One stage functional end-to-end stapled intestinal anastomosis and resection performed by nonexpert surgeons for the treatment of small intestinal obstruction in 30 dogs

Objectives: To describe stapled 1‐stage functional end‐to‐end intestinal anastomosis for treatment of small intestinal obstruction in dogs and evaluate outcome when the technique is performed by nonexpert surgeons after limited training in the technique. Study Design: Case series. Animals: Dogs (n=30) with intestinal lesions requiring an enterectomy. Methods: Stapled 1‐stage functional end‐to‐end anastomosis and resection using a GIA‐60 and a TA‐55 stapling devices were performed under supervision of senior residents and faculty surgeons by junior surgeons previously trained in the technique on pigs. Procedure duration and technical problems were recorded. Short‐term results were collected during hospitalization and at suture removal. Long‐term outcome was established by clinical and ultrasonographic examinations at least 2 months after surgery and from written questionnaires, completed by owners. Results: Mean±SD procedure duration was 15±12 minutes. Postoperative recovery was uneventful in 25 dogs. One dog had anastomotic leakage, 1 had a localized abscess at the transverse staple line, and 3 dogs developed an incisional abdominal wall abscess. No long‐term complications occurred (follow‐up, 2–32 months). Conclusion: Stapled 1‐stage functional end‐to‐end anastomosis and resection is a fast and safe procedure in the hand of nonexpert but trained surgeons.     

Partial Gastrectomy with an Automatic Stapling Instrument for Treatment of Gastric Necrosis Secondary to Gastric Dilatation-Volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.     

Comparison of skin staples with sutures for anastomosis of the small intestine in dogs

OBJECTIVES: To develop a technique for approximation of end-to-end intestinal anastomoses by using a disposable skin stapler and to compare the stapling technique with an interrupted hand-sewn approximating end-to-end anastomosis of the canine jejunum. STUDY DESIGN: In vitro evaluation of the stapling technique, followed by an in vivo study of healing and clinical response in dogs. ANIMAL POPULATION: 18 mixed-breed adult dogs. METHODS: The anastomotic technique was developed and tested in fresh canine jejunum. Fourteen stapled approximating anastomoses (SAA) and 14 hand-sewn approximating anastomoses (HAA) were performed in 6 cadavers under simulated surgical conditions. Anastomotic construction times, initial bursting strengths, initial lumen diameters, and gross appearance of the 2 techniques were compared. Healing and clinical response were evaluated in 12 purpose-bred dogs assigned to 2 groups of 6 animals each. Each dog had 1 SAA and 1 HAA performed in the jejunum, 50 cm apart. Six dogs were killed on postoperative day 4, and 6 dogs were killed on postoperative day 21. Anastomotic construction time, gross and histological healing, bursting strength, lumen diameter, and circumference were compared between techniques. RESULTS: Mean construction time for SAA was significantly faster than for HAA (P = .0001). None of the anastomoses leaked, and there were no major clinical complications in any dog. Bursting strengths were not significantly different at any time for the 2 techniques. Initial bursting strength was 31% to 35% of the normal jejunum. A nonsignificant decrease in bursting strength was observed by postoperative day 4 (26% to 28% of normal), and a significant increase in bursting strength was observed by postoperative day 21 (100% to 109% of normal). Neither technique decreased the initial lumen diameter. However, both techniques resulted in a similar degree of luminal stenosis as the anastomoses healed. Anastomotic lumen diameter was significantly decreased from normal in both groups at day 4 (86% to 88% of normal) and day 21 (90% to 91% of normal). There was no significant difference between the circumference of the anastomoses and normal jejunum at any time. Histological analysis showed similar healing for the hand-sewn and stapled techniques at 4 and 21 days after surgery. For both surgical techniques, day 21 anastomoses had significantly less inflammation and necrosis, significantly more fibrosis, and significantly better continuity of histological layers when compared with day 4 anastomoses. CONCLUSION: Approximating end-to-end intestinal anastomosis with a skin stapler is equivalent in bursting strength, lumen diameter, lumen circumference, and healing characteristics to the traditional hand-sewn technique, but it can be performed in significantly less time. CLINICAL RELEVANCE: Skin stapling devices can be used to create technically simple, rapid, and safe end-to-end anastomoses in canine jejunum.     

