Objective—To determine complications associated
with anal sacculectomy in dogs with non-neoplastic
anal sac disease and compare complication rates for
open versus closed techniques.
Procedure—Medical records were reviewed for
information on signalment, history, physical examination
findings, type of anal sac disease, surgical technique
(closed, standard open [surgery performed prior
to 1980], or modified open [surgery performed after
1980]), and postoperative complications.
Results—In 57 dogs, a closed technique was used,
and in 38, an open technique was used. Only 3 dogs
developed short-term complications (excessive
drainage, scooting and inflammation, and seroma formation),
and 14 developed long-term complications
(continued licking of the surgery site, fecal incontinence,
fistulation, and stricture formation).
Development of postoperative complications was significantly
associated with surgical technique. Dogs
that underwent standard open sacculectomy prior to
1980 were 13.67 times as likely to have a long-term
complication as were dogs that underwent closed
sacculectomy. Weight of the dog, type of anal sac disease,
age at the time of surgery, and whether the
wound was closed surgically were not significantly
associated with whether dogs developed postoperative
Conclusions and Clinical Relevance—Results suggest
that anal sacculectomy is a safe and effective
treatment for non-neoplastic anal sac disease in dogs
and is associated with a low rate of complications.
The standard open technique was associated with
the greatest number of complications, whereas complication
rates for the closed and modified open techniques
were similar to each other. (J Am Vet Med
To determine whether jejunal serosal patches could securely seal large, open defects in duodenal segments harvested from canine cadavers and to compare intraluminal pressures at which leakage first occurred and maximal intraluminal pressures for repaired duodenal segments between 2 suture patterns.
Duodenal and jejunal segments from 9 canine cadavers.
20 constructs were created through repair of large, open duodenal defects with circumferential suturing of an intact jejunal segment (jejunal serosal patch). Constructs were randomly assigned to have the serosal patch anastomosed to the duodenal segment by a simple continuous or simple interrupted suture pattern. The pressure at which the first leakage was observed and the maximum pressure obtained during testing were recorded and compared between suture patterns.
Initial leakage pressure was significantly higher with the simple interrupted pattern (mean ± SD, 68.89 ± 5.62 mm Hg), compared with the simple continuous pattern (59.8 ± 20.03 mm Hg). Maximum intraluminal pressures did not significantly differ between the simple interrupted (91 ± 8.27 mm Hg) and simple continuous patterns (90.7 ± 16.91 mm Hg). All constructs, regardless of suture pattern, withstood supraphysiologic pressures.
CONCLUSIONS AND CLINICAL RELEVANCE
Jejunal serosal patches adequately sealed large, open duodenal defects and prevented leakage in these constructs. Constructs with simple continuous or simple interrupted suture patterns withstood physiologic and supraphysiologic intraluminal pressures, although constructs with a simple interrupted suture pattern initially leaked at higher pressures. (Am J Vet Res 2020;81:985–991)
OBJECTIVE To compare intraluminal pressure at initial leakage (leakage pressure), leakage location, and maximum intraluminal pressure (MIP) for various staple line offset configurations of functional end-to-end stapled anastomosis (FEESA).
SAMPLE Grossly normal jejunal segments from 4 canine cadavers.
PROCEDURES 52 jejunal segments (4 control and 24 anastomosis constructs [2 segments/standard FEESA construct]) were prepared for testing. Segments were assigned to three 8-segment gastrointestinal anastomosis staple line offset groups: complete offset (CSO group), partial gastrointestinal anastomosis offset (PSO group), and no gastrointestinal anastomosis offset (NSO group). Results for leakage pressure, leakage location, and MIP were compared.
RESULTS Mean ± SD leakage pressure differed significantly among all groups and was highest for the PSO group (34.4 ± 3.7 mm Hg), followed by the CSO group (25.9 ± 4.1 mm Hg) and the NSO group (18.8 ± 1.5 mm Hg). Leakage location did not differ significantly among groups but was most commonly associated with the thoracoabdominal staple line. The MIP did not differ significantly among groups (PSO, 83.1 ± 9.4 mm Hg; CSO, 81.7 ± 6.7 mm Hg; and NSO, 58.5 ± 7.7 mm Hg).
CONCLUSIONS AND CLINICAL RELEVANCE In this study, partial staple line offset leaked at a significantly higher pressure, which represented the greatest leakage protection of tested constructs. The thoracoabdominal staple line was more susceptible to leakage than was the gastrointestinal anastomosis staple line. Results suggested that surgeons should avoid FEESA with no staple line offset, strive for partial offset of the gastrointestinal anastomosis staples, and provide precise placement of the thoracoabdominal staple line.
Objective—To compare in vitro security of 6 friction knots used as a first throw in the creation of a vascular ligation.
