence rate was 4·8% (3/63). No difference in mortality associated with indication for surgery, whether multiple procedures were performed, surgeon qualifications, or evidence of peritonitis at the time of surgery was identified.

CLINICAL SIGNIFICANCE

In this retrospective study, the overall mortality and dehiscence rates using disposable skin staples were similar to previously reported outcomes following resection and anastomosis.

Synovial hemangioma in the stifle joint of a dog

Synovial hemangioma was diagnosed in an 8-year-old castrated male Belgian Sheepdog with lameness of 3 months' duration. Pain, soft-tissue swelling, and hemarthrosis were localized to the left stifle joint. Projections of synovial membrane with reddish-purple nodules, excised via arthrotomy, were composed histologically of variably sized vascular channels that were lined by well-differentiated endothelial cells and separated by fibrous septa. Distension of some channels resulted in endothelial disruption, thrombosis, hemorrhage, necrosis, and focal spindle-cell proliferation. The limb was amputated to remove remaining neoplastic tissue. The hemangioma extended focally into the joint capsule and popliteal soft tissue but did not invade skeletal muscle or bone. The dog was free of detectable neoplasia 6 months after amputation. Synovial hemangioma is a rare benign vascular proliferation in people, most commonly in the knee, and should be included in the differential diagnosis for canine synovial tumors.

Use of skin staples for rapid closure of gastrointestinal incisions in the treatment of canine linear foreign bodies

A technique was developed for closure of gastrotomy and enterotomy incisions using disposable skin staples. The technique was used successfully in three dogs with gastrointestinal linear foreign bodies that required a gastrotomy and one or more enterotomies. The method allows for secure closure of gastrointestinal incisions and minimizes the surgical time in patients requiring multiple gastrointestinal incisions.

Comparison of skin staples with sutures for anastomosis of the small intestine in dogs

OBJECTIVES

To develop a technique for approximation of end-to-end intestinal anastomoses by using a disposable skin stapler and to compare the stapling technique with an interrupted hand-sewn approximating end-to-end anastomosis of the canine jejunum.

STUDY DESIGN

In vitro evaluation of the stapling technique, followed by an in vivo study of healing and clinical response in dogs.

ANIMAL POPULATION

18 mixed-breed adult dogs.

METHODS

The anastomotic technique was developed and tested in fresh canine jejunum. Fourteen stapled approximating anastomoses (SAA) and 14 hand-sewn approximating anastomoses (HAA) were performed in 6 cadavers under simulated surgical conditions. Anastomotic construction times, initial bursting strengths, initial lumen diameters, and gross appearance of the 2 techniques were compared. Healing and clinical response were evaluated in 12 purpose-bred dogs assigned to 2 groups of 6 animals each. Each dog had 1 SAA and 1 HAA performed in the jejunum, 50 cm apart. Six dogs were killed on postoperative day 4, and 6 dogs were killed on postoperative day 21. Anastomotic construction time, gross and histological healing, bursting strength, lumen diameter, and circumference were compared between techniques.

RESULTS

Mean construction time for SAA was significantly faster than for HAA (P = .0001). None of the anastomoses leaked, and there were no major clinical complications in any dog. Bursting strengths were not significantly different at any time for the 2 techniques. Initial bursting strength was 31% to 35% of the normal jejunum. A nonsignificant decrease in bursting strength was observed by postoperative day 4 (26% to 28% of normal), and a significant increase in bursting strength was observed by postoperative day 21 (100% to 109% of normal). Neither technique decreased the initial lumen diameter. However, both techniques resulted in a similar degree of luminal stenosis as the anastomoses healed. Anastomotic lumen diameter was significantly decreased from normal in both groups at day 4 (86% to 88% of normal) and day 21 (90% to 91% of normal). There was no significant difference between the circumference of the anastomoses and normal jejunum at any time. Histological analysis showed similar healing for the hand-sewn and stapled techniques at 4 and 21 days after surgery. For both surgical techniques, day 21 anastomoses had significantly less inflammation and necrosis, significantly more fibrosis, and significantly better continuity of histological layers when compared with day 4 anastomoses.

