Evaluation of a vessel-sealing device for small intestinal resection and anastomosis in normal horses

OBJECTIVES: To compare arterial bursting pressure after vessel closure using a vessel-sealing device (LigaSure Atlas Laparoscopic Sealer/Divider Instrument; Valleylab, Boulder, CO), a ligate-and-divide stapling device (LDS), and 2-0 polydioxanone suture. To evaluate the LigaSure Atlas as a method for ligation of the mesenteric vasculature during small intestinal resection in normal horses. STUDY DESIGN: Experimental study. ANIMALS: Part A: jejunal segments from 19 horses. Part B: 6 horses, aged 1 to 18 years, weighing 330 to 509 kg. METHODS: Part A: Jejunal segments with mesenteric vessels were collected from 19 horses. After closure by 1 of 3 methods (LigaSure Atlas, LDS, 2-0 polydioxanone) arteries were cannulated, and bursting pressure was measured by incrementally increasing intraluminal pressure until failure. Part B: Six horses had jejunal resection and anastomosis using a vessel-sealing device (LigaSure Atlas) to provide hemostasis of the mesenteric vasculature. Horses were monitored clinically for 4 weeks. RESULTS: Part A: Mean +/- SEM bursting pressure after 2-0 polydioxanone ligation (1,014.50 +/- 279.05 mm Hg) was significantly greater than mean bursting pressure after LigaSure (554.25 +/- 228.79 mm Hg), which was significantly greater than the mean bursting pressure after LDS (373.25 +/- 183.69). Part B: No major operative or postoperative hemorrhage occurred after application of the LigaSure Atlas for sealing and transecting mesenteric vasculature during small intestinal resection in normal horses. CONCLUSIONS: The LigaSure Atlas appears to be a safe method for hemostasis of the mesenteric vasculature during small intestinal resection in normal horses. CLINICAL RELEVANCE: Benefits of the LigaSure Atlas vessel-sealing device include reduced time required to provide hemostasis, acceptable arterial bursting pressure, no remaining foreign material, and no risk for ligature slippage. In our experience, use of the LigaSure Atlas during small intestinal resection and anastomosis in horses is safe for ligation of vessels less than or equal to 7-mm diameter.     

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.     

An in vitro comparison of two suture intervals using braided absorbable loop suture in the equine linea alba

OBJECTIVE: To compare bursting strength and failure modes of ventral median abdominal incisions closed with loop suture in a simple continuous pattern using two different suture-bite intervals. STUDY DESIGN: In vitro experiment. SAMPLE POPULATION: Equine cadavers (n=14; weighing >318 kg; postmortem interval <2 hours). METHODS: A template was used to make a 25 cm incision with suture interval and bite size of either 1.0 cm x 1.5 cm or 1.5 cm x 1.5 cm. A 200 L polyurethane bladder was inserted within the abdomen and insufflated to create abdominal wall tension. Celiotomies were closed with a #2 braided lactomer 9-1 continuous pattern with a loop suture. Deviation from the linea, closure time (minutes), total suture length (cm), suture length to wound ratio (SL:WL), bursting pressure (mm Hg), and failure modes (fascial or suture) were compared between groups using a Mann-Whitney U test. Significance was set at P<.05. RESULTS: No significant differences were identified between closing time, total suture length used, SL:WL, bursting pressure, or failure mode. Fascial failure was the main failure mode for both techniques; suture failure occurred rarely and knot failure did not occur. CONCLUSION: Based on the overall bursting pressure and failure mode, #2 braided lactomer loop suture placed in a continuous pattern should provide sufficient security for closure of the equine linea alba during recovery and the immediate postoperative period. CLINICAL RELEVANCE: Although there were no significant differences in the 2 patterns evaluated, the 1.5 cm x 1.5 cm pattern may have potential advantages for closure time, less total suture remaining in the wound, and strength.     

