• 1. Chan DL, Freeman LM. Nutrition in critical illness. Vet Clin North Am Small Anim Pract 2006; 36: 12251241.

  • 2. Campbell SA, Daley CA. Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs. J Am Anim Hosp Assoc 2011; 47:e50E55.

    • Search Google Scholar
    • Export Citation
  • 3. Heuter K. Placement of jejunal feeding tubes for post-gastric feeding. Clin Tech Small Anim Pract 2004; 19: 3242.

  • 4. Mansfield CS, James FE, Steiner JM, et al. A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. J Vet Intern Med 2011; 25: 419425.

    • Search Google Scholar
    • Export Citation
  • 5. Tapia J, Murguia R, Garcia G, et al. Jejunostomy: techniques, indications, and complications. World J Surg 1999; 23: 596602.

  • 6. Minard G. The history of surgically placed feeding tubes. Nutr Clin Pract 2006; 21: 626633.

  • 7. Crowe DT, Devey JJ. Clinical experience with jejunostomy feeding tubes in 47 small animal patients. J Vet Emerg Crit Care 1997; 7: 719.

    • Search Google Scholar
    • Export Citation
  • 8. Hewitt SA, Brisson BA, Sinclair MD, et al. Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs. J Am Vet Med Assoc 2004; 225: 6571.

    • Search Google Scholar
    • Export Citation
  • 9. Daye RM, Huber ML, Henderson RA. Interlocking box jejunostomy: a new technique for enteral feeding. J Am Anim Hosp Assoc 1999; 35: 129134.

    • Search Google Scholar
    • Export Citation
  • 10. Wohl JS. Nasojejunal feeding tube placement using fluoroscopic guidance: technique and clinical experience in dogs. J Vet Emerg Crit Care 2006; 16 (suppl 1): S27S33.

    • Search Google Scholar
    • Export Citation
  • 11. Beal MW, Brown AJ. Clinical experience utilizing a novel fluoroscopic technique for wire-guided nasojejunal tube placement in the dog: 26 cases (2006–2010). J Vet Emerg Crit Care (San Antonio) 2011; 21: 151157.

    • Search Google Scholar
    • Export Citation
  • 12. Tasaka K, Farrar JT. Intraluminal pressure of the small intestine of the unanesthetized dog. Pflugers Arch 1976; 364: 3544.

  • 13. Shikata J, Shida T, Amino K, et al. Experimental studies on the hemodynamics of the small intestine following increased intraluminal pressure. Surg Gynecol Obstet 1983; 156: 155160.

    • Search Google Scholar
    • Export Citation
  • 14. Song EK, Mann FA, Wagner-Mann CC. Comparison of different tube materials and used of Chinese finger trap or four friction suture technique for securing gastrostomy, jejunostomy, and thoracostomy tubes in dogs. Vet Surg 2008; 37: 212221.

    • Search Google Scholar
    • Export Citation
  • 15. Jergens AE, Morrison JA, Miles KG, et al. Percutaneous endoscopic gastrojejunostomy tube placement in healthy dogs and cats. J Vet Intern Med 2007; 21: 1824.

    • Search Google Scholar
    • Export Citation
  • 16. Nieto JE, Dechant JE, Snyder JR. Comparison of one-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end anastomosis in equine jejunum. Vet Surg 2006; 35: 669673.

    • Search Google Scholar
    • Export Citation
  • 17. Gandini M, Bertuglia A. In vitro evaluation of an inverted end-to-end equine jejunojejunal anastomosis using skin staples. Vet Surg 2006; 35: 678682.

    • Search Google Scholar
    • Export Citation
  • 18. Gandini M. In vitro evaluation of a closed-bowel technique for one-layer hand-sewn inverting end-to-end jejunojejunostomy in the horse. Vet Surg 2006; 35: 683688.

    • Search Google Scholar
    • Export Citation
  • 19. García-Olmo D, Payá J, Lucas FJ, et al. The effects of the pharmacological manipulation of postoperative intestinal motility on colonic anastomoses. An experimental study in a rat model. Int J Colorectal Dis 1997; 12: 7377.