CONCLUSION

Approximating end-to-end intestinal anastomosis with a skin stapler is equivalent in bursting strength, lumen diameter, lumen circumference, and healing characteristics to the traditional hand-sewn technique, but it can be performed in significantly less time.

CLINICAL RELEVANCE

Skin stapling devices can be used to create technically simple, rapid, and safe end-to-end anastomoses in canine jejunum.

Evaluation of a skin stapler for belt-loop gastropexy in dogs

A new method for attachment of a belt-loop gastropexy using disposable, stainless steel skin staples was compared with a traditional hand-sewn belt-loop gastropexy technique in 24 fresh dog cadavers. Mean gastropexy times were 212 seconds for the stapled technique and 435 seconds for the hand-sewn technique. The stapled belt-loop gastropexy was significantly faster than the hand-sewn technique (P less than 0.001). There was no statistically significant difference in the mean maximum tensile strength between the two attachment methods. This study provides a basis for clinical evaluation of the stapled belt-loop gastropexy technique in dogs.

Effect of perioperative prophylactic antimicrobial treatment in dogs undergoing elective orthopedic surgery

OBJECTIVE

To determine whether perioperative antimicrobial prophylaxis would reduce incidence of postoperative infection among dogs undergoing elective orthopedic procedures.

DESIGN

Randomized, controlled, blinded, intention clinical trial.

ANIMALS

Dogs of any breed, sex, or age undergoing elective orthopedic surgery at a veterinary teaching hospital.

PROCEDURES

Dogs were randomly assigned to 1 of 3 groups: treatment with saline solution, treatment with potassium penicillin G, and treatment with cefazolin. Treatments were intended to be administered within 30 minutes prior to surgery; a second dose was administered if surgery lasted > 90 minutes. Dogs were monitored for 10 to 14 days after surgery for evidence of infection.

RESULTS

After the first 112 dogs were enrolled in the study, it was found that infection rate for control dogs (5/32 dogs) was significantly higher than the rate for dogs treated with antimicrobials (3/80 dogs). Therefore, no more dogs were enrolled in the study. A total of 126 dogs completed the study. Monte Carlo simulations indicated that compared with dogs that received antimicrobials prophylactically, dogs that received saline solution developed infections significantly more frequently. Difference in efficacy, however, was not observed between the 2 antimicrobial drugs used.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that perioperative antimicrobial prophylaxis decreased postoperative infection rate in dogs undergoing elective orthopedic surgery, compared with infection rate in control dogs. Cefazolin was not more efficacious than potassium penicillin G in these dogs.

Partial colonic obstruction following ovariohysterectomy: a report of three cases

Partial extramural obstruction of the descending colon was diagnosed in two dogs and a cat as a complication of elective ovariohysterectomy. In each case, the obstruction was caused by fibrous tissue that encircled or crossed the descending colon, severely restricting the organ's normal mobility and luminal diameter. Clinical signs secondary to obstipation were observed in two cases, five weeks and 27 months after elective ovariohysterectomy. In one dog without clinical signs, the adhesion was an incidental finding during a laparotomy performed nine years after the ovariohysterectomy. The fibrous adhesions were removed surgically in all three cases without additional complications.

Cutaneous antimicrobial preparation prior to intravenous catheterization in healthy dogs: clinical, microbiological, and histopathological evaluation

The purpose of this study was to determine the effects of a one-minute chlorhexidine gluconate skin preparation protocol prior to cephalic vein catheterization. Twenty-three healthy beagle dogs had one leg aseptically prepared and the opposite leg served as a control. Twenty-six- and 77-hour time groups were studied. Chlorhexidine-treated legs had significantly lower cutaneous bacterial counts than the control legs prior to catheter insertion and prior to catheter withdrawal for both time groups. Control legs developed significantly more dermatitis than the treated legs after 77 h. A one-minute preparation with 4% chlorhexidine gluconate was an effective method for sustained reduction of cutaneous bacterial counts at peripheral intravenous catheter insertion points in dogs. Increased cutaneous bacterial counts were associated with significantly more microscopic dermatitis in untreated legs after 77 h of catheterization.