Transrectal stapling for colonic resection and anastomosis (10 cases)

The purpose of this retrospective study was to determine the feasibility of using the end-to-end anastomosis (EEA) stapling device transrectally for managing distal colonic disease in clinical veterinary cases. Ten animals met the criteria of having distal colonic or rectal resection and anastomosis with the EEA stapling device. The only complications seen after discharge from the hospital were colonic stricture at the anastomosis site in two animals and transient colitis in two animals. The stapled anastomosis has good success when properly applied, and the incidences of stricture formation, leakage, and other potential complications can be kept to a minimum.     

Subtotal Colectomy With Surgical Stapling Instruments Via a Trans-cecal Approach for Treatment of Acquired Megacolon in Cats

Surgical stapling equipment was used to perform an end-to-end colonic anastomosis in 15 cats for the treatment of acquired megacolon. An end-to-end stapling device was passed to the anastomotic site by a trans-cecal approach. Subsequent closure of the cecal incision was accomplished with a thoracoabdominal stapling device. Two cats had hemorrhagic episodes immediately after surgery that required blood transfusions. All 15 cats have had good to excellent health after subtotal colectomy and colocolostomy performed using this stapling technique. Results of this study have demonstrated that "single surgical field" placement of the end-to-end stapling device has the primary advantage of simplicity and a lower chance of contamination compared with (dual field) rectal passage of similar devices. Closure of the cecal access incision is easily performed without reducing the diameter of the large intestinal lumen. The stapling technique provided an efficient and consistent method for anastomosis of the large bowel in cats.     

Gastropexy with an automatic stapling instrument for the treatment of gastric dilatation and volvulus in 20 dogs

Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were introduced into the tunnels, and the device was fired to create the gastropexy. One dog died of systemic sequelae of GDV during the early postoperative period. None of the remaining 19 dogs developed a recurrence of GDV during follow-up periods ranging from 5 to 43 months. In 11 dogs, the integrity of the gastropexy was evaluated by abdominal ultrasonography and either negative contrast gastrography or double contrast gastrography; in these dogs, the radiographic and/or the ultrasonographic findings were suggestive of an intact gastropexy. There were no complications involving the gastropexy staple line. The results of this study indicate that an effective and consistent permanent gastropexy can be created, using surgical stapling equipment.     

A Potential Technique Error in Stapled Side-to-Side Anastomosis of the Small Intestine of the Horse

Anastomotic leakage was noted to occur at the junction of the staple lines used to create the stoma during small intestine side-to-side anastomosis. The anastomosis was performed in a clinical equine patient by joining the lateral surfaces of the intestinal segments using a gastrointestinal anastomosis stapling instrument (GIA). The cause of this problem was investigated by performing six anastomoses in the jejunum of a single anesthetized adult horse using the GIA; three anastomoses were created by joining the antimesenteric edges of the bowel segments and three anastomoses were created by joining the lateral surfaces of the bowel segments. Bowel segments were then dissected to examine the stoma and the integrity of the staple lines. No defects were detected in anastomoses performed by joining the antimesenteric edges. Anastomoses performed by joining the lateral surfaces all had a defect at the junction of the double rows of staples used to create the stoma. Such defects would have allowed leakage of fluid and/or ingesta at the anastomotic site.     

