Ch 92 - Small Intestine Flashcards

1
Q

Gill JAVMA 2019

Factors associated with dehiscence and mortality rates
following gastrointestinal surgery in dogs

A

Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L).

dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06).

Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs.

CONCLUSIONS AND CLINICAL RELEVANCE These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Strelchik JAVMA 2019

Intestinal incisional dehiscence rate following enterotomy for foreign body removal in 247 dogs

A

8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge.

Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge.

Duration of hospitalization was longer for dogs in the dehiscence group than for dogs in the nondehiscence group.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that enterotomy for intestinal foreign body removal had a lower rate of dehiscence in dogs during the study period, compared with rates previously reported; however, the low rate should not be used as a reason to perform an enterotomy rather than an enterectomy when needed. Surgeons should thoroughly evaluate the bowel and perform an enterotomy only when indicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lopez JAVMA 2021

Comparison of patient outcomes following enterotomy
versus intestinal resection and anastomosis
for treatment of intestinal foreign bodies in dogs

A

RESULTS
Dehiscence rates were 3.8% (7/183) for enterotomy
Dehiscence rate was 18.2% (8/44) for IRA,
Overall dehiscence rate was 6.6% (15/227).

The odds of intestinal dehiscence for IRA were 6.09 times (95% CI, 1.89 to 19.58) the odds for enterotomy.
An American Society of Anesthesiologists score > 3 (OR, 4.49; 95% CI, 1.43 to 14.11) and an older age (OR, 1.02 [95% CI, 1.01 to 1.02] for each 1-month increase in age) were significantly associated with greater odds of intestinal dehiscence, regardless of surgical procedure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chu Vet Surg 2020

Ex vivo comparison of leakage pressures and leakage
location with a novel technique for creation of functional
side-to-side canine small intestinal anastomoses

A

Objective: To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage.

Study design: Experimental, ex vivo. Sample population: Jejunal segments (n = 130) from 10 healthy canine cadavers. Methods: Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically.

Results: Initial leakage pressure was greater in group D than in groups A, B, and C (P < .011). There was a difference in ILL among groups (P = .003).

Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D.

Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P < .004).

Histological examination was consistent with collagenous fusion without cavitation defects.

Conclusion: Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device.
Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses.
Clinical significance: Despite the success and feasibility of creating an FSSSIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Larose Vet Surg 2020

Clinical findings and outcomes of 153 dogs surgically
treated for intestinal intussusceptions

A

Results: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]).

Most cases had no identifiable cause (104/155 [67%]).

Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA.

Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction.

Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events.

Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively.

Fourteen-day postoperative mortality rate was 6%.

Conclusion: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications.

Clinical significance: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Culbertson Vet Surg 2021

Intraoperative surgeon probe inspection compared to leak
testing for detecting gaps in canine jejunal continuous
anastomoses: A cadaveric study

A

Methods: Intestinal segments were randomly selected by four volunteers who
created six simple continuous anastomoses: two constructs using standard
technique with 2–3 mm suture spacing (ST, 8 total), and four constructs with
one 4-mm gap (IG, 16 total). All 24 anastomoses were examined with PT (1 volunteer)
prior to LT (3 volunteers). LT was performed within a maximal peristaltic
pressure range (34–54 cmH2O). The presence and location of
anastomotic leaks (LA) detected with LT were compared with gaps detected
with PT.
Results: Nineteen out of twenty-four (79.2%) samples had at least one probe
drop, and four out of twenty-three (17.4%) samples leaked. LT results from one
sample were excluded due to iatrogenic suture failure. PT was 100% sensitive
(95% CI: 51.01, 100%) with a 100% negative predictive value (95% CI: 56.55,
100%) at detecting gaps compared with LT. The location of all LA was accurately
identified with PT and confirmed during LT.
Conclusion: PT was highly sensitive at detecting gaps compared with LT. All
LA were accurately detected by PT. None of the segments negative during PT
leaked.
Clinical Significance: The diagnostic value of PT appears adequate to recognize
gaps in cadaveric small intestinal anastomoses. PT offers surgeons an
alternative to detect suture gaps that may contribute to postoperative dehiscence
of intestinal anastomoses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Maxwell Vet Surg 2021

Outcomes of dogs undergoing immediate or delayed
surgical treatment for gastrointestinal foreign body
obstruction: A retrospective study by the Society of
Veterinary Soft Tissue Surgery

A

Surgical intervention was classified as immediate when it occurred within 6 hours of presentation and delayed when it occurred >6 hours after presentation.

Results: Outcomes did not differ between dogs treated immediately (n = 584) or over 6 hours after presentation (n = 210).

Intestinal necrosis and perforations were more common when surgery was delayed (P = .008; P = .019) but became nonsignificant after controlling for preoperative differences.

Risk factors for necrosis and perforations included duration of clinical signs, increased lactate, linear foreign material, and timing of surgery.

Enterectomies (P = .004) as well as the duration of surgery (P = .004) and anesthesia (P = .001) were increased when surgery was delayed.

Immediate surgery was associated with earlier return to feeding (P = .004) and discharge from the hospital (P < .001);

(5%) dogs in each group (n = 33 immediate; n = 11 delayed) either had a negative explore or the foreign body was milked aborally into the colon at the time of surgery.

