Comparison of three suture techniques for anastomosis of the small intestine in the horse

Seven horses were used to compare the Gambee, the crushing, and a 2-layer inverting suture pattern composed of a simple continuous layer in the mucosa oversewn with a continuous Lembert pattern in the seromuscular layer. Horses were evaluated at 30 days for adhesion formation, lumen diameter, and quality of healing at the anastomotic sites. One horse was euthanatized 9 days after surgery after 24 hours of ileus and colic; necropsy revealed septic peritonitis and widespread adhesions. One horse had no adhesions. The remaining horses had adhesions associated with 50% of the Gambee and 50% of the crushing anastomoses. There were no adhesions related to the 2-layer inverting techniques in these 6 horses. There was no significant difference in percentage reduction of lumen diameters between the 3 techniques, and there was no evidence of chronic obstruction resulting from any of the anastomotic techniques. Histologically, the inflammatory response and fibrosis were minimal in the single layer patterns, but there was increased fibrosis and suture tract inflammation in the 2-layer inverting technique.     

犬肠吻合术中改良单层缝合与传统双层缝合对比研究

将相同条件下饲养的36只6~8月龄,体重相当,精神状态良好的试验犬随机分为3组,A组为改良的单层缝合组,B组为双层缝合组,C组为空白对照组。观察与比较两种缝合方法后犬的存活率、手术时间、体重变化、D-木糖含量、脂肪酶含量、淀粉酶含量、肠道X线摄片、肠腔直径及组织结构的变化。比较犬肠吻合术中改良的肠单层缝合与传统双层缝合的方法和效果,找出更适合犬肠管缝合中的肠吻合方法。通过以上试验得出,改良单层缝合更省时,且愈合效果良好,肠腔不会造成狭窄,对消化功能的影响较小,适合应用于犬肠吻合。     

Pullout strength for three suture patterns used for canine tracheal anastomosis

OBJECTIVE: To compare pullout strength of 3 suture patterns used for canine tracheal anastomosis. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Cadaveric canine tracheae (n = 20). METHOD: Tracheal segments were anastomosed with 1 of 3 suture patterns: simple continuous, simple interrupted, and simple interrupted reinforced with horizontal mattress, each encircling annular cartilage rings adjacent to the transection site. Horizontal mattress sutures encircled the annular rings proximal and distal to the rings closest to the anastomosis. Each construct was distracted (0.5 mm/s) in a materials testing machine to failure. Load-displacement curves were generated and failure load (pullout strength) determined and mode of failure recorded. RESULTS: Tracheal anastomosis with a simple interrupted pattern was significantly weaker (mean+/-SD pullout strength, 102.55+/-30.14 N) than simple continuous (135.53+/-15.47 N) or simple interrupted plus horizontal mattress (132.39+/-21.46 N), which were not different from each other. Mode of failure was consistently by suture tear out. CONCLUSIONS: Both simple continuous and simple interrupted reinforced with horizontal mattress suture patterns have significant biomechanical advantage over a simple interrupted pattern alone in canine cadaveric tracheal anastomosis. The simple continuous pattern had the least variability in pullout strength. CLINICAL RELEVANCE: A simple continuous technique should be considered when selecting a tension-relieving pattern for canine tracheal anastomosis. It offers the same biomechanical advantage as a simple interrupted pattern reinforced with a horizontal mattress pattern and its strength appears to be reliably maintained when tested in canine cadaver tracheae.     

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.     

Comparison of carbon fibre and nylon suture for repair of transected flexor tendons in the horse

Carbon fibre-polylactic acid composites and monofilament non-absorbable suture material were compared for the repair of surgically transected superficial digital flexor tendons in 10 horses. All surgical wounds healed by first intention. The repaired tendons were enlarged, the carbon implanted tendons being larger than those sutured. The horses were killed at six, eight, 12,20 or 24 weeks. Greater fibrous thickening occurred in tendons repaired with carbon fibre, especially at 12 weeks postoperatively. Carbon fibre incited a greater histological response with macrophages, lymphocytes, plasma cells, eosinophils and fibroblasts. The fibrous tissue in the repair sites appeared to mature and the collagen to align at a similar rate irrespective of the method of repair. Only that tissue within and immediately surrounding the carbon bundles was immature at six months. There was minimal tendency for carbon filaments to separate and those that did were often surrounded by epithelioid macrophages forming a granuloma. Massive eosinophil concentrations were present between each granuloma. With each sequential test period the sutured tendons became increasingly stronger than the carbon implanted tendons. This may have been because of the immature core of tissue associated with the carbon bundles. No carbon particles were detected in draining lymph nodes.     