Clinical assessment and outcome of three techniques for jejunal resection and anastomosis in horses: 59 cases (1989-2000)

OBJECTIVE: To compare postoperative complications, short- and long-term survival, and surgical times for hand-sewn end-to-end (EE), stapled functional end-to-end (FEE), and stapled side-to-side (SS) anastomotic techniques for jejunal resection in horses. DESIGN: Retrospective study. ANIMALS: 59 horses. PROCEDURE: Medical records were reviewed to obtain signalment, diagnosis, treatment, and outcome for horses that underwent jejunojejunostomy in our hospital. Only horses that recovered from anesthesia were included in the study. RESULTS: Among the 59 horses, there were 33 EE, 15 FEE, and 11 SS anastomoses. No difference was found in duration of surgery among the 3 techniques. The most common postoperative complications were colic episodes (56%), ileus (53%), diarrhea (20%), and adhesions (15%). Horses with SS anastomosis had a significantly shorter duration of postoperative ileus than the EE group did. No significant difference in duration of postoperative ileus was found among the other groups. No difference was found among the 3 anastomotic techniques in regard to survival rate at the time of discharge, 6 months after surgery, or 1 year after surgery. Overall survival rates after jejunal anastomosis were 88% at the time of discharge, 65% at 6 months after surgery, and 57% at > or = 1 year after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: The hand-sewn EE, stapled FEE, and stapled SS anastomotic techniques should be considered equivalent methods for small intestinal anastomosis in the horse. However, the stapled SS technique may be preferred because of possible decreased duration of postoperative ileus.     

Cecocolic Anastomosis for the Surgical Management of Cecal Impaction in Horses

Fourteen horses with cecal impaction were treated by cecocolic anastomosis. In nine horses, the anastomosis followed enterotomy and evacuation of the cecal contents, and in two horses it followed saline infusion and massage of the cecum. In three horses, the anastomosis was the only surgical procedure performed. Cecocolic anastomosis was performed between the lateral and dorsal cecal teniae, and the lateral and medial free teniae of the right ventral colon. The anastomosis was hand sutured in five horses. In all other horses, the GIA surgical stapling instrument was used in combination with hand sutured seromuscular layer closures and became the preferred surgical technique. The anastomosis allowed an alternative route for the transit of ingesta from the cecum to the right ventral colon.
Twelve of the 14 horses survived 2 months or longer after surgery (short-term survival rate, 86%) and 10 horses survived 12 months or longer after surgery (long-term survival rate, 71%). Early postoperative complications included mild abdominal pain (6 horses), wound infections (3 horses), fatal peritonitis (2 horses), and large colon distention necessitating reoperation (2 horses).     

Comparison of laparoscopic ovariohysterectomy and ovariohysterectomy in dogs

OBJECTIVES: To evaluate technique, complication rates, postoperative pain scores, and clinical outcomes in dogs after laparoscopic ovariohysterectomy (LOVH) or traditional ovariohysterectomy (OVH). STUDY DESIGN: Prospective clinical trial. ANIMALS OR SAMPLE POPULATION: Thirty-four intact female dogs, weighing 2.4-31 kg. METHODS: LOVH (16 dogs) was performed by ligation of the uterus and ovaries with surgical wire, and then removal by an assisted laparoscopic technique. OVH was performed in 18 dogs. Subjective and objective pain scores were assigned at 0, 2, 8, and 24 hours. Surgical time, complications, and pain and incision scores were evaluated. Dogs were followed for up to 6 months. RESULTS: The mean surgical time for LOVH (120 minutes; range, 47-175 minutes) was significantly longer than for OVH (69 minutes; range, 25-140 minutes). Significantly lower pain scores (subjective, in 2 of 10 categories; objective, in 8 of 10 categories) were identified with LOVH at 1 or more time periods. Surgical complications with LOVH were postoperative fever and anorexia (1 dog), minor splenic (3) or pedicle hemorrhage (4), intermittent vaginal hemorrhagic discharge (1), and suture reaction (3). Surgical complications with OVH were hemorrhage from an ovarian pedicle requiring reoperation (1 dog), dehiscence of the abdominal wall (1), and seroma (1). Anesthetic complications included hypotension in 8 OVH dogs and 1 LOVH dog, and hypothermia in 4 OVH and 9 LOVH dogs. The mean incision scores were lower for LOVH at all time periods. CONCLUSION: LOVH was performed successfully in young nonparous dogs >10 kg. Surgical time and complication rates were greater; however, LOVH postoperative pain scores were < or =OVH scores. CLINICAL RELEVANCE: LOVH is a potentially safe surgical alternative to traditional OVH in dogs. Equipment cost and necessity for more than 1 surgeon may limit its usefulness in small animal practice.     