Conclusion: Although outcomes were not associated with surgical timing, the unadjusted prevalence of gastrointestinal injury and, thus, the requirement for complex surgical procedures was higher in the delayed group. Clinical significance: Earlier surgical treatment of stabilized dogs with GIFBO may involve fewer complex procedures and accelerate recovery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Quitzan Vet Surg 2022

Influence of staple line number and configuration on the
leakage of small intestinal functional end-to-end stapled
anastomosis: An ex vivo study

A

Jejunal segments (N = 72) from 10 mature, canine cadavers. Methods: Jejunal segments (10 cm) were randomly assigned to a control group (8 segments) and 4 FEESA groups (16 segments/group (8 constructs/ group)), according to the number of rows of staples used in the vertical (V) and transverse lines (T), respectively: Control, 2-row V/2-row T (2V/2T), 2-row V/3-row T (2V/3T), 3-row V/2-row T (3V/2T), 3-row V/3-row T (3V/3T). Initial leak pressure (ILP), maximum intraluminal pressure (MIP), and initial leakage location (ILL) were compared.

Results: The ILP (mean ± SD) for control segments, 2V/2T, 2V/3T, 3V/2T and 3V/3T were 321.38 ± 34.59, 32.88 ± 7.36, 50.13 ± 10.46, 34.38 ± 11.78, 69.88 ± 21.23 mmHg, respectively.

All FEESAs initially leaked at lower pressures than intact segments. The only other differences detected between groups consisted of ILPs that were higher when FEESAs were closed with 3V/3T (69.88 ± 21.23 mmHg) than 2V/2T (32.88 ± 7.36, P < .001).

Initial leakage occurred predominantly from the transverse staple line rather than the anastomotic crotch (P < .001).

Conclusion: Placing 3 rows of staples in the transverse line (with or without a third row in the vertical staple line) improved resistance to leakage of FEESAs in normal cadaveric specimens. Clinical significance: The addition of a third row of staples in the transverse line (with or without a third row in the vertical staple line) in FEESAs should be further investigated as a strategy to reduce intestinal leakage clinically.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Brand Vet Surg 2019

Effects of needle gauge and syringe size on small intestinal
leakage at injection sites

A

Fresh porcine intestines were divided into 5-cm or 10-cm segments and randomly assigned to the one of nine treatment groups: 25-gauge, 22-gauge, and 20-gauge needles attached to full 12-mL, half-full 20-mL, and full 20-mL syringes (n = 20/group). The jejunal segments were occluded with Rochester- Carmalt forceps prior to injection of diluted India ink. Injection time and leakage were noted by a blinded observer.

Results: Leakage occurred in 36% of 5-cm and 15% of 10-cm segments and was immediate without palpation in 33.8% and 11% of segments, respectively.

Protective effects were seen for 22-gauge needles in both 5-cm (P = .002) and 10-cm (P = .001) segments,
whereas injection of 20 mL had a higher odds ratio of leakage compared with injection of 10 mL and 12 mL in 5-cm segments (P = .003).

Conclusion: Injections with 22-gauge needles reduced the frequency of leakage, while 20 mL instilled in 5-cm segments increased the frequency of leakage in intact segments of porcine jejunum.

Clinical significance: Injection with a smaller syringe size attached to a 22-gauge needle through a 10-cm segment of small intestine may lower the frequency of leakage from the injection site, but influence on the detection of surgical site leakage remains unknown.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Coeuriot JFMS 2022

Ultrasound appearance of the
duodenal papilla in clinically
healthy cats

A

The dimensions of the DP were a mean ± SD width of 3.13 ± 0.68 mm and height of 2.47 ± 0.63 mm in the transverse section, and

length of 3.98 ± 1.27 mm and height of 2.44 ± 0.57 mm in the longitudinal section.

The DP
was homogeneous, subjectively isoechoic to fat and had a round and oval shape in the transverse and longitudinal
sections, respectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fealey Vet Surg 2020

Initial leak pressures of four anastomosis techniques in cooled cadaveric canine jejunum

A

Methods: Eight-centimeter cooled canine cadaveric jejunal segments were randomly assigned to a control group (six segments) and four treatment groups (16 segments each [two segments/anastomotic construct]): (1) handsewn anastomosis (HSA), (2) barbed suture anastomosis (B-HSA), (3) stapled functional end-to-end anastomosis (SFEEA), and (4) stapled functional end-to-end anastomosis with an oversew (SFEEA-O). Control segments and anastomotic constructs were infused intraluminally to the point of leakage. Initial leak pressures were recorded and compared. Results: Initial leak pressures (median + range) for jejunal control segments, HSA, B-HSA, SFEEA, and SFEEA-O were 331.88 mmHg (range, 315.34– 346.64), 35.17 (20.29–56.24), 24.99 (6.08–38.64), 28.77 (18.80–85.09), and 35.92 (12.05–80.71), respectively. No difference was detected between leak pressures of anastomosed segments (P = .35), all of which were more variable and lower than those of intact segments. Conclusion: No difference in initial leak pressures was detected between the four anastomosis techniques tested in cooled canine cadaveric jejunum. Clinical significance: All four anastomosis techniques evaluated in this study may be suitable in dogs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fruehwald JAVMA 2024

Association of mesenteric volvulus
in police working dogs with and without
a prior prophylactic laparoscopic gastropexy

A

3 cases of mesenteric volvulus were noted in this patient population. Two (2.4%) of the 82 PWDs that had undergone prophylactic laparoscopic gastropexy developed MV, whereas 1 (0.3%) of the 288 PWDs that had not undergone a gastropexy procedure developed MV.