Comparison of staple and suture techniques for end-to-end anastomosis of the small colon in horses

Two techniques for end-to-end anastomosis of the small colon were evaluated in each of 6 horses. A simple interrupted suture pattern that excluded the mucosa and was oversewn with an inverting suture was compared with a triangulated double-row pattern of stainless steel staples. Anastomotic sites were evaluated at 2 weeks, 2 months, and 6 months for extent of abdominal adhesions, lumen diameter at anastomotic sites, bursting pressures, and healing response. Clinical postoperative complications were not associated with either technique. At postmortem examination, there was extensive adhesion formation from the mesocolon to the stapled anastomotic site. The suture technique resulted in greater luminal diameters (P less than or equal to 0.05), with good apposition of the tissue layers. Staples were missing as early as 2 weeks after surgery, and their loss was associated with separation of the muscularis at later evaluation periods. Regardless of technique, all but one anastomotic segment burst away from the anastomotic site along the mesenteric taenial band. For the 12 anastomoses performed in normal horses, the suturing technique was better than the stapling technique because of significantly larger lumen diameters, better anastomotic healing, and minimal intra-abdominal adhesion formation.     

Evaluation of a laparoscopic technique for collection of serial full-thickness small intestinal biopsy specimens in standing sedated horses

OBJECTIVE: To assess a technique for laparoscopic collection of serial full-thickness small intestinal biopsy specimens in horses. ANIMALS:13 healthy adult horses. PROCEDURES: In the ex vivo portion of the study, sections of duodenum and jejunum obtained from 6 horses immediately after euthanasia were divided into 3 segments. Each segment was randomly assigned to the control group, the double-layer hand-sewn closure group, or the endoscopic linear stapler (ELS) group. Bursting strength and bursting wall tension were measured and compared among groups; luminal diameter reduction at the biopsy site was compared between the biopsy groups. In the in vivo portion of the study, serial full-thickness small intestinal biopsy specimens were laparoscopically collected with an ELS from the descending duodenum and distal portion of the jejunum at monthly intervals in 7 sedated, standing horses. Biopsy specimens were evaluated for suitability for histologic examination. RESULTS: Mean bursting strength and bursting wall tension were significantly lower in the ELS group than in the hand-sewn and control groups in both the duodenal and jejunal segments. Use of the hand-sewn closure technique at the biopsy site reduced luminal diameter significantly more than use of the stapling technique. In the in vivo part of the study, all 52 biopsy specimens collected during 26 laparoscopic procedures were suitable for histologic examination and no clinically important perioperative complications developed. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic collection of serial full-thickness small intestinal biopsy specimens with a 45-mm ELS may be an effective and safe technique for use in healthy adult experimental horses.     

Modified functional end-to-end stapled intestinal anastomosis: technique and clinical results in 15 dogs

OBJECTIVES: To evaluate the use of a gastrointestinal anastomosis (GIA) stapling device to perform small intestinal anastomosis in the dog. METHODS: A retrospective study to evaluate the use of a GIA stapling device to perform small intestinal anastomosis in 15 dogs. RESULTS: Reasons for intervention included dehiscence of a previous enterotomy (four of 15), intestinal neoplasia (five of 15), vascular compromise (three of 15), intussusception (two of 15) and foreign body (one of 15). The mean time taken to perform the anastomosis was 7.7 minutes (range five to 12 minutes). No operative complications were recorded and all dogs recovered from the surgery. Major (two dogs) and minor (six dogs) short-term complications of pyrexia and anorexia were recorded in six dogs. In five of these, the cause was considered to be related to a pre-existing peritonitis. One dog was euthanased five months postoperatively for a multi-centric recurrence of intestinal lymphoma. Six month follow-up confirmed an unremarkable and complete recovery in all remaining dogs. No major or minor long-term complications were recorded in any individual. CLINICAL SIGNIFICANCE: A modified stapled functional end-to-end intestinal anastomosis holds merit and should be considered a viable alternative to other stapled and sutured anastomosis techniques.     

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.     

In vitro bursting pressures of jejunal enterotomy closures in llamas

OBJECTIVE: To evaluate closure strength (in vitro bursting pressure) of jejunal enterotomies in llamas. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Jejunal specimens (n=72) from 6 llamas. METHODS: Differences in bursting pressures and luminal diameters were compared between 2 layer enterotomy closures with an initial full thickness simple continuous pattern oversewn with either a continuous Lembert or Cushing suture pattern using 3 sizes (2-0, 3-0, 4-0) of polyglactin 910 and polydioxanone. RESULTS: Bursting pressures were significantly higher for enterotomies closed with polydioxanone than polyglactin 910, independent of suture size, but there was no difference between Lembert and Cushing oversew patterns. Use of a Lembert pattern reduced intestinal diameter more than a Cushing pattern regardless of suture material or size. CONCLUSIONS: Although polydioxanone resisted higher bursting pressures than polyglactin 910, both suture materials should be considered satisfactory for jejunal enterotomy closure in llamas based on typical intraluminal pressures expected in clinical patients. The optimal oversew pattern may be continuous Cushing to maximize the luminal diameter in small intestinal enterotomy closures. CLINICAL RELEVANCE: In vitro bursting pressures may help to predict which enterotomy sites would leak post-operatively, although further studies are necessary to determine the outcome in clinical patients.     

Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba

OBJECTIVE: To determine the bursting strength of ventral median abdominal incisions closed by either simple continuous or inverted cruciate suture patterns. STUDY DESIGN: Experimental. ANIMAL OR SAMPLE POPULATION: Twelve equine cadavers. METHODS: A 25 cm ventral median incision was made through the linea alba and a 200 L polyurethane bladder was placed within the abdomen. Either a simple continuous or an inverted cruciate pattern using 3 polyglactin 910 with a bite size and suture interval of 1.5 cm was used to close linea incisions. Closure time was recorded for each pattern. The bladder was inflated with air at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and the wound failure modes were recorded. Deviation from the linea (cm), total suture length (cm), suture length to wound length ratio (SL:WL), closure time (min), bursting pressure (mm Hg), and failure modes were compared between groups using Welch-Aspin t-tests. The effects of independent subject variables were assessed for possible effects on bursting strength using analysis of covariance. RESULTS: Mean bursting pressure was significantly greater for the simple continuous pattern than for the inverted cruciate pattern (P = .01). Significantly less suture material (P = .0002) was required with the continuous pattern than with the inverted cruciate pattern. Mean closure time, SL:WL, deviation from the linea, and failure modes were not significantly different between groups. No significant effects were noted for independent variables in both groups on bursting strength. CONCLUSIONS: In this model, a simple continuous closure pattern for ventral median abdominal incisions was stronger than an inverted cruciate pattern. A simple continuous pattern leaves less foreign material in the wound, which may be of benefit in reducing incisional complications. CLINICAL RELEVANCE: Use of a continuous closure pattern for the linea alba may offer greater wound security during episodes of increased intra-abdominal pressure in horses.     

Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997).

OBJECTIVE: To describe and compare a simple continuous suture pattern with a simple interrupted pattern for enterotomy closure or end-to-end intestinal anastomosis. DESIGN: Retrospective study. ANIMALS: 58 dogs and 25 cats that underwent enterotomy or intestinal resection and anastomosis. PROCEDURE: Signalment, surgical procedure, suture pattern, suture material, confirmation of dehiscence, and follow-up were reviewed. Groups were compared by procedure (anastomosis or enterotomy) and by suture pattern. RESULTS: 57 animals underwent continuous closure; 26 had interrupted closure. Only polydioxanone or polypropylene suture materials were used. Overall, 81 (98%) animals had no signs of intestinal dehiscence and survived > 2 weeks. Two animals had confirmed dehiscence after foreign body removal, 1 of 57 (2%) after continuous closure, and 1 of 26 (4%) after interrupted closure. CLINICAL IMPLICATIONS: The simple continuous closure pattern is an acceptable alternative to simple interrupted closure for small intestinal anastomosis or enterotomy closure.     

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.     

Esophagotomy Closure in the Dog A Comparison of a Double-Layer Appositional and Two Single-Layer Appositional Techniques

Esophagotomies were performed on 36 dogs and closed with 3-0 polydioxanone in double-layer simple interrupted, single-layer simple interrupted, or single-layer simple continuous patterns. The operative time was shortest for single-layer simple continuous closure, followed by single-layer simple interrupted and double-layer simple interrupted, respectively. Three dogs with each suture pattern were euthanatized at hours 0 and 1, and days 4 and 28 after surgery. The esophagotomy incisions were subjected to bursting strength testing and examined microscopically. The bursting wall tension was higher for all three suture pattern groups at 28 days than at 0 and 1 hour. The double-layer closure had higher bursting wall tension than the single-layer closures at 0 hour and 4 days. Single-layer simple continuous closure had the lowest bursting wall tension for each time period. Single-layer simple interrupted closure had the highest bursting wall tension at 28 days. Microscopic examination revealed close approximation of tissue planes for the double-layer closure and mucosal ever-sion for the simple interrupted and simple continuous single-layer closures. Healing was superior histologically with the double-layer closure.     