Use of an ultrasonically activated scalpel for splenectomy in 10 dogs with naturally occurring splenic disease

OBJECTIVE:To evaluate the safety and efficacy of an ultrasonically activated scalpel for performing splenectomy, with minimal ligation, in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (10) with naturally occurring splenic disease. METHODS: Between October 2003 and February 2004, splenectomy was performed using an ultrasonically activated scalpel and a double seal method, in 10 dogs with naturally occurring splenic disease. Time for splenectomy and number of ligatures required were recorded. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short-term survival were evaluated. RESULTS: Mean operative time for splenectomy, exclusive of celiotomy and closure, was 18 minutes (range, 8-25 minutes). The mean number of ligatures needed to perform splenectomy was 1 (range, 0-2 ligatures). One dog hemorrhaged from the splenic vein after ultrasonic scalpel transection of a vessel >5-mm diameter and required a ligature. The ultrasonic scalpel was easy to use, with a minimal learning curve. None of the dogs had postoperative abdominal hemorrhage; 9 dogs were discharged and 1 dog was euthanatized because of septicemia. CONCLUSION: Ultrasonic activated scalpel may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle in dogs with minimal need for vascular ligation. CLINICAL RELEVANCE: Ultrasonic scalpels can be used to perform splenectomy in dogs with naturally occurring splenic disease.     

Transfer of Free Vascular Cutaneous Flaps by Microvascular Anastomosis Results in Six Dogs

Skin defects on the distal extremities of six dogs were reconstructed with free vascular cutaneous transfers by microvascular anastomosis. The donor flaps were based on the superficial cervical artery and vein. In five of the dogs, bone was exposed and skin was lost from half of the circumference of the limb. Two had infected fractures with sequestra and three had acute shearing injuries. The sixth dog had sensory denervation of the left antebrachium and a carpal acral lick granuloma. Before surgery, the patency of potential recipient vessels was confirmed with arteriography in five dogs and an ultrasonic doppler in one dog. Microvascular technique was used to reestablish circulation to the flaps after they were transferred to the recipient site. Total ischemic time of the flaps averaged 100 minutes. All flaps survived. Successful reconstruction of the cutaneous defects was achieved in these six cases.     

Long-term prospective evaluation of intestinal anastomosis using stainless steel staples in 14 dogs

This prospective clinical study evaluated the use, complications, and clinical and ultrasonographic follow-ups of end-to-end intestinal anastomoses with skin staples in naturally occurring diseases in canine small and large intestines. Intestinal anastomoses were performed in 14 dogs and pre-, peri-, and postoperative data were recorded. Postoperative clinical and ultrasound evaluations were performed at regular intervals for 1 year. The mean time taken to construct the anastomosis was 5 min. There were no intraoperative complications. Hemorrhage and colonic stricture were the main postoperative complications. Staple loss occurred in 2 cases. Absence of wall layering and focal wall thickening were observed in all cases at each ultrasonographic follow-up. Hyperechoic fat was observed in all but 1 of the cases at month 1. Nine dogs were alive with normal digestive function at the end of the study. The skin stapler technique enabled rapid construction of consistent anastomoses with inexpensive stapling material.     