Choanal atresia and secondary nasopharyngeal stenosis in a dog

A 20-month-old, intact male shih tzu was evaluated for chronic upper airway disease. Endoscopic examination established a diagnosis of choanal atresia, a developmental anomaly of the posterior nasal cavity. Although surgical intervention provided temporary relief, stenosis of the nasopharynx by obstructive scar tissue was confirmed within four weeks. A permanent tracheostomy provided long-term relief of the respiratory difficulty. This is the first report of choanal atresia or nasopharyngeal stenosis in a dog.

Bilateral incisional gastropexies for treatment of intermittent gastroesophageal intussusception in a puppy

Intermittent gastroesophageal intussusception was diagnosed in an 8-week-old puppy that had had recurrent regurgitation since it was acquired at 6 weeks old. Abnormalities were not detected on survey radiographs or positive-contrast esophagograms; the intussusception was evident only during endoscopic examination of the esophagus. Treatment consisted of bilateral incisional gastropexies attaching the gastric fundus and body to the left and right body walls, respectively. Clinical signs resolved completely after surgery. Gastroesophageal intussusception is rare in dogs, and most dogs with gastroesophageal intussuception have severe clinical abnormalities, including collapse, respiratory difficulties, and shock. However, for dogs with intermittent gastroesophageal intussusception, the only clinical sign may be recurrent regurgitation. Bilateral incisional gastropexies appear to be useful for preventing recurrence of gastroesophageal intussusception in dogs.

Severe idiopathic thymic hemorrhage in two littermate dogs

Two 6-month-old littermate Shetland Sheepdogs were found to have severe thymic hemorrhage unassociated with trauma or poisoning. One dog survived the insult with supportive care, and the other died and was necropsied. Antemortem laboratory data and radiographic findings for both dogs were consistent with acute blood loss into the mediastinum. Hemorrhage was restricted to the thymus and mediastinum in both dogs.

Evaluation of risk factors for blastomycosis in dogs: 857 cases (1980-1990)

An epidemiologic study was conducted by use of the Veterinary Medical Data Base to investigate risk factors for blastomycosis in dogs. From January 1980 through June 1990, 971 cases of blastomycosis in dogs from 22 North American veterinary teaching hospitals were identified. Of these cases, 114 (11.7%) were excluded from the study because of incomplete information regarding age, body weight, sex, and neuter status. A control group of 417,079 dogs was selected that included all other dogs with medical conditions unrelated to blastomycosis for which records were submitted to the data base during the same period. The prevalence of blastomycosis in dogs was 205/100,000 admissions during the study period. When veterinary teaching hospitals were grouped on the basis of their general geographic location, dogs in the East South central, East North central, West South central, and South Atlantic regions had a significantly (P < 0.05) increased risk of acquiring blastomycosis, compared with that of dogs in the Mountain/Pacific region. When teaching hospitals from all geographic regions were considered, dogs had a significantly (P < 0.05) increased risk of acquiring blastomycosis in autumn, compared with that in spring. Sporting dogs and hounds, as defined by the American Kennel Club, were at increased risk for blastomycosis. At highest risk were Bluetick Coonhounds, Treeing-walker Coonhounds, Pointers, and Weimaraners, compared with mixed-breed dogs. Ages of dogs with blastomycosis tended to be normally distributed. Generally, the highest-risk group was composed of sexually intact male dogs, 2 to 4 years old, weighing 22.7 to 34.1 kg. This same pattern was observed for sporting dogs and hounds.(ABSTRACT TRUNCATED AT 250 WORDS)