Police working dogs with PLG were estimated to be at 7.2 times greater odds of MV (point estimate OR, 7.18; 95% CI, 0.642 to 80.143); however, the low incidence of MV in this population limited statistical power, and thus this effect did not achieve statistical significance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gollnick JFMS 2023

Retrospective evaluation of surgical
treatment of linear and discrete
gastrointestinal foreign bodies
in cats: 2009–2021

A

A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB.

No cats developed postoperative septic peritonitis, and all cats survived.

The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%.

Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB.

Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017).

Conclusions and relevance Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hiebert JFMS 2022

Intestinal dehiscence and mortality
in cats undergoing gastrointestinal
surgery

A

In total, 126 cats were included. One cat developed GI dehiscence following complete resection of a jejunal adenocarcinoma.

Twenty-three cats (18.2%) died within 10 days of surgery.

Cats with PSP (P = 0.0462) (13.5% had PSP)
or that developed hypothermia 25–72 h postoperatively (P = 0.0055) had higher odds of mortality in multivariate analysis.

Cats with PSP had 6.7-times higher odds of mortality than cats not diagnosed with PSP.

Conclusions and relevance In cats receiving GI surgery, the incidence of GI incisional dehiscence was <1%.
Cats with PSP had a higher likelihood of mortality.
SIRS was a common finding in cats with septic peritonitis, but was not associated with mortality.
Postoperative mortality during the home recovery period might be significant in cats. Future studies evaluating postoperative mortality in cats should consider extending the research period beyond the date of discharge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Demars JSAP 2023

Surgical removal of intestinal FB using a lap-assisted endoscopic approach in dogs and cats and comparison with enterotomy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Crino JSAP 2023

Conservative mgmt of metallic pointed FB in dogs and cats 17 Cases

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lozano JSAP 2023

Evaluation of acid base and electrolyte status in dogs with upper GI obstruction

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sombrio JSAP 2024

Accuracy and reliability of tele-ultrasonography in diagnosing GI obstruction in dogs and cats

A

Had low positive predictive value so cases may go to surgery that don’t truly have an obstruction

19
Q

Luce JAVMA July 2022

A

RESULTS
The proportions of abnormal SNAP cPL test results in the GIFBO and non-GIFBO groups were 12% (3/25) and 16% (4/25), respectively, with no significant difference. The only differences between groups were that GIFBO canines were more likely to be male (P = 0.02) and had a slightly longer duration of clinical signs at presentation (P = 0.01). Abnormal SNAP cPL test results were associated with increasing age (P = 0.01).
CLINICAL RELEVANCE
SNAP cPL test results are mostly reliable but can still be abnormal in a small percentage of dogs with GIFBO. Abnormal results in dogs without pancreatitis occurred more frequently in older dogs of the present study. Abdominal imaging is advised for dogs with abnormal SNAP cPL test results.

20
Q

Maggier JAVMA 2024

Intestinal full-thickness needle-core biopsy
via laparotomy is safe, rapid, and effective and less invasive than standard incisional biopsy in dogs and cats

A

Mean needle-core biopsy collection time (262 seconds) was significantly shorter than standard incisional biopsy collection time (599 seconds; P < .000001). The incidence of minor complications was 10% (inflammation of the skin surgical site secondary to licking). One catastrophic complication occurred on a standard incisional biopsy site in 1 cat in a context of bile peritonitis (5% of all cases). There were no complications associated with the needle-core biopsy. All but 1 cat were discharged, with a median of 2 days (range, 1 to 4 days) after surgery.

The diagnoses resulting from both techniques were 100% concordant for the distinction between inflammatory bowel disease and intestinal lymphoma via histopathology and immunochemistry.

CLINICAL RELEVANCE Needle-core biopsy is safe, rapid, and effective and is less invasive than standard incisional biopsy.

21
Q

Sevy JAVMA 2024

Abdominal computed tomography and exploratory
laparotomy have high agreement in dogs
with surgical disease

A

There was 97% agreement

22
Q

Steyck JAVMA 2022

Gastrointestinal signs and a need for nutritional management may persist long term in dogs and cats undergoing resection of the ileocolic junction: 35 cases (2008–2020)

A

RESULTS Twenty dogs and 15 cats underwent resection of the ICJ for treatment of a variety of conditions.

Ten of 20 dogs (50%) and 11/15 cats (73%) were reported by their owners to have a good long-term outcome based on the lack of long-term gastrointestinal signs or the ability to control gastrointestinal signs with diet and supplements alone.

Despite owner-reported good outcomes, long-term diarrhea, weight loss, and muscle loss were common.