Comparison of three feeding techniques after esophageal mucosal resection and anastomosis in the horse

The effects of 3 feeding techniques on healing of a cervical esophageal mucosal resection and anastomosis were investigated in 16 horses. Horses were fed a moistened pelleted diet 1 of 3 ways: 1) per os (n = 5), 2) by nasogastric (n = 5) or 3) by esophagostomy tube (n = 6) until the 14th postoperative day. The pelleted diet was then fed orally in all horses until euthanasia on the 60th postoperative day. Immediate postoperative feeding per os was unsatisfactory, as only 2 of 5 horses survived in this group. Endoscopic evaluation revealed that mucosal dehiscence of varying degrees occurred, with subsequent stricture formation in all horses. Although the incidence of some complications (fistula, sinus tract and traction diverticulum) was higher in the nasogastric tube-fed horses, 2 of 6 horses in the esophagostomy tube-fed group did not survive to the end of the study. There was more cervical phlegmon in the esophagostomy tube-fed group, and this resulted in increased periesophageal fibrosis on histopathologic examination. Radiographic measurements showed that esophageal lumen diameter increased predominantly between 30 and 45 days postoperatively. The mucosal healing time was significantly faster (p = 0.05) in the esophagostomy tube-fed group.     

2种肠管吻合手术的术后愈合及黏连情况比较

课题组前期研制出一种新型携带多种药物成分的内支撑物,并将其应用于试验犬的肠管吻合术中,此研究表明采用内支撑物应用于犬肠管吻合术,与传统吻合术比较,可降低手术操作的难度,缩短吻合时间,且术后无明显并发症,愈合良好。为了进一步探讨这种新吻合技术的可行性及相关机制,课题组从腹腔黏连评分、吻合口爆破压和羟脯氨酸含量等方面对2组犬的术后愈合情况进行比较研究。以健康本地犬为试验动物,分为内置支撑物组(NZ组,12只)和传统手术组(CS组,12只),分别在术后3,7,14,28d,剖腹探查,观察吻合部位愈合情况,进行腹腔黏连评分,并对吻合口爆破压、吻合口组织中羟脯氨酸含量等项目进行检测。腹腔黏连结果表明术后7,14,28d,CS组的腹腔黏连评分显著高于NZ组,结果具有统计学意义(P<0.05),术后3d,CS组的腹腔黏连评分与NZ组相比无显著性差异(P>0.05);术后7,14d,CS组的吻合口爆破压显著低于NZ组(P<0.05),而在术后3,28d,2组吻合口爆破压相比无显著性差异(P>0.05);2组的羟脯氨酸含量均随时间的增长而增加,而在各个时间点上2组相比无显著性差异(P>0.05)。最终试验结果表明,相对传统小动物肠管吻合术而言,使用内支撑物进行该手术能减少术后黏连,吻合部位的愈合情况更为良好。     

Nutritional and clinicopathological effects of post operative parenteral nutrition following small intestinal resection and anastomosis in the mature horse

REASONS FOR PERFORMING STUDY: There is an absence of data describing the nutritional requirements and nutritional status of horses following surgery for colic; furthermore, the potential effect of parenteral nutrition (PN) on improving nutritional status in such cases is unknown. HYPOTHESIS: Post operative colic cases suffer from a potentially detrimental negative energy balance and the PN formulation developed in this study would lead to clinicopathologically detectable improvements in the subjects' nutritional status. METHODS: Several clinicopathological variables, some known to be associated with nutritional status, were compared in 2 groups of horses in the post operative period following colic surgery; Group N (n = 15) were treated with PN and Group C (n = 15) were starved routinely. RESULTS: Group N had significantly lower serum concentrations of triglycerides, total bilirubin, albumin and urea and significantly higher serum concentrations of glucose and insulin compared with Group C in the post operative period. CONCLUSIONS: The control group of horses demonstrated significant clinicopathological evidence of starvation and the described PN protocol resulted in a demonstrably improved nutritional status in the treated horses. POTENTIAL RELEVANCE: Further study is required to investigate clinical benefits and possible harmful side effects of post operative parenteral nutrition before the technique can be advocated for widespread use in practice.     

In vitro evaluation of a closed-bowel technique for one-layer hand-sewn inverting end-to-end jejunojejunosotomy in the horse

OBJECTIVE: To report a technique for closed-bowel 1-layer inverting end-to-end jejunojejunal anastomosis in horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Fresh cadaveric jejunal segments from 12 horses. METHODS: For each bowel segment a 1-layer closed and a 2-layer inverting end-to-end jejunojejunosotomy was created. Anastomosis construction time and anastomotic bursting pressure were measured and compared. RESULTS: Closed-bowel anastomosis was significantly faster to create than a 2-layer technique. Luminal narrowing (<30%) was similar with both techniques and comparable with other inverting techniques. Bursting pressure was significantly higher for the 2-layer technique, although all anastomoses resisted pressures higher than those reported for other jejunojejunal anastomosis techniques. CONCLUSIONS: A 1-layer hand-sewn, closed, inverting jejunojejunosotomy using a modified Doyen clamp was easy and faster to perform, and resulted in functional characteristics similar to, a 2-layer hand-sewn inverting technique. CLINICAL RELEVANCE: A closed, 1-layer inverting technique could be considered for equine jejunal anastomosis but requires in vivo evaluation before recommendation for clinical use.     