Sample—20 constructs of 6 friction knots created with 2–0 polyglyconate suture.
Procedures—Security of the surgeon's throw, Miller's knot, Ashley modification of the Miller's knot, modified Miller's hand-tie, constrictor knot, and strangle knot was evaluated. Each knot configuration was constructed around each of 2 balloon dilation catheters used as small- and large-diameter vascular pedicle models and pressure tested to failure (leakage) 10 times. Results were compared by means of ANOVA and Student t tests.
Results—Mean leakage pressure for the surgeon's throw was significantly lower than that of all other knots tested in both pedicle models. The Miller's knot, constrictor knot, and strangle knot had mean leakage pressures > 360 mm Hg regardless of model diameter, whereas the surgeon's throw, Ashley modification of the Miller's knot, and modified Miller's hand tie consistently leaked at pressures at or below those found in arteries under normal physiologic conditions (pressures of 90 to 140 mm Hg).
Conclusions and Clinical Relevance—Security of the Miller's knot, constrictor knot, and strangle knot was considered excellent. In vitro results suggested that, when constructed correctly, these friction knots may be preferable first-throw constructs during vascular pedicle ligation and should be further evaluated for clinical use. The surgeon's throw was less reliable as a first throw for vascular pedicle ligation in the model tested.
To compare 3 anal purse-string suture techniques for resistance to leakage and to identify the suture technique requiring the fewest tissue bites to create a consistent leak-proof orifice closure.
18 large-breed canine cadavers.
3 purse-string suture techniques (3 bites with 0.5 cm between bites [technique A], 5 bites with 0.5 cm between bites [technique B], and 3 bites with 1.0 cm between bites [technique C]) were evaluated. Each technique involved 2-0 monofilament nylon suture that was placed in the cutaneous tissue around the anus and knotted with 6 square throws. Standardized 2.0-cm-diameter circular templates with the designated bite number and spacing indicated were used for suture placement. Leak-pressure testing was performed, and the pressure at which saline was first observed leaking from the anus was recorded. The median and interquartile (25th to 75th percentile) range (IQR) were compared among 3 techniques.
Median leak pressure for technique A (101 mm Hg; IQR, 35 to 131.3 mm Hg) was significantly greater than that for technique C (19 mm Hg; IQR, 14.3 to 25.3 mm Hg). Median pressure did not differ between techniques A and B (50 mm Hg; IQR, 32.5 to 65 mm Hg) or between techniques B and C.
Placement of an anal purse-string suture prevented leakage at physiologic colonic and rectal pressures, regardless of technique. Placement of 3 bites 0.5 cm apart (technique A) is recommended because it used the fewest number of bites and had the highest resistance to leakage.
Case Description—A 5-year-old Labrador Retriever was evaluated because of a 3-day history of lethargy, anorexia, vomiting, stranguria, and anuria after routine ovariohysterectomy.
Clinical Findings—On initial examination, signs of abdominal pain and enlargement of the urinary bladder were detected. Clinicopathologic abnormalities included leukocytosis, azotemia, and hyperkalemia. Radiography and surgical exploration of the abdomen revealed urinary bladder torsion at the level of the trigone; histologically, there was necrosis of 90% of the organ.
Treatment and Outcome—After excision of the necrotic wall of the urinary bladder (approx 0.5 cm cranial to the ureteral orifices), the remaining bladder stump was closed with a colonic seromuscular patch. Eleven weeks later, cystoscopy revealed an intramural ureteral stricture, for which treatment included a mucosal apposition neoureterocystostomy. Thirteen months after the first surgery, the dog developed pyelonephritis, which was successfully treated. By 3 months after subtotal cystectomy, the dog's urinary bladder was almost normal in size. Frequency of urination decreased from 3 to 4 urinations/h immediately after surgery to once every 3 hours after 2 months; approximately 4 months after the subtotal cystectomy, urination frequency was considered close to normal.
Clinical Relevance—Urinary bladder torsion is a surgical emergency in dogs. Ischemia of the urinary bladder wall may result from strangulation of the arterial and venous blood supply and from overdistension. Subtotal resection of the urinary bladder, preserving only the trigone area and the ureteral openings, and colonic seromuscular augmentation can be used to successfully treat urinary bladder torsion in dogs.
Objective—To compare volumes of square knots and Aberdeen knots in vitro and evaluate security of these knot types when used as buried terminal knots for continuous intradermal wound closures in canine cadavers.
Sample—24 surgically closed, full-thickness, 4-cm, epidermal wounds in 4 canine cadavers and 80 knots tied in vitro.
