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- Author or Editor: Daniel D. Smeak x
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Abstract
OBJECTIVE
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.
SAMPLE
Duodenal and jejunal segments from 9 canine cadavers.
PROCEDURES
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.
RESULTS
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)
Abstract
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.
Abstract
Objective—To compare in vitro security of 6 friction knots used as a first throw in the creation of a vascular ligation.
Design—Experimental study.
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.
Abstract
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.
Design—Retrospective study.
Animals—95 dogs.
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 complications.
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 Assoc 2002;221:662–665)
Abstract
OBJECTIVE
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.
ANIMALS
18 large-breed canine cadavers.
PROCEDURES
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.
RESULTS
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.
CLINICAL RELEVANCE
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.
Abstract
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.
Abstract
OBJECTIVE
To evaluate holding security of 4 friction knots created with various monofilament and multifilament sutures in a vascular ligation model.
SAMPLE
280 friction knot constructs.
PROCEDURES
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).
RESULTS
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.
Abstract
OBJECTIVE
To compare the volume of saline (0.9% NaCl) solution required to reach a maximum intraluminal peristaltic pressure of 25 mm Hg in dogs of various sizes.
SAMPLES
25 grossly normal jejunal segments from 6 canine cadavers < 20 kg (small dogs) and 25 segments from 5 cadavers ≥ 20 kg (large dogs).
PROCEDURES
Jejunal specimens were obtained within 1.5 hours after euthanasia. Harvested tissue was transected into 12-cm-long segments, mesentery was trimmed, and each segment was measured from the antimesenteric to mesenteric serosal edges. A 10-cm segment was isolated with Doyen forceps, securing a pressure sleeve within the lumen. Intraluminal saline was infused, and the volume was recorded when a pressure of > 25 mm Hg was achieved. Data were analyzed only from specimens in which the pressure remained between 24 and 26 mm Hg for > 5 seconds.
RESULTS
Mean ± SD intestinal measurement for large dogs (17.82 ± 1.44 mm) was greater than that for small dogs (12.38 ± 1.38 mm) as was the volume of saline solution infused (17.56 ± 7.17 mL vs 3.28 ± 1.41 mL, respectively). The volume infused increased by 1.31 mL (95% CI, 1.08 to 1.18) for every 1-mm increase in intestinal measurement and by 1.06 mL (95% CI, 1.052 to 1.068) for every 1-kg increase in body weight.
CONCLUSIONS AND CLINICAL RELEVANCE
The volume of saline solution used for intestinal leak testing should be determined on the basis of patient intestinal measurement or body weight. In vivo studies are necessary to establish the optimal volume for intestinal leak testing.