Biomechanical analysis of suture anchors and suture materials in the canine femur

Objective— Biomechanical analysis of acute load to failure (ALF) of 3 veterinary and 1 human suture anchor and cyclic load to failure with two suture material/suture anchor constructs in canine femoral condyles.
Study Design— Biomechanical in vitro study.
Sample Population— Cadaveric femora from 20–30 kg dogs.
Methods— Three veterinary and 1 human suture anchor were placed in the cranial and caudal aspects of the femoral condyle and subjected to 0° ALF. Anchors were loaded with 5 USP Fiberwire or 27 kg test nylon leader line (NLL) and subjected to 90° cyclic testing for 10,000 cycles followed by ALF at 90°.
Results— No significant difference in ALF for any anchor type was detected in the cranial aspect of the femoral condyle; however all veterinary anchors had higher ALF in the caudal aspect of the femoral condyle. In cyclic testing, the constructs in descending order (most cycles to least) were: (1) FlexiTwist/NLL, (2) Securos/Fiberwire, Securos/NLL, (3) IMEX/Fiberwire, IMEX/NLL, and (4) FlexiTwist/Fiberwire, Fastin/Fiberwire. Fiberwire was significantly stronger than NLL in post-cycling ALF testing.
Conclusions— Veterinary anchors had higher ALF in the caudal versus cranial aspect of the femoral condyle. Except for the FlexiTwist in which NLL performed better, Fiberwire and NLL both had similar cyclic performance with each veterinary anchor type. The veterinary anchors exceeded the human anchor in ALF and cycles to failure.
Clinical Relevance— The tested veterinary suture anchors with Fiberwire or NLL may be used in the femoral condyle, preferably in the caudal aspect, and should withstand estimated loading conditions in appropriately confined postoperative canine patients.     

A case of spermatic arteriovenous anastomosis in the horse.

A large anastomosis of the spermatic artery and vein is described. This was found while surgically removing an abdominal testis. Before surgery the animal wanted to rear after exercise and could not stand on 3 legs for any length of time while being shod. This unusual behaviour disappeared after removal of the mass. The performance and conformation of the horse has also greatly improved.     

Eosinophilic intestinal diseases of the horse

Eosinophilic intestinal diseases of the horse are not commonly reported. Similar diseases are reported in man, but for either species, these eosinophilic diseases, are poorly understood. Eosinophilic intestinal disease may be accompanied by eosinophilic disease of other organs, or eosinophilia may be restricted to the intestine. When infiltration of eosinophils is restricted to the intestine, horses have a good prognosis for resolution of clinical signs, even though the treatment may include celiotomy with intestinal decompression or resection and administration of a corticosteroid. When eosinophilic intestinal disease is accompanied by infiltration of other organs, such as skin, pancreas, lungs or liver, the horse's prognosis for survival is very poor.     

Ovarian and intestinal angiomatosis in a horse

Dozens of red, raised nodules scattered along the serosal surface of the small intestine and the right and left ovaries were observed as incidental findings on gross examination in a 21-year-old Thoroughbred mare euthanatized for severe lameness. Histologically, these nodules were composed of numerous, variably sized, redundant vascular profiles filled with red blood cells and fibrin thrombi. Based on the presence of multiple nodules composed of benign vascular channels scattered within the small intestine and ovary, a diagnosis of angiomatosis is proposed. To the authors' knowledge, this is the first report of small intestinal and ovarian angiomatosis in a horse.     

Fixation of chronic suture exostosis in a mature horse

This case report describes the clinical findings, diagnosis and treatment of a 14‐year‐old Warmblood gelding with suture exostosis. The horse was referred to our clinic because of bilateral swelling in the region of the frontal and nasal bone junction and bilateral epiphora. Epiphora was the main concern for the owner and the reason for further investigation and treatment. Radiographic examination showed extensive bone proliferation on the dorsal frontal and nasal bones. Computed tomographic (CT) images further characterised the periosteal proliferation as new bone formation and localised it along the frontonasal and frontolacrimal suture lines. Computed tomographic images also showed pathological changes of both lacrimal ducts. A chronic fracture was suspected to be the cause of the periosteal proliferation, and surgical treatment using 2 small 2.4 Unilock plates was chosen to stabilise the suture between the frontal and nasal bones. The swelling decreased and the epiphora resolved by 6 months post operatively. A CT examination 2 years later showed complete healing.     

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.