Of the 6 dogs evaluated in the hospital, 3/6 (50%) had muscle loss, 2/6 (33%) had low taurine concentrations, and 1 dog each had low cobalamin, folate, 25-hydroxyvitamin D, and ionized calcium. Neither of the 2 cats evaluated in the hospital had nutritional abnormalities identified. CLINICAL RELEVANCE Owners should be informed of the possibility of long-term gastrointestinal clinical signs and the potential need for long-term nutritional management after ICJ resection

23
Q

Sumner Vet Surg 2019

Evaluation of suture reinforcement for stapled intestinal
anastomoses: 77 dogs (2008-2018)

A

Retrospective study
Results: The only differences identified between groups consisted of higher preoperative albumin (2.89 ± 0.56 vs 2.34 ± 0.62 g/dL; P = .006) and lower postoperative dehiscence rate (0/30 vs 7/48; P = .028) in dogs with an oversewn FEESA.
**14% of the non overseewn FEESA dehisced. **

Oversewing the FEESA was identified as the significant factor in a model with oversewing and preoperative albumin fit to the outcome of dehiscence (oversew P = .010, albumin P = .761).

The location of the dehiscence was specified in four of seven dogs, all along the transverse staple line. Patterns used for oversew were unspecified (n = 11), simple continuous (8), Cushing (4), simple interrupted (2), cruciate (1), interrupted horizontal mattress (1), and Lembert (1).

Conclusion: Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence. Clinical significance: Our results provide evidence to support additional investigation of suture reinforcement (oversewing) at the transverse staple line of FEESA to reduce postoperative dehiscence.

24
Q

Tidd Vet Surg 2019

Outcomes in 40 cats with discrete intermediate- or large-cell
gastrointestinal lymphoma masses treated with surgical mass
resection (2005-2015)

A

Cats were included if they survived curative intent surgery and had a known outcome for at least two weeks. Postoperative death was permitted. Data collected included anatomic site, surgical margins, lymphoma subtype, chemotherapy use, and postoperative and long-term outcome (beyond two weeks).

Results: Affected sites consisted of small intestines (n = 23), large intestines (n = 9), and stomach (n = 8).

Thirty-six of 40 cats survived to discharge, and 31 cats were alive at suture removal.

Median long-term follow-up of 22 cats was 111 days (range, 16-1407).

Cats that survived to suture removal had a median survival time (MST) of 185 days (95% confidence interval: 72-465).

Cats with large intestinal masses lived longer than those with small intestinal or gastric masses whether all cats (MST, 675, 64, 96 days, respectively; P = .03) or only those surviving to suture removal were considered.

Complete surgical resection (n = 20) was positively associated with survival (370 vs 83 days, P = .016).

Conclusion: Most cats in this population survived the perioperative period, with MST similar to those reported historically with medical management. Clinical significance: Surgical resection may be a reasonable consideration in cats with solitary lymphoma, particularly those with large intestinal masses.

25
Q

Chang Vet Surg 2021

Influence of preconstructed effector loop location using a
barbed unidirectional suture on leakage pressures
following canine enterotomy closure

A

Methods: Jejunal segments were harvested and randomly assigned based upon effector loop location from the beginning of the incisional line. Groups (n = 12/group) included 0 mm, 5 mm, 10 mm, 15 mm, and intact controls (n = 6/group), repaired using a 3–0 unidirectional barbed suture in a simple continuous pattern. Initial leakage pressure (ILP), maximum intraluminal pressure (MIP), repair time, and leakage location were recorded.

Results: Mean ILP for 0 mm group (24.42 ± 8.43 mmHg) was lower (p ≤ .001) compared to all experimental groups with ILP  40% lower.

There was no difference in MIP among experimental groups (p = .239).

Repair time increased (p < .0001) as the distance of the effector loop increased ≥5 mm from the beginning of the incisional line.

Leakage location differed among groups (p < .001) with leakage in the 0 mm group from the incisional line (75%), compared to leakage from predominantly from the suture holes in other groups, respectively.

Conclusion: Effector loop location influenced ILP and leakage location. Effector loops placed at the beginning of the incisional line (0 mm) decreased ILP compared to loops placed at 5, 10, and 15 mm.

Clinical significance: Effector loop location using a unidirectional barbed suture should be placed ≥5 mm from beginning of the incisional line for enterotomy closure. Further in vivo studies are necessary to determine the clinical significance of these findings.

26
Q

Matz Vet Surg 2022

Ex vivo comparison of different thoracoabdominal stapler
sizes for typhlectomy in canine cadavers

A

Methods: Ileocecocolic segments were exteriorized following right paracostal laparotomy after euthanasia. Cecal base length and wall thickness were measured. Each cecum was randomly assigned to 1 of 3 groups (TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm). The cecal base was stapled and the cecum was removed. A 10 cm segment including the stapled cecal excision site was tested for initial leak pressure.

Results: The mean ± standard deviation body weights across the groups were 18.7 ± 6.1 kg, 16.2 ± 7.5 kg, and 14.2 ± 5.5 kg for the TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm groups, respectively (P = .48).

There were no differences for mean cecal base length or wall thickness.

Mean initial leak pressure (ILP) across groups was 182 ± 111 mmHg (TA 30 V3 2.5 mm), 112 ± 57 mmHg (TA 60 3.5 mm), and 77 ± 60 mmHg (TA 60 4.8 mm) (P = .78).

