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 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.     

Comparison of suture materials and suture patterns for inverting intestinal anastomosis of the jejunum in the horse

In 7 horses, 4 anastomoses were done in the small intestine in each, using the combinations of synthetic absorbable monofilament and multifilament suture materials with continuous- and interrupted-suture patterns in the serosubmucosal layer of a 2-layer inverting-suture technique. Horses were evaluated 30 days after the operation for adhesion formation, lumen diameter, evidence of chronic obstruction, and suture tract inflammation at the anastomosis. Postoperative obstruction occurred in 5 of the 7 horses, and 6 horses survived. One horse was euthanatized on postoperative day 6 after 48 hours of ileus and obstruction; necropsy revealed a partial intussusception involving the anastomosis done with continuous multifilament-suture material. Two other horses that became obstructed between postoperative days 3 and 5 had protracted ileus and gastric reflux up to 48 hours' duration, but survived. Horses that had obstruction after the 6th postoperative day recovered within 4 hours of onset. The continuous inverting-suture pattern in the serosubmucosal layer resulted in significantly (P less than 0.05) fewer adhesions than did the interrupted pattern, and suture material had no effect on adhesion formation. There was no significant difference in the percentage of reduction of lumen diameter between the variations of the 2-layer technique, and there was no evidence of chronic obstruction related to any of the anastomoses. Suture tract inflammation was moderate in the anastomoses, using continuous-multifilament suture, with neutrophils being the predominant cell type. The anastomoses with continuous-monofilament suture had mild inflammation with focal accumulations of neutrophils. Minimal inflammation was associated with both types of suture in the interrupted pattern.     

Resection and anastomosis of small intestine: current methods applicable to the horse

Intraoperative techniques for assessing the viability of ischaemic bowel are discussed. Intravenous administration of sodium fluorescein appears useful but further investigation of the method is required. Methods of resection and anastomosis of small intestine are described and illustrated, including the use of automatic stapling instruments.     

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.     

Evaluation of three techniques for end-to end anastomosis of the small colon in horses

In an attempt to determine the best method for surgical removal of devitalized small colon lesions, 12 horses underwent a double small colon resection and end-to-end anastomosis. In 4 horses (study 1), an appositional single-layer (APP-1) suture pattern was compared with an inverting 2-layer (INV-2) suture pattern. In 8 horses (study 2), an appositional 2-layer (APP-2) suture pattern was compared with the INV-2 suture technique. Polydioxanone suture (size 1-0), was used. Horses were evaluated at necropsy 3, 10, 14, 28, or 56 days after surgery. Postoperative complications (peritonitis, impaction, or excessive adhesions) were encountered in 100, 42, and 13% of the APP-1, INV-2, and APP-2 anastomoses, respectively. Postmortem evaluation of the small colon revealed dehiscence of the anastomotic site, diffuse peritonitis, and adhesion formation in 3 of the 4 horses in which the resection line was closed with the APP-1 pattern. With the INV-2 and APP-2 techniques, more intestinal inversion was present in the nontaenial than in the taenial portion of the small colon. More postoperative impactions were found with the INV-2 (n = 5) anastomoses than with the APP-2 (n = 1) technique; this appeared to be the result of excessive tissue inversion. There was no difference in lumen diameter between the INV-2 and the APP-2 techniques (P greater than or equal to 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of the mechanical strength of two stapled anastomosis techniques for equine small intestine

OBJECTIVE: To compare bursting strength, time of construction, and cost of a closed one-stage, stapled functional end-to-end jejunojejunostomy (FEE) with a stapled side-to-side jejunojejunostomy (STS). STUDY DESIGN: Experimental, randomized block design. ANIMALS: Seven adult horses without gastrointestinal disease. METHODS: The jejunum was isolated, and three FEE, three STS, and three control segments were created in each horse using a randomized block design. Anastomosis time was recorded. The intraluminal pressure at failure and mode of failure were recorded. Length at failure was measured on digitized images. Bursting pressure (BP), bursting wall tension (BWT), anastomosis time, and cost were compared. RESULTS: Control jejunal segments were stronger (P < or = .0001) in bursting strength and bursting wall tension (P < or = .0001) than either anastomosis type; no difference was found between anastomosis types for either variable. Functional end-to-end jejunojejunostomy was significantly quicker and less costly than STS (P < or = .0001). CONCLUSIONS: Mechanically there were no significant differences between the FEE and STS techniques. The FEE technique maintained the physiologic direction of peristalsis of the segments, required less tissue manipulation, and was faster and more economical to create. CLINICAL RELEVANCE: The