Collection and evaluation of full-thickness small intestinal biopsy specimens is useful for investigation of small intestine physiology in experimental horses,1–4 and serial collection of biopsy specimens is occasionally necessary to confirm diagnosis of refractory intestinal disorders in clinical horses.5,6 At present, full-thickness small intestinal biopsy specimens in horses are collected through flank laparotomy or midline celiotomy incisions.5,7-9 However, these procedures are invasive and can be associated with substantial postoperative complications such as incisional infections, wound dehiscence, herniation, and development of abdominal adhesions.10 In the authors' opinion, repeated midline celiotomy or flank laparotomy cannot be used to collect serial full-thickness small intestinal biopsy specimens in experimental horses because these procedures are associated with high risk for postoperative complications11 and would negatively impact the horses' health.
Laparoscopy has been used to collect full-thickness intestinal biopsy specimens for diagnosis of multiple gastrointestinal diseases in humans.12,13 This procedure is associated with a short hospital stay, less postoperative pain, and minimal complications and is considered to be a safe and efficient alternative to midline celiotomy in humans.12,13 Automatic endoscopic stapling devices have been used for laparoscopic collection of full-thickness small intestinal biopsy specimens in humans.12,13 In horses, use of these automatic stapling devices reduces surgical time and risk of contamination, compared with conventional hand-sutured anastomosis techniques.14–16
Laparoscopy is established as a minimally invasive surgical technique in horses.17 It allows for excellent observation of and access to abdominal organs and is associated with minimal postoperative pain and complications.17–19 A laparoscopic technique for collection of full-thickness biopsy specimens of the cecum and duodenum by use of a single-layer intracorporeal suturing technique in horses has been reported.17–21 However, the technique is technically challenging, and its use is limited to surgeons with advanced laparoscopic intracorporeal suturing skills. Furthermore, the technique is associated with risk of abdominal contamination and postoperative septic peritonitis.20
The purpose of the study reported here was to evaluate a laparoscopic technique involving use of an ELS for collection of serial full-thickness small intestinal biopsy specimens in healthy experimental adult horses. We hypothesized that use of an ELS to collect intestinal biopsy specimens laparoscopically would be associated with lower bursting strength and bursting wall tension at the biopsy site, that anastomosis could be performed with less luminal diameter reduction at the biopsy site than if double-layer hand-sewn closure were used, and that the specimen derived would be suitable for histologic examination. We also hypothesized that the lower bursting strength and bursting wall tension and luminal diameter remaining at the biopsy site after serial fullthickness biopsy with an ELS would not be associated with intraor postoperative complications.
Endoscopic linear stapler
Biosyn, Auto Suture Co, Ville St-Laurent, QC, Canada.
Long 45A Endocutter ETS-Flex45, ENDOPATH, Ethicon Endo-Surgery Inc, Cincinnati, Ohio.
Reloads 4.1-mm ETS45, ENDOPATH, Ethicon Endo-Surgery Inc, Cincinnati, Ohio.
Magic Wrap, Glasgow Manufacturing, London, ON, Canada.
SENSOTEC BP211BN Model LM, 50 PSIG, SENSOTEC Inc, Columbus, Ohio.
A-Tech S7DC, A-Tech instruments Ltd, Scarborough, ON, Canada.
National Instruments PCI-6023E, National Instruments, Austin, Tex.
LabVIEW, version 7.1, National Instruments, Austin, Tex.
Model No. Sw-1K, Transducer technologies, Rio Nedo, Temecula, Calif.
Image J, version 1.37, Research Services Branch, National Institutes of Health, Bethesda, Md.
Electronic syringe infusion pump, Model AS40A, Baxter Healthcare Corp, Deerfield, Ill.
512X Endopath disposable surgical trocar, Ethicon Endo-Surgery Inc, Cincinnati, Ohio.
Endopath Disposable 10-mm Babcock Forceps, Ethicon Endo-Surgery Inc, Cincinnati, Ohio.
Prolene, Ethicon Inc, Somerville, NJ.
SAS, version 9.1.3, SAS Institute Inc, Cary, NC.
Endo Stitch suturing device, Auto Suture Co, Ville St-Laurent, QC, Canada.
Polysorb Endo Stitch disposable loading unit, Auto Suture Co, Ville St-Laurent, QC, Canada.
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