Conclusion: Each stapler size that was evaluated resulted in a mean ILP in excess of typical intraluminal pressures under normal circumstances. There were no differences among groups. Clinical significance: The results of this cadaveric study support the use of any of the stapler sizes evaluated in similarly sized dogs. A prospective study is needed to be able to correlate stapler size and clinical outcome.

27
Q

Rahn Vet Surg 2023

Postoperative injectable opioid use and incidence of
surgical site complications after use of liposomal
bupivacaine in canine gastrointestinal foreign body surgery

A

Likely not licensed in Europe so won’t come up

Dogs that received LB were heavier (n = 65, median 28.5 kg) than those that did not (n = 140, median 24.4 kg) (p = .005). Postoperative fentanyl use (p < .05 between 13 and 72 h) and hourly rates (p < .05 between 13 and 48 h) were less, and postoperative time in the intensive care unit (ICU) (p < .001) and hospital were shorter (p < .001) in dogs receiving LB. Postoperative wound complications were seen in 7/65 dogs (10.8%, 95% CI = 4.4–21.0%) with LB and 4/140 (2.9%, 95% CI = 0.8–7.2%) without LB (p = .039). Conclusion: Use of LB was associated with reduced postoperative analgesic use, and shortened ICU and hospital stay but also with wound complications. Clinical significance: Caution should be used when using LB in (clean) contaminated surgeries.

28
Q

Williams Vet Surg 2023

Clinical outcomes of the use of unidirectional barbed
sutures in gastrointestinal surgery for dogs and cats:
A retrospective study

A

Results: Six gastrotomies, 21 enterotomies, and nine enterectomies were closed with a simple continuous pattern with unidirectional barbed glycomer 631 sutures.
Nine dogs had multiple surgical sites closed with unidirectional barbed sutures.

None of the cases in the study developed leakage, dehiscence, or septic peritonitis during the 14-day short-term follow up. Long-term follow up information was collected for 19 patients. The median long-term follow-up time was 1076 days (range: 20–2179 days).

Two dogs had intestinal obstruction due to strictures at the surgical site 20 and 27 days after surgery. Both were resolved with an enterectomy of the original surgical site.

Conclusion: Unidirectional barbed suture was not associated with a risk of leakage or dehiscence after gastrointestinal surgery in dogs and cats. However, strictures may develop in the long term.

Clinical significance: Unidirectional barbed sutures can be used during gastrointestinal surgery in client-owned dogs and cats. Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary.

29
Q

Miller Vet Surg 2024

Cooled and fresh feline intestine did not differ in leak testing or tissue thickness

A

No difference in ILP, MIP or thickness of tissue. Intestine cooled for upo to 29 h can be used for leak testing studies

30
Q

Miller Vet Surg 2024

Performance time and leak pressure of hand-sewn
and skin staple intestinal anastomoses and enterotomies
in cadaveric cats

A

Jejunal segments (8 cm) were harvested and tested on the same day as euthanasia. From each cadaver, one segment was randomly assigned to control (C), hand-sewn enterotomy (HSE), and skin staple enterotomy (SSE) groups, and two segments were randomly assigned to hand-sewn anastomosis (HSA) and skin staple anastomosis (SSA) groups. Construct completion time, initial leak pressure (ILP), and maximum intraluminal pressure were compared. Leakage location was reported.

Results: Mean time (s) ± SD was longer (p < .001) for HSA (317.0 ± 50.9) than SSA (160.8 ± 13.1) and for HSE (172.0 ± 36.5) than SSE (20.3 ± 5.0).

ILP (mean ± SD) for C (600.0 mmHg ±0.0) was higher (p < .001) than all constructs.

ILP (mean ± SD) for SSA (124.2 mmHg ±83.7) was not different (p = .49) than HSA (86.1 ± 51.9),
**but HSE (200.3 ± 114.7) was higher (p < .001) than SSE (32.2 ± 39.7). Immediate leakage from the center of enterotomy closure was observed in 7/20 SSE. **

Conclusions: HSA construct completion took twice as long as SSA with no difference in intraluminal pressures. Although HSE construct completion took 8x as long as SSE, HSE had higher intraluminal pressures. Clinical significance:** In cats, SSA may be an alternative to HSA for intestinal anastomosis, but SSE is not recommended as an alternative to HSE for intestinal enterotomy closure.**

31
Q

Sanders Vet Surg 2024

A

GI thickness, duration and leak pressure of 5 intestinal anastomosis techniques in cats

  • All techniques were appropriate, exceeded physiologic leak pressures
32
Q

Thompson Vet Surg 2024

Effects of cyanoacrylate on leak pressure of cooled canine enterotomies

A

The glue increased the ILP

33
Q

Sabetti Vet Surg 2024

Endoscopic and surgical treatment of non-neoplastic proximal duodenal ulceration in dogs, and anatomical study of proximal duodenal vascularisation

A

Proximal duodenal ulceration is often characterised by continuous bleeding, and treatment is challenging. The aims of this study were to investigate the role of vascularisation in proximal duodenal ulceration and describe clinical aspects, endoscopic features and treatment in dogs.

Material and Methods: Polyurethane foam casts of gastroduodenal vessels were obtained from five dogs which had died from disorders unrelated to the digestive system.