    • Search Google Scholar
    • Export Citation
  • 20. Wheeless CR Jr, Zanagnolo V, Bowers D, et al. The effect of growth hormone on the bursting strength of ileal anastomotic segments in radiation-injured rat bowel. Gynecol Oncol 1998; 70: 121122.

    • Search Google Scholar
    • Export Citation
  • 21. Ikeuchi D, Onodera H, Aung T, et al. Correlation of tensile strength with bursting pressure in the evaluation of intestinal anastomosis. Dig Surg 1999; 16: 478485.

    • Search Google Scholar
    • Export Citation
  • 22. Downey DM, Harre JG, Dolan JP. Increased burst pressure in gastrointestinal staple-lines using reinforcement with a bioprosthetic material. Obes Surg 2005; 15: 13791383.

    • Search Google Scholar
    • Export Citation
  • 23. Semevolos SA, Reed SK, Gamble K. In vitro bursting pressures of jejuna enterotomy closures in llamas. Vet Surg 2007; 36: 6467.

  • 24. Goto T, Kawasaki K, Fujino Y, et al. Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc 2007; 21: 15081511.

    • Search Google Scholar
    • Export Citation
  • 25. Saile K, Boothe HW, Boothe DM. Saline volume necessary to achieve predetermined intraluminal pressure during leak testing of small intestinal biopsy sites in the dog. Vet Surg 2010; 39: 900903.

    • Search Google Scholar
    • Export Citation
  • 26. Otterson MF, Sarr MG. Normal physiology of small intestinal motility. Surg Clin North Am 1993; 73: 11731192.

Advertisement

In vitro evaluation of bursting pressure and intestinal luminal area of three jejunostomy tube placement techniques in dogs

View More View Less
  • 1 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 2 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695.
  • | 3 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 4 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 5 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 6 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 7 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 8 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695.
  • | 9 Department of Statistics, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC 27695.

Abstract

OBJECTIVE To compare pursestring, Witzel (seromuscular inversion), and seromuscular incision jejunostomy tube placement techniques in vitro.

SAMPLE Jejunal specimens from 10 dogs.

PROCEDURES Jejunal segments (50 cm) were harvested immediately prior to euthanasia from 10 mixed-breed dogs Specimens were harvested with the orad and aborad ends clamped and stored in saline (0.9% NaCl) solution–soaked towels during instrumentation. Three jejunostomy tubes were placed via 3 techniques (pursestring, Witzel, and seromuscular incision), and 2 double lumen central venous catheters were placed at each intestinal end for luminal filling and leak testing. Intestinal luminal area was measured ultrasonographically with specimens suspended in a warm undyed saline solution bath with the intestinal lumen filled with dyed saline solution (intraluminal pressure, 6 mm Hg). Leak testing was performed by means of infusion of dyed saline solution (4 mL/min) until each jejunostomy site failed. Intestinal luminal area and leakage pressure were compared between the 3 tube placement techniques.

RESULTS The Witzel and seromuscular incision techniques decreased the intestinal luminal area measured at the tube insertion site, albeit nonsignificantly. For the seromuscular incision technique, a significant decrease in intestinal luminal area at the intraluminal site of measurement was found. For 2/30 specimens (1/10 pursestring and 1/10 seromuscular incision), failure occurred at pressures within the range of previously reported peak peristaltic pressure for dogs. Failure occurred at supraphysiologic peristaltic pressures for the remaining 28 specimens, including all 10 specimens for the Witzel technique.

CONCLUSIONS AND CLINICAL RELEVANCE In this in vitro study, all specimens for the Witzel technique withstood physiologic peristaltic pressures during leak testing. Both tunneling techniques (Witzel and seromuscular incision) created a decrease in intestinal luminal area. Further investigation, including in vivo testing, is indicated to evaluate the clinical relevance of these findings.

Contributor Notes

Dr. Risselada's present address is Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695.

Address correspondence to Dr. Risselada (mrissel@ncsu.edu).