Trichobezoar Obstruction after Stapled Jejunal Anastomosis in a Dog

Objective— To describe an unusual long-term complication of circular end-to-end anastomosis (CEEA) stapling in a dog.
Study Design— Clinical case report.
Animal— An 11-year-old, female neutered, Labrador Retriever.
Methods— The dog was referred for clinical signs of bowel obstruction. An enterectomy was performed 2 years before presentation using a CEEA stapling device. Palpation, plain radiographs, and ultrasound of the abdomen confirmed the presence of a mass in the bowel, causing obstruction, and requiring surgical approach.
Results— An exploratory celiotomy revealed a 5 cm mass in the jejunum, involving the site of the previous surgery. The mass was removed by enterectomy. Dissection of the mass revealed the presence of many staples at the previous enterectomy site, and a trichobezoar entangled in the exposed parts of the staples.
Conclusions— An enterectomy was required to treat an intestinal obstruction caused by a trichobezoar entangled in a CEEA-stapled anastomosis.
Clinical Relevance— Development of trichobezoar and subsequent bowel obstruction should be considered an unusual but potential long-term complication of CEEA-stapled anastomosis.     

Microneurovascular Free Digital Pad Transfer in the Dog

By cadaver dissections, the fifth digit of the canine hind limb was determined to have a consistent neurovascular anatomy, and therefore be a suitable donor for an axial pattern digital pad flap. The defined digital pad flap was transferred to the region of an excised metacarpal pad by microneurovascular anastomoses in five operations on four dogs. One flap failure was considered to result from failure of the venous anastomosis. In all four successful transfers, cutaneous sensation was reestablished on average in 78 days. There was histologic evidence of nerve regeneration across the anastomosis in one dog at week 24. The transferred pads of three dogs monitored for 15 months underwent hypertrophic changes. There were no complications in two active dogs. In one dog, superficial ulceration of a region of the flap adjacent to the pad required surgical revision. This dog continued to show mild lameness after daily runs of 3 to 4 km.     

Use of a vessel sealant device for splenectomy in dogs

Objective: To (1) describe a technique for splenic vessel hemostasis and (2) report complications and outcome after use of bipolar sealant device during splenectomy in dogs. Study Design: Case series. Animals: Dogs (n=27) with naturally occurring splenic disease. Methods: Between January 2006 and March 2008, splenectomy was performed using a vessel sealant device in 27 dogs with naturally occurring splenic disease. Number of sutures needed for splenectomy and complications were recorded. Splenic artery diameter was measured using a caliper. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short‐term survival were evaluated. Results: Splenectomy was performed successfully in 27 dogs with the vessel sealant device; none of the dogs required vessel ligation with suture. The splenic artery was dissected and adequately sealed in each dog. One dog was readmitted 4 days after surgery with hemoabdomen. Abdominal exploration revealed splenic pedicle hemorrhage and pancreatitis, the vessel sealant device was used to coagulate splenic pedicle bleeding. The dog was alive at suture removal. Conclusion: In dogs, a vessel sealant device may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle without sutures.     

A Retrospective Study of Inguinal Hernia in 35 Dogs

Inguinal hernia was associated with trauma in five dogs and was considered nontraumatic in 30 dogs. There were 11 males, 13 intact females, and six spayed females with nontraumatic inguinal hernia. Six dogs had bilateral hernias. Five dogs were younger than 4 months at the time of diagnosis. In 11 older dogs with nontraumatic inguinal hernia, the hernias were identified less than 7 days before surgical repair; in 14 older dogs, the hernias had been recognized for 1 to 60 months. Clinical signs in dogs without small intestinal incarceration were usually limited to a visible or palpable mass without pain or systemic illness. Hemiorrhaphy approaches included inguinal, midline with contralateral ring evaluation, and celiotomy with or without inguinal exposure. Fat and omentum were the most common hernial contents. Small intestine was within the hernias of 12 dogs. Six dogs had nonviable small intestine. Postoperative complications included two incisional infections, one incisional dehiscence, two cases of peritonitis and sepsis associated with bowel leakage after intestinal resection and anastomosis, and one hernia recurrence. The overall prevalence of postoperative complications was 17%, and the mortality rate was 3%. Vomiting for 2 to 6 days was predictive of nonviable small intestine. Dogs younger than 2 years were at 11 times greater risk for nonviable small intestine than dogs older than 2 years. Four of five dogs with nontraumatic inguinal hernia and nonviable small intestine were intact males, whereas none of 13 intact females were affected. Only one of 14 dogs with longstanding hernias had nonviable small intestine.     

