Gastrointestinal surgical techniques such as biopsy specimen collection, foreign body removal, or tissue resection and anastomosis are commonly indicated for diagnosis and treatment of diseases of the small intestine.1–4 After enterectomy, surgical anastomoses can fail, resulting in leakage during the first 3 to 5 days after the procedure. Intestinal leakage or dehiscence has the potential for devastating consequences and commonly leads to peritonitis and, unless successfully treated, to death.1–4 Leakage within 24 hours after surgery will happen when the intestinal wall is not viable or when the surgical technique used was inappropriate. The reported incidence of intestinal leakage and dehiscence is between 3% and 28% of enterectomies performed.
Presence of a foreign body within the intestine, hypotension, hypoalbuminemia, or peritonitis at the time of enterectomy are risk factors for leakage and dehiscence.1,2 Decreasing the risk of leakage after intestinal resection and anastomosis is important for improving the long-term outcome of gastrointestinal surgery in dogs and cats (particularly in patients with 1 or more risk factors). Supplemental techniques reported to achieve this include serosal patching, omental wrapping, polyglycolic acid mesh supplementation, peritoneal graft wrapping, and fibrin sealant application,1–12 yet little objective evidence exists that these techniques provide mechanical support or protection against leakage in the postoperative period.
In a case series7 involving 11 dogs and 1 cat with hollow viscus perforation and leakage attributable to enterotomy, intestinal perforation, anastomosis, or cystotomy, the leakage was successfully resolved through serosal patching. Serosal patching refers to placement of a healthy segment of intestine in direct serosal-to-serosal contact, effectively creating full-thickness intestinal coverage. The term serosal patch, although common in the literature, does not clearly describe the nature of the mechanical and physiologic support provided by the supporting intestinal segment. The purpose of the study reported here was to evaluate the leakage pressure of small intestinal anastomoses supplemented with a serosal patch in dogs. The hypothesis was that anastomoses supplemented with a serosal patch would have similar failure characteristics as the anastomoses performed without a serosal patch.
Beuthanasia-D Special, Intervet Inc, Merck Animal Health, Summit, NJ.
Biosyn, 4-0 USP, provided by Covidien Animal Health, Mansfield, Mass.
Mikro-Tip catheter transducer, Millar Instruments Inc, Houston, Tex.
SonoLab, Sonometrics Corp, London, ON, Canada.
Fisher Scientific, Pittsburg, Pa.
Harvard Apparatus, Holliston, Mass.
JMP, SAS Institute Inc, Cary, NC.
Cochran S, Twedt DC, Boscan P. Evaluation of gastric transit time, motility, and pH during sevoflurane anesthesia in dogs (abstr). Vet Anaesth Analg 2011;38:3.
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