In addition, 12 dogs having proximal duodenal ulcers diagnosed by endoscopic examination were enrolled in a treatment trial. After the endoscopic diagnosis of a duodenal ulcer, all the dogs were treated medically and, in the absence of resolution, were subsequently treated by endoscopic electrocauterisation or by surgery.

Results: A submucosal vascular network was evident in all the casts, with a prominent venous plexus seen exclusively in the first half inch of the duodenum.

In clinical cases, on endoscopic examination, the duodenal ulcer was located at the proximal part of the duodenum, involving the mesenteric portion of the wall.

The dogs not responding to medical treatment (6/12) were treated with endoscopic electrocauterisation, surgical coagulation or resection of the proximal duodenal portion.
All the dogs survived until discharge, and the median survival time following discharge was 107.5 days.

Clinical Significance: Based on the anatomical details highlighted in this study, the continuous bleeding observed in our patients may have been due to the prominent venous plexus evidenced at the level of the proximal duodenum. Surgical and endoscopic treatments in six patients resolved the ulcer bleeding with no recurrences noted during follow-up.

34
Q

Sabetti Vet Surg 2024
Endoscopic and surgical treatment of non-neoplastic proximal duodenal ulceration in dogs, and anatomical study of proximal duodenal vascularisation

A

Cast of the prox. duo mucosal vessels

35
Q

Mullen Vet Surg 2020

Gastrointestinal thickness, duration, and leak pressure of six intestinal anastomoses in dogs

A

Methods: Gastrointestinal thickness was recorded. Eight-centimeter cooled canine cadaveric jejunal segments were randomly assigned to a control group (20 segments) and six treatment groups (20 segments/group [10 constructs/ group]): (1) handsewn anastomosis (HSA), (2) functional end-to-end stapled anastomosis (FEESA)-blue thoracoabdominal (TA; FEESA-TAB), (3) FEESAgreen TA (FEESA-TAG), (4) FEESA TA-gastrointestinal anastomosis (GIA), (5) FEESA with suture oversew (FEESA-O), and (6) skin staples (SS). Construct assembly time, initial leak pressure (ILP), maximum intraluminal pressure (MIP), and leakage location were compared.

Results: Initial leak pressures (mean ± SD) for control (308.38 ± 115.91 mm Hg), HSA (41.96 ± 15.97), FEESA-TAB (31.71 ± 15.71), FEESA-TAG (27.24 ± 14.11), FEESA-GIA (25.62 ± 11.22), FEESA-O (31.01 ± 17.38), and SS (44.42 ± 28.88) groups were compared.

No difference in ILP (P > .24) or MIP (P > .17) was detected between treatment groups.

Sutured anastomoses took up to 10 times longer to complete (P = .0025). The stomach, duodenum, jejunum, and ileum mural thicknesses (mean ± SD) were 3.99 ± 0.44 mm, 2.34 ± 0.16, 2.49 ± 0.28, and 2.30 ± 0.31, respectively.

Conclusion: The ILP of all anastomoses exceeded maximum intraluminal peristaltic pressures. Stapled anastomoses were faster to complete. Clinical significance: All anastomoses may be considered when performing an intestinal resection and anastomosis, with stapled anastomoses resulting in a shorter surgical time. Canine intestinal thickness may warrant use of a larger staple size.

36
Q

Mullen Vet Surg 2021

Ex vivo comparison of leak testing of canine jejunal
enterotomies: Saline infusion versus air insufflation

A

The ILPs of control segments did not differ whether injected with saline (405.71 ± 56.97 mmHg) or air (376.84 ± 42.54, p = 1.00). Enterotomy closures leaked at lower pressures when injected with air (ILP: 68.52 ± 6.56) compared to saline (87.76 ± 5.20, p = .03). Similar results were obtained when comparing MIPs. A moderate association (r = .51) was identified between volume of air infused and ILPs. The strength of the association improved when stratified by cadaver. The location of leakage—most commonly suture tracks—was identified for all air constructs and for 14 of 25 saline constructs. Conclusion: Enterotomy closures leaked at lower pressures after intraluminal injection of air compared to saline. Clinical Significance: Intraoperative leak testing of small intestinal enterotomy closures may be rendered more sensitive and precise by the use of air instead of saline as the infusate.The ILPs of control segments did not differ whether injected with saline (405.71 ± 56.97 mmHg) or air (376.84 ± 42.54, p = 1.00). Enterotomy closures leaked at lower pressures when injected with air (ILP: 68.52 ± 6.56) compared to saline (87.76 ± 5.20, p = .03). Similar results were obtained when comparing MIPs. A moderate association (r = .51) was identified between volume of air infused and ILPs. The strength of the association improved when stratified by cadaver. The location of leakage—most commonly suture tracks—was identified for all air constructs and for 14 of 25 saline constructs.

Conclusion: Enterotomy closures leaked at lower pressures after intraluminal injection of air compared to saline. Clinical Significance: Intraoperative leak testing of small intestinal enterotomy closures may be rendered more sensitive and precise by the use of air instead of saline as the infusate.

37
Q

Mullen JAVMA 2021

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled
techniques in dogs: 131 cases (2008–2019)

A

RESULTS Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs.

Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs.

The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques.