Jejunal incarceration by an omental tear in a dog.

A 2-year-old male mixed-breed dog was examined after being hit by a car, and exploratory celiotomy revealed jejunal incarceration through an omental tear. The affected intestinal segment was distended and black, and had small serosal tears. Clinical signs of disease and hematologic, serum biochemical findings during surgery were consistent with concurrent diagnosis of sepsis. The dog responded to supportive treatment and resection of the affected intestinal segment by jejunal end-to-end anastomosis.     

Disseminated candidiasis secondary to fungal and bacterial peritonitis in a young dog

Objective – To describe a severe case of bacterial sepsis and disseminated candidiasis in a previously healthy dog.
Case Summary – Fungal sepsis was identified in a 2-year-old dog following intestinal dehiscence 4 days after abdominal surgery. Septic peritonitis was identified at admission and evidence of dehiscence at the previous enterotomy site was found during an exploratory laparotomy. Both gram-positive cocci and Candida albicans were cultured from the abdominal cavity. Candida sp. was also subsequently cultured from a central venous catheter. Euthanasia was performed due to failure to respond to therapy. Fungal organisms, morphologically consistent with Candida spp., were found in the lungs and kidney on postmortem histopathologic examination indicating disseminated candidiasis.
New or Unique Information Provided – Candida peritonitis is a well-recognized entity in humans and contributes to morbidity and mortality in critically ill patients. Abdominal surgery, intestinal perforation, presence of central venous catheters, and administration of broad-spectrum antibiotics are all considered to be suspected risk factors. This report describes the first known case of systemic candidiasis occurring secondary to Candida peritonitis and bacterial sepsis in a critically ill dog.     

Foreign body attachment to polypropylene suture material extruded into the small intestinal lumen after enteric closure in three dogs

Three dogs in which polypropylene suture material was used to close an enteric surgery site in a continuous pattern were evaluated at a later date because of recurrence of signs of intestinal disease. Surgery in each dog revealed that the suture material had been extruded into the lumen of the intestine and acted as a site for attachment of a foreign body. The nonabsorbable nature of polypropylene and its use in a continuous pattern are possible explanations for this complication. Polydioxanone or poliglecaprone 25 may be suitable alternatives to polypropylene for use in a continuous pattern for closure of small intestinal surgery sites.     

Partial Maxillectomy in the Dog Comparison of Suture Materials and Closure Techniques

This study compares the healing of oronasal defects created by partial maxillectomy when closed using two different suture materials and two different suture patterns. In experiment 1, 24 dogs were divided into four equal groups. Partial maxillectomy was performed on each dog and was closed using either a two-layer simple interrupted suture pattern (12 dogs) or a modified Mayo mattress pattern (12 dogs) with either polyglactin 910 (12 dogs) or polypropylene (12 dogs) sutures. On the seventh postoperative day, the dogs were euthanized, suture line bursting pressures were measured, and wound healing was evaluated grossly and histopathologically. Suture line dehiscence occurred in one dog from each of the four groups. These were the only dogs in which electrocoagulation had been used. The healing of suture lines closed with the two-layer simple interrupted pattern was superior to that of those closed with the modified Mayo mattress pattern based on the degree of gross oral ulceration, suppurative inflammation, fibrosis and oral epithelial covering at the suture line, and the number of necrotic sites in the adjacent tissue. The healing of suture lines closed with polypropylene was superior to that of those closed with polyglactin 910 based on suture line bursting pressures and the degree of suppurative inflammation and tissue necrosis at the suture sites. In Experiment 2, partial maxillectomies were performed on four dogs, and closure was achieved using a two-layer simple interrupted suture pattern with either polyglactin 910 (two dogs) or polypropylene (two dogs). On the 30th postoperative day, the dogs were euthanized, and wound healing was evaluated grossly and histopathologically. All suture lines were well healed. All polyglactin 910 oral sutures were absent, while all polypropylene oral sutures were still present.     

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.     