Esophageal replacement in the dog by microvascular colon transfer

An orthotopic colon graft based on the middle colic artery and vein was implanted with microvascular technique and a stapling instrument in five dogs. The grafts were successful in four dogs. A similar colon autograft was used to replace the entire thoracic esophagus in five dogs. The recipient vessels were the left carotid artery and left external jugular vein. Four of the grafts failed because of kinking and thrombosis of the arterial supply (2 dogs) or the venous outflow (2 dogs). One graft, which had a viable vascular supply, developed a severe leak at the colon-to-stomach anastomosis, and the dog was euthanatized on day 3. The recipient vascular pedicle was modified and used successfully to replace a portion of the cervical esophagus in three dogs. The grafts survived, the dogs could swallow liquids and semisolid food well, and, at necropsy after 4 weeks, the anastomotic sites were well healed. The graft sites contained essentially normal colon mucosa.     

Esophageal Replacement in the Dog by Microvascular Colon Transfer

An orthotopic colon graft based on the middle colic artery and vein was implanted with microvascular technique and a stapling instrument in five dogs. The grafts were successful in four dogs. A similar colon autograft was used to replace the entire thoracic esophagus in five dogs. The recipient vessels were the left carotid artery and left external jugular vein. Four of the grafts failed because of kinking and thrombosis of the arterial supply (2 dogs) or the venous outflow (2 dogs). One graft, which had a viable vascular supply, developed a severe leak at the colon-to-stomach anastomosis, and the dog was euthanatized on day 3. The recipient vascular pedicle was modified and used successfully to replace a portion of the cervical esophagus in three dogs. The grafts survived, the dogs could swallow liquids and semisolid food well, and, at necropsy after 4 weeks, the anastomotic sites were well healed. The graft sites contained essentially normal colon mucosa.     

Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991-2000)

OBJECTIVE: To identify factors associated with leakage following intestinal anastomosis in dogs and cats. DESIGN: Retrospective study. ANIMALS: 90 dogs and 25 cats. PROCEDURE: Medical records of all dogs and cats that underwent intestinal resection and anastomosis between 1991 and 2000 were reviewed, and information on 27 factors was recorded. RESULTS: Anastomotic leakage was identified in 13 of the 90 dogs but in none of the 25 cats. Preoperative factors significantly associated with development of anastomotic leakage in dogs included preoperative peritonitis, serum albumin concentration, a left shift, and indication for surgery (dogs with intestinal foreign bodies were more likely to have leakage than dogs that underwent surgery for any other cause). Postoperative and case management factors significantly associated with development of leakage included duration of hospitalization, supplemental alimentation, whether the dog ate the day after surgery, blood product administration, and outcome (died vs survived). Discriminant analysis was performed, and dogs with 2 or more of the following factors were predicted to develop anastomotic leakage: preoperative peritonitis, intestinal foreign body, and serum albumin concentration < or = 2.5 g/dL. The model accurately predicted whether leakage would develop in 67 of 80 (84%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a variety of factors may be associated with development of intestinal anastomotic leakage in dogs. In particular, dogs with 2 or more of the following risk factors are predicted to be at high risk for developing anastomotic leakage: preoperative peritonitis, intestinal foreign body, and serum albumin concentration < or = 2.5 g/dL.