Ch 93 - Colon Flashcards
Latimer JAVMA 2019
Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness
large intestinal incisions in dogs
Overall 7-day postoperative intestinal dehiscence rate 9 of 90 (10%)
5/9 of these dogs died
Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence.
Mortality rate 15 of 90 (17%).
Preoperative anorexia,
hypoglycemia, or neutrophils with toxic changes and those that
received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings.
CONCLUSIONS AND CLINICAL RELEVANCE Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported,
Grossman JAVMA 2021
Evaluation of outcomes following subtotal colectomy for the treatment of idiopathic megacolon in cats
Major perioperative complications occurred in 9.9% (15/151) of cats, and 14% (12/87) of cats died as a direct result of treatment or complications of megacolon.
Major complications included cardiopulmonary arrest within 10 days of surgery (n = 4), colectomy dehiscence (3), abdominal incision dehiscence (2), postoperative renal failure (1), septic peritonitis of unconfirmed etiology (1), postoperative necrosis of the rectal wall (1), retained surgical sponge (1), sudden development of a mass dorsal to the colectomy site causing compression over the anastomosis site (1), and persistent hematochezia requiring colonoscopy (1).
Two cats underwent surgical correction for colectomy dehiscence: 1 cat on day 4 and the other cat on day 9 after surgery. The subtotal colectomy dehiscence rate was 2.1% (3/142) for cats that underwent follow-up for ≥ 10 days after surgery.
The median survival time was not reached.
Cats with (vs without) a body condition score < 4/9 (hazard ratio [HR], 5.97),
preexisting heart disease (HR, 3.21),
major perioperative complications (HR, 27.8), or long-term postoperative liquid feces (HR, 10.4) had greater hazard of shorter survival time.
**Constipation recurrence occurred in 32% (24/74) of cats at a median time of 344 days and was not associated with retention versus removal of the ICJ;
**however, ICJ removal was associated with long-term liquid feces (OR, 3.45), and a fair or poor outcome on owner assessment (OR, 3.6). **
**
Overall, 77% (57/74) of owners in the present study determined that the quality of life of their cat following surgery was good (required daily medication or dietary management) or excellent (had no clinical signs and required no medication or dietary management)
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that subtotal colectomy was associated with long survival times and a high rate of owner satisfaction. Removal of the ICJ was associated with less favorable outcomes in cats of the present study - so should be retained where possible
Lux JAVMA 2021
Evaluation of short-term risk factors associated
with dehiscence and death following full-thickness incisions of the large intestine in cats: 84 cases (1993–2015)
The overall dehiscence rate 8.3% (7/84 cats)
Overall survival to hospital discharge rate 94% (79/84 cats)
Factors associated with dehiscence and nonsurvival to hospital discharge included presence of band neutrophils,
performance of partial colectomy with colonic resection and anastomosis,
administration of blood products,
postoperative cardiopulmonary arrest, and
incisional inflammation or infection.
Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence.
Factors associated with dehiscence only included hypoalbuminemia, renal dysfunction, administration of blood products or > 2 classes of antimicrobials, and intra-abdominal fecal contamination.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that intestinal dehiscence and mortality rates associated with large intestinal incisions in cats may be higher than previously proposed, although the risk of either outcome was still low. Factors suggestive of systemic illness were associated with colonic dehiscence or death, and focused prospective studies of risk factors are warranted.
Sapora Vet Surg 2019
Ex vivo comparison of hand-sutured versus circular stapled anastomosis in canine large intestine
Four segments from each colon were randomly assigned to one of four techniques:
hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and
4-0 barbed glycomer 631 (BG), and
circular stapled colonic anastomoses using 4.8 mm Endto- End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon.
Results: Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm.
Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p = .0313, C4.8mm-BG p = .0131, C3.5mm-G p = .0469, C3.5mm-BG p = .0313).
Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg.
Conclusion: End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. Clinical significance: These results provide evidence to support handsuturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.