Colonic anastomosis in calves: an experimental study

Colonic anastomosis was conducted in 12 calves divided equally into four groups. Four suture patterns, viz. single inversion (continuous Connell), double inversion (two rows of continuous Cushing), single eversion (continuous everted mattress), double eversion (single eversion reinforced with simple continuous) were used. In each animal, anastomosis of the same technique was performed at four places. Each technique was evaluated in terms of clinical and gross observations, lumen stenosis and bursting pressure. Observations were made on the 7th, 14th and 28th day after anastomosis. None of the anastomotic techniques showed any untoward incident during the 28 days of postoperative study. Stricture formation at the site of anastomosis was minimal with the single inversion technique whereas it was maximum with the single eversion technique. Pressure for disruption of intestinal segments was higher after inversion than eversion techniques. It was concluded that the one-layer inversion anastomosis technique proved to be the best among the four techniques because (i) of its reduced incidence of adhesions; (ii) it maintains adequate lumen diameter; (iii) it withstands maximum pressure. The double layer inversion technique was conceded to be the second best choice for colonic anastomosis followed by the double eversion and single eversion techniques.     

Comparison of two laparoscopic suture patterns for repair of experimentally ruptured urinary bladders in normal neonatal calves

OBJECTIVE: To compare 2 laparoscopic suture patterns for repair of experimentally ruptured urinary bladders in normal neonatal calves. STUDY DESIGN: Experimental surgical study. ANIMALS: Thirty male Holstein calves. METHODS: A bladder defect was created in 24 anesthetized calves (day 0). They were randomly divided into 4 groups (n=6/group). In groups 1 and 3, the defect was closed laparoscopically using a one layer full thickness simple continuous (FTSC) suture pattern (pattern A). In groups 2 and 4, the defect was closed laparoscopically in 2 layers using a FTSC suture pattern followed by Lembert continuous suture pattern (pattern B). Groups 1 and 2 calves were euthanatized at the end of the surgery and groups 3 and 4 at day 10. Six healthy calves were also euthanatized and used as a control group. The bladders were harvested and tested for bursting strength (BS). The surgical time (ST) data from the two groups for each pattern were pooled. A Student t-test was used to compare ST data. For the BS data, a 2-factor ANOVA test with post-hoc Student t-test was used to determine if treatment, time, or treatment-time interaction was significant. A Dunnett's test was used to compare BS of the 4 treatment groups to the control group. P<.05 was considered significant. RESULTS: Mean ST was significantly shorter for pattern A than for pattern B. In all treatment groups, the mean bladder BS (MBBS) was significantly lower than the MBBS for the control group. The MBBS was significantly lower for group 1 than for group 2. There was no significant difference in the MBBS between groups 3 and 4. CONCLUSION: In this study, a 1-layer laparoscopic closure technique had advantages compared with 2-layer laparoscopic closure technique. Further work is required before a 1-layer laparoscopic closure technique can be recommended clinically. CLINICAL RELEVANCE: One-layer bladder closure is fast and safe in clinically normal calves and permits additional research to evaluate its safety in foals and clinical ruptures.     

Effect of carboxymethylcellulose and a hyaluronate-carboxymethylcellulose membrane on healing of intestinal anastomoses in horses

OBJECTIVE: To evaluate the effect of sodium carboxymethylcellulose (SCMC) or a hyaluronate-carboxymethylcellulose membrane (HA membrane) on healing of the small intestine in horses. ANIMALS: 18 healthy adult horses. PROCEDURE: Midline celiotomy and 2 jejunal resection-and-anastomosis surgeries were performed. In treated horses, SCMC (n = 6) or a HA membrane (6) was applied to the jejunum to cover the anastomosis. There were 6 untreated control horses. Horses were euthanatized 10 days after surgery. For each horse, 1 anastomosis was used for histologic examination, and the second was used to determine intestinal bursting strength. Intestinal bursting tension, serosal granulation tissue, serosal fibrin deposition, and width of the fibrous seal at the anastomosis were compared among groups. RESULTS: 3 control horses had adhesions associated with the anastomosis, but none of the treated horses had adhesions associated with the anastomosis. Mean thickness of fibrin deposited on the serosal surfaces for the SCMC and HA-membrane groups was significantly less than that for control horses. Mean thickness of serosal granulation tissue, width of fibrous seal between inverted musculature, inflammatory cell infiltrate scores, and bursting tension did not differ significantly among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Use of SCMC or application of a HA membrane to small intestinal anastomoses in horses resulted in fewer adhesions and decreased fibrin deposition, and it did not adversely affect anastomotic healing. In horses at increased risk for intra-abdominal adhesions, SCMC or application of HA membranes may decrease the frequency of adhesions without adversely affecting healing of small intestinal anastomoses.