CONCLUSIONS AND CLINICAL RELEVANCE Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

38
Q

Mullen Vet Surg 2023

A quantitative evaluation of the effect of foreign body obstruction and enterectomy technique on canine small intestinal microvascular health

A

A total of 24 dogs with an intestinal foreign body obstruction and 30 systemically healthy dogs.

Methods: An SDF videomicroscope imaged the microvasculature at the site of the foreign body. Subjectively viable intestine received an enterotomy whereas nonviable intestine received an enterectomy using a handsewn (4-0 polydioxanone, simple continuous) or a functional end-to-end stapled technique (GIA 60 blue, TA 60 green) was used on an alternating basis. The microvasculature adjacent to the enterectomy was interrogated. Quantitative measures of microvascular health were calculated for each site and compared with healthy dogs.

Results: Microvascular density (mean ± SD) at the site of obstruction (140.84 ± 77.40) was lower than healthy controls (251.72 ± 97.10, p < .01).

There was no difference in microvascular parameters (density or perfused boundary region, PBR) between obstructed dogs with subjectively viable and nonviable intestine (p > .14).

Perfused boundary region = PBR

The density (p = .66) and PBR of microvessels (p = .76) adjacent to the sutured enterectomy or TA green staple line did not differ.

Conclusion: Sidestream dark field videomicroscopy can identify obstructed intestine and quantitate the severity of microvascular compromise. Handsewn and stapled enterectomies equally preserve perfusion. Clinical significance: Stapled enterectomies do not lead to greater vascular compromise than handsewn enterectomies.

39
Q

Duffy Vet Surg 2020

Influence of oversewing the transverse staple line during functional end-to-end stapled intestinal anastomoses in dogs

A

Methods: Jejunal segments were harvested within 2 hours of euthanasia and anastomosed (24 jejunal segments per group, consisting of two segments per construct with n = 12/ group). Constructs were then randomly assigned to receive FEESA alone, FEESA + Cushing oversew, or FEESA + simple-continuous oversew of the transverse staple line with 3-0 polydioxanone.
Results for initial leakage pressure (ILP) and maximal leakage pressure (MLP) and initial leakage location (LL) were compared between groups.

Results:
Mean ILP was 1.8-fold higher for FEESA + Cushing oversew (62.4 ± 7.8 mm Hg) compared with FEESA alone and FEESA + simple-continuous oversew (P < .001).

Mean MLP were higher for both oversewn techniques compared with FEESA alone (P < .001).

Oversewing the transverse staple line with either pattern increased mean MLP by 1.4-fold compared with FEESA alone.

Leakage occurred at the level of the transverse staple line in nonoversewn constructs (P < .001).

Conclusion: Oversewing the transverse staple line after FEESA increased MLP and decreased the occurrence of leakage at this location. Oversewing with a Cushing pattern increased ILP compared with oversew with a simplecontinuous pattern. Clinical significance: Our results provide evidence to support oversewing the transverse staple line after FEESA. Doing so may reduce the occurrence of postoperative dehiscence. These findings warrant additional focused investigation in vivo through a prospective randomized clinical trial.

40
Q

Duffy Vet Surg 2020

Ex vivo comparison of the effect of storage temperature on canine intestinal leakage pressures

A

Thirty-six jejunal segments (n = 12 segments/group) were harvested immediately after euthanasia and assigned to a fresh group (tested within 4 hours), chilled group (stored for 24 hours at 4 C before testing), or freeze–thaw group (frozen at −20 C for 7 days and thawed at 21 C for 6 hours before testing).

A 2-cm antimesenteric enterotomy was performed and repaired with 4-0 monofilament suture in a simple-continuous pattern. Initial leakage pressure (ILP), maximal intraluminal pressure (MIP), and leakage location were recorded, with testing performed at room temperature.

Results: Mean ± SD ILP for fresh, chilled, and frozen–thawed specimens was 52.9 ± 8.4, 51.8 ± 11.9 and 29.8 ± 4.4 mm Hg, respectively.

There was a difference in ILP among groups (P < .003), with freeze–thaw samples demonstrating lower ILP compared with other groups.

There was no difference in MIP between groups (P = .186)

There was a difference in leakage location among groups (P = .004), with the majority of chilled and freeze–thaw samples leaking at the suture holes compared with the incisional line in fresh samples.

**Conclusion: Freezing and subsequent thawing prior to specimen testing reduced ILP compared with use of fresh and chilled specimens but did not affect MIP among experimental groups. **

Clinical significance: Cadaveric canine intestinal specimens tested immediately after collection or after chilling for 24 hours should be recommended for ex vivo burst pressure assessment in dogs. Additional studies to evaluate loss in testing viability of chilled intestinal specimens are warranted to help govern experimental methodologies.

41
Q

Duffy Vet Surg 2020

Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model

A

Methods: Typhlectomies were assigned to one of three closure techniques: simple continuous closure with a Parker-Kerr pattern with 4-0 polydioxanone (group 1), closure with a 60-mm gastrointestinal stapler loaded with a 3.8-mm staple cartridge (group 2), and placement of a Cushing suture to augment the stapled closure (group 3). The median (range) of initial leakage pressure (ILP) and maximum leakage pressure (MLP) was compared between groups along with leakage location.