Procedures—Continuous intradermal closures were performed with 4–0 polyglyconate and completed with a buried knot technique. Surgeon (intern or experienced surgeon) and termination knot type (4-throw square knot or 2 + 1 Aberdeen knot; 12 each) were randomly assigned. Closed wounds were excised, and a servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, and mode of construct failure were recorded. Volumes of 2 + 1 Aberdeen (n = 40) and 4-throw square knots (40) tied on a suture board were measured on the basis of a cylindrical model.
Results—Aberdeen knots had a mean smaller volume (0.00045 mm3) than did square knots (0.003838 mm3). Maximum load and displacement did not differ between construct types. Mean stiffness of Aberdeen knot constructs was greater than that of square knots.
Conclusions and Clinical Relevance—The 2 + 1 Aberdeen knot had a smaller volume than the 4-throw square knot and was as secure. Although both knots may be reliably used in a clinical setting as the termination knot at the end of a continuous intradermal line, the authors advocate use of the Aberdeen terminal knot on the basis of ease of burying the smaller knot. (J Am Vet Med Assoc 2015;247:260–266)
Objective—To identify a list of core surgical skills and determine the frequency of use and proficiency in performance of these skills expected of entry-level veterinarians by general practitioners.
Sample—750 general practitioners randomly chosen from the AVMA membership database.
Procedures—Survey respondents rated the proficiency and frequency of use expected of entry-level veterinarians in regard to 26 surgical skills. Demographic information (gender; graduation year; practice type, geographic location, and setting; number of veterinarians in practice; number of surgical procedures performed per week; and number of new graduates mentored in the past 5 years) of respondents was obtained.
Results—387 (52%) general practitioners responded to the survey. Greater than 60% of respondents expected new graduates to have high proficiency and require minimal supervision for 21 of 26 skills. Greater than 60% of respondents assigned 6 of the skills a low expected frequency of use rating. Orthopedic skills, creation of square knots by use of a 1-handed tie technique, and use of electrosurgical and laser instruments received some of the lowest ratings.
Conclusions and Clinical Relevance—Core surgical skills were identified. Results indicated a broad consensus among general practitioners independent of demographic characteristics. Results may aid veterinary colleges in identification of the surgical skills that are most important to include in surgical curricula and for which new graduates should attain proficiency according to general practitioners.
To evaluate holding security of 4 friction knots created with various monofilament and multifilament sutures in a vascular ligation model.
280 friction knot constructs.
10 friction knots of 4 types (surgeon's throw, Miller knot, Ashley modification of the Miller knot, and strangle knot) created with 2-0 monofilament (polyglyconate, polydioxanone, poliglecaprone-25, and glycomer-631) and braided multifilament (silk, lactomer, and polyglactin-910) sutures were separately tied on a mock pedicle and pressure tested to the point of leakage. Linear regression analysis was performed to compare leakage pressures among suture materials (within friction knot type) and among knot types (within suture material).
Mean leakage pressure of surgeon's throws was significantly lower than that of all other knots tested, regardless of the suture material used. All the other knots had mean leakage pressures considered supraphysiological. Significant differences in mean leakage pressure were detected between various friction knots tied with the same type of suture and various suture types used to create a given knot. Variability in leakage pressure among knots other than the surgeon's throw was greatest for poliglecaprone-25 and lowest for polydioxanone.
CONCLUSIONS AND CLINICAL RELEVANCE
Most differences in knot security, although statistically significant, may not have been clinically relevant. However, results of these in vitro tests suggested the surgeon's throw should be avoided as a first throw for pedicle ligation and that poliglecaprone-25 may be more prone to friction knot slippage than the other suture materials evaluated.
OBJECTIVE To compare security of continuous intradermal suture lines closed by use of barbed suture with 3 end-pass configurations or without an end-pass configuration.
SAMPLE 40 full-thickness, 4-cm-long, parasagittal wounds in canine cadavers.
PROCEDURES Each continuous intradermal closure was terminated with 1 of 3 end-pass techniques or without an end-pass configuration (control group). A servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, mode of construct failure, and load at first suture slippage at termination (ie, terminal end of the suture line) were recorded.
RESULTS Values for maximum load, displacement, and stiffness did not differ significantly among the 3 end-pass techniques, and load at first suture slippage at termination was not significantly different among the 4 groups. A 1-pass technique slipped in 5 of 9 samples; 3 of these 5 slips caused failure of wound closure. A 2-pass technique slipped in 3 of 9 samples, none of which caused failure of wound closure. Another 2-pass technique slipped in 4 of 10 samples; 2 of these 4 slips caused failure of wound closure. The control group had slippage in 10 of 10 samples; 9 of 10 slips caused failure of wound closure
CONCLUSIONS AND CLINICAL RELEVANCE An end-pass anchor was necessary to terminate a continuous intradermal suture line, and all 3 end-pass anchor techniques were suitable to prevent wound disruption. The 2-pass technique for which none of the suture slippages caused wound closure failure provided the most reliable configuration.