Objective—To determine effects of staple size, precompression time, and tissue thickness on staple shape and tissue approximation in side-to-side jejunocecal anastomosis in equine specimens.
Sample—Cecum, ileum, and jejunum specimens obtained from 18 healthy horses at an abattoir.
Procedures—Specimens were allotted into 2 groups. Anastomoses were stapled with 4.8-or 3.8-mm staples. Precompression time was 15 seconds for both groups. Staple lines were cut into proximal, middle, and distal sections. Thickness of intestinal walls was measured with a calibrated tissue micrometer, photographs were obtained, and intestinal tissues were digested. An investigator measured staples and assessed the shape of staples on high-definition digital images. Number of optimally shaped staples and staple height were compared among sections and between groups.
Results—Use of 4.8-mm staples resulted in poor approximation of tissues in the distal sections of anastomoses. The percentage of optimally shaped staples was 538 of 551 (97.6%) and 616 of 634 (97.2%) for 4.8- and 3.8-mm staples, respectively. The percentage of optimally shaped staples did not differ significantly between groups for the same sections. There was a lower percentage of optimally shaped staples in the distal sections than in the proximal and middle sections of each group. Mean staple height did not differ significantly among sections of each group.
Conclusions and Clinical Relevance—Use of 3.8-mm staples with an adequate precompression time for jejunocecal anastomosis in horses resulted in proper staple shape. These findings could be used to improve the technique and outcome for stapled jejunocecal anastomoses in horses.
7 horses (3 geldings, 2 mares, and 2 stallions) were examined because of acute colic caused by small intestinal obstruction involving the aborad portion of the jejunum and orad portion of the ileum.
All horses underwent a routine colic examination on arrival and had a diagnosis of strangulating obstruction of the small intestine.
TREATMENT AND OUTCOME
All horses underwent emergency exploratory laparotomy, in which the affected aborad portion of the jejunum and orad portion of the ileum were resected; in 5 horses, a hand-sewn end-to-end jejuno-ileal anastomosis was combined with a hand-sewn incomplete ileocecal bypass to produce a hybrid jejuno-ileo-cecal anastomosis. In 2 horses, the hand-sewn end-to-end jejuno-ileal anastomosis was combined with a half-stapled, half–hand-sewn incomplete ileocecal bypass. The procedures restored continuity of the small intestine with partial bypass of the ileocecal valve. All horses survived to hospital discharge, and none developed colic or ileus during the postoperative period. Follow-up revealed that 6 horses were living and had no subsequent signs of colic (4 to 17 months after surgery), and 1 was euthanized because of colic 17 months after surgery.
Results for these horses suggested the hybrid jejuno-ileo-cecal anastomosis could be considered as an option for the resolution of small intestinal strangulating lesions involving the orad portion of the ileum. Studies are needed to assess short-term and long-term effects of the procedure in horses.
CASE DESCRIPTION 8 horses (5 geldings and 3 mares) were evaluated for laparoscopic closure of the nephrosplenic space following a history of recurrent left dorsal displacement of the large colon.
CLINICAL FINDINGS All horses underwent a physical examination and routine clinicopathologic testing. Transrectal palpation and transabdominal ultrasonography were performed to exclude the presence of organs in the left paralumbar region.
TREATMENT AND OUTCOME A left flank laparoscopic approach with the horses standing was used. A continuous suture was placed in a craniocaudal direction between the renal and splenic capsules with unidirectional barbed suture material. This allowed obliteration of the nephrosplenic space without the need for knots to secure the leading and terminal ends of the suture line. In all horses, transrectal palpation was performed 2 months after surgery; at this time, closure of the caudal part of the nephrosplenic space was evident. In 2 horses, follow-up laparoscopy was performed, and complete closure of the nephrosplenic space was confirmed. Telephone follow-up revealed that none of the horses had any signs of recurrent left dorsal displacement of the large colon.
CLINICAL RELEVANCE Results suggested that laparoscopic nephrosplenic space closure with unidirectional barbed suture material could be considered as an option for prevention of left dorsal displacement of the large colon in horses. In the horses of this report, barbed suture material allowed secure ablation of the nephrosplenic space and eliminated the need for intracorporeal knot tying.
OBJECTIVE To determine the most effective hemostatic knot configuration performed by veterinary students following a brief training session with an experienced surgeon and a subsequent deliberate self-training period.
SAMPLE 24 fourth-year veterinary students with no previous surgical knot–tying experience.
PROCEDURES In a 1-hour training session, an experienced surgeon showed veterinary students how to perform 5 hemostatic knot configurations (giant, slip, strangle, surgeon's, and transfixing), which they then practiced at home on a hemostasis simulator for 2 weeks. Thereafter, students performed each knot 4 times (twice each with monofilament and multifilament suture) on a hemostasis simulator. An experienced surgeon evaluated the correct execution of knots and measured their effectiveness by use of a manometer to measure vessel pressure distal to the ligature. Each student completed a questionnaire regarding their perceived learning and execution difficulty and sealing security for each knot. Responses were compared among knots and suture materials.
RESULTS Overall, students considered the surgeon's knot the easiest to learn and the strangle knot the most difficult. The slipknot was also considered the easiest knot to perform, and the giant knot was considered the most difficult. The strangle knot was deemed the most effective in reducing vessel pressure distal to the ligature.
CONCLUSIONS AND CLINICAL RELEVANCE The strangle knot was the most effective hemostatic knot in inexperienced hands, although veterinary students considered it more difficult to learn than other, perhaps more commonly taught, knots. Therefore, teaching of the strangle knot should be encouraged in veterinary schools.