Results: Typhlectomies in group 3 leaked at higher ILP (310 mm Hg; 188-310) than those in groups 1 (43 mm Hg; 31-80) and 2 (109.5 mm Hg; 68-173; P < .0001). Maximum leakage pressure were greater in group 3 than in other groups (P < .0001). Leakage was detected in 20 of 24 (83%) typhlectomies, located at the incisional line in 13 of 24 (54%) specimens and from suture holes in seven of 24 (29%) specimens.

Conclusion: Placement of a Cushing suture pattern to augment stapled incisions improved the ability of typhlectomies to sustain pressure compared with sutured or stapled cadaveric specimens alone. Clinical significance: These results provide evidence to support placement of a Cushing suture pattern to augment the staple line for typhlectomies in dogs, although in vivo studies are required to determine the clinical significance of these findings.

42
Q

Duffy Vet Surg 2021

Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

A

Methods: Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90-mm thoracoabdominal stapling device and a 4.8-mm staple cartridge; group 2, hand-sewn double-layer inverting suture closure with 3-0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern. Leakage and pressure testing were performed. Initial leakage pressure (ILP), maximal leakage pressure (MLP), and leakage location were recorded. Significance was set at P < .05. Results: Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2-fold and 2.8-fold, respectively, compared with stapled closures alone (P < .001). Constructs closed with double-layer suture closure reached ILP and MLP 4.5-fold and threefold greater, respectively, compared with those with stapled closures alone (P < .001). Maximal leakage pressure did not differ between groups 2 and 3 (P = .14). Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs. Conclusion: Double-layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques. Reinforcing staple closures with an inverting suture line improved resistance to leakage. Clinical significance: Reinforcing single-layer closure of partial gastrectomies with an inverting Cushing pattern is recommended to improve resistance to leakage. In vivo investigation is warranted to evaluate influence of closure technique on gastric healing, postoperative stasis, ischemic injury, and postoperative dehiscence.

43
Q

Duffy Vet Surg 2022

Influence of crotch suture augmentation on leakage
pressure and leakage location during functional end-to-end
stapled anastomoses in dogs

A

Methods: Jejunal specimens were tested within 24 hours of collection. A FEESA was performed and randomly assigned to 1 of 4 treatment groups (n = 12/group): (1) no crotch suture (NCS); (2) simple interrupted crotch suture (SICS); (3) two simple interrupted crotch sutures (TCS) placed laterally on opposing jejunal limbs; (4) simple continuous crotch suture (SCCS) augmentation. Crotch sutures were performed using 3-0 USP polydioxanone. Initial (ILP) and maximal (MLP) leakage pressures (Mean ± SD mm Hg) and leakage location were recorded and compared between groups.

Results: Initial leakage pressure was greater after placement of TCS (37.8 ± 6.4, P < .039) and SCCS (47.6 ± 11.0, P < .002) than NCS (27.1 ± 2.5) and SICS (33.0 ± 6.0).

Maximal leakage pressure was greater in specimens including SICS, TCS, and SCCS than those without crotch suture augmentation (P < .043).

Leakage occurred at the anastomotic crotch in 8/12 NCS, 6/12 SICS, 11/12 TCS, and 12/12 SCCS constructs (P < .001).

Conclusion: Augmentation of FEESA with TCS and SCCS increased ILP and decreased the occurrence of leakage from the anastomotic crotch, while all methods of anastomotic crotch augmentation increased MLP.

Clinical significance: Augmenting the FEESA with crotch suture(s) improved the resistance of the jejunal anastomosis to leakage in normal cadaveric segments. Placing 2 crotch sutures or use of a simple continuous pattern for anastomotic augmentation appeared to be superior to the placement of a single suture.

44
Q

Duffy Vet Surg 2022

Influence of barbed suture oversew of the transverse
staple line during functional end-to-end stapled
anastomosis in a canine jejunal enterectomy model

A

Methods: Ninety-eight jejunal segments (n = 14/FEESA group, n = 14 controls) were harvested and randomly assigned to a control group, FEESA + monofilament suture oversew, FEESA + unidirectional barbed suture oversew or FEESA + bidirectional barbed suture oversew. Oversew techniques were performed using a Cushing suture pattern. Initial (ILP) and maximum leakage pressure (MLP), repair time (s), and location of observed leakage were recorded. Results: No differences were detected in ILP (p = .439) or MLP (p = .644) respectively between experimental groups. Repairs times using barbed suture were   18% faster ( 25 s faster; p < .001) compared to monofilament suture. There was no difference between barbed suture types (p = .697). Mean ILP (p < .001) and MLP (p < .0001) were 6.6x and 5.1x greater respectively in the control group. Leakage location occurred predominately at the crotch of the FEESA in all groups.

Conclusion: FEESAs closed with a transverse staple line oversew using barbed suture, regardless of barb orientation, were completed faster and resulted in similar resistance to anastomotic leakage compared to monofilament suture. Clinical significance: Oversewing the transverse staple line following FEESA using barbed suture offers similar resistance to anastomotic leakage, and may be associated with decreased surgical times in dogs compared to monofilament suture. Further studies are necessary to determine the benefits of barbed suture use in both open and laparoscopic gastrointestinal surgical applications following FEESA in dogs.