• 1.

    Giuffrida MA, Brown DC. Small intestine. In: Tobias KM, Johnston SA, eds. Veterinary surgery: small animal. 2nd ed. St Louis: Saunders, 2012;17321760.

    • Search Google Scholar
    • Export Citation
  • 2.

    Ralphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am Vet Med Assoc 2003;223:7377.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Allen DA, Smeak DD, Schertel ER. Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. J Am Anim Hosp Assoc 1992;28:7076.

    • Search Google Scholar
    • Export Citation
  • 4.

    Snowdon KA, Smeak DD, Chiang S. Risk factors for dehiscence of stapled functional end-to-end intestinal anastomoses in dogs: 53 cases (2001–2012). Vet Surg 2016;45:9199.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Grimes JA, Schmiedt CW, Cornell KK, et al. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs. J Am Vet Med Assoc 2011;238:486494.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Duell JR, Mankin KMT, Rochat MC, et al. Frequency of dehiscence in hand-sutured and stapled intestinal anastomoses in dogs. Vet Surg 2016;45:100103.

  • 7.

    Gilbert JM, Trapnell JE. Intraoperative testing of the integrity of left-sided colorectal anastomoses—a technique of value to the surgeon in training. Ann R Coll Surg Engl 1988;70:158160.

    • Search Google Scholar
    • Export Citation
  • 8.

    Wu Z, van de Haar RC, Sparreboom CL, et al. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis 2016;31:14091417.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Allaix ME, Lena A, Degiuli M, et al. Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections. Surg Endosc 2019;33:15921599.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Wheeler JM, Gilbert JM. Controlled intraoperative water testing of left-sided colorectal anastomoses: are ileostomies avoidable? Ann R Coll Surg Engl 1999;81:105108.

    • Search Google Scholar
    • Export Citation
  • 11.

    Kwon S, Morris A, Billingham R, et al. Routine leak testing in colorectal surgery in the surgical care and outcomes assessment program. Arch Surg 2012;147:345351.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Beard JD, Nicholson ML, Sayers RD, et al. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 1990;77:10951097.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Ricciardi R, Roberts PL, Marcello PW, et al. Anastomotic leak testing after colorectal resection: what are the data? Arch Surg 2009;144:407412.

  • 14.

    Ciasca TC, David FH, Lamb CR. Does measurement of small intestinal diameter increase diagnostic accuracy of radiography in dogs with suspected intestinal obstruction? Vet Radiol Ultrasound 2013;54:207211.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Sharma A, Thompson MS, Scrivani PV, et al. Comparison of radiography and ultrasonography for diagnosing small-intestinal mechanical obstruction in vomiting dogs. Vet Radiol Ultrasound 2011;52:248255.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Fossum TW. Surgery of the digestive system. In: Fossum TW, eds. Small animal surgery. 4th ed. St Louis: Mosby, 2012;497552.

  • 17.

    Saile K, Boothe HW, Boothe DM. Saline volume necessary to achieve predetermined intraluminal pressures during leak testing of small intestinal biopsy sites in the dog. Vet Surg 2010;39:900903.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Matz BM, Boothe HW, Wright JC, et al. Effect of enteric biopsy closure orientation on enteric circumference and volume of saline needed for leak testing. Can Vet J 2014;55:12551257.

    • Search Google Scholar
    • Export Citation
  • 19.

    Brand KJ, Hess E, Risselada M. Effects of needle gauge and syringe size on small intestinal leakage at injection sites. Vet Surg 2019;48:12371244.

  • 20.

    Ricciardi R, Roberts PL, Read TE, et al. How often do patients return to the operating room after colorectal resections? Colorectal Dis 2012;14:515521.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2012;1:CD003144.

    • Search Google Scholar
    • Export Citation
  • 22.

    StatPearls. Small bowel resection. Available at: www.ncbi.nlm.nih.gov/books/NBK507896/.

  • 23.

    Sajid MS, Siddiqui MR, Baig MK. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database Syst Rev 2012;1:CD005477.

    • Search Google Scholar
    • Export Citation
  • 24.

    George WD. Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg 1991;78:337341.

  • 25.

    White RN. Modified functional end-to-end stapled intestinal anastomosis: technique and clinical results in 15 dogs. J Small Anim Pract 2008;49:274281.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Ullman SL, Pavletic MM, Clark GN. Open intestinal anastomosis with surgical stapling equipment in 24 dogs and cats. Vet Surg 1991;20:385391.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Jardel N, Hidalgo A, Leperlier D, et al. One stage functional end-to-end stapled intestinal anastomosis and resection performed by nonexpert surgeons for the treatment of small intestinal obstruction in 30 dogs. Vet Surg 2011;40:216222.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Sumner SM, Regier PJ, Case JB, et al. Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008–2018). Vet Surg 2019;48:11881193.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Mutascio LM, Breur GJ, Moore GE, et al. Effects of a surgical sealant on leakage pressure and circumference of fresh canine cadaver small intestinal anastomoses. Am J Vet Res 2018;79:13351340.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Ellison GW. Wound healing in the gastrointestinal tract. Semin Vet Med Surg Small Anim 1989;4:287293.

  • 31.

    Tasaka K, Farrar JT. Intraluminal pressure of the small intestine of the unanesthetized dog. Pflugers Arch 1976;364:3544.

  • 32.

    Ellison GW. Complications of gastrointestinal surgery in companion animals. Vet Clin North Am Small Anim Pract 2011;41:915934.

Advertisement

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008–2019)

View More View Less
  • 1 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608.
  • | 2 Department of Statistics, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32608.

Abstract

OBJECTIVE

To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine.

ANIMALS

131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA).

PROCEDURES

Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up.

RESULTS

Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques.

CONCLUSIONS AND CLINICAL RELEVANCE

Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

Contributor Notes

Address correspondence to Dr. Regier (pregier@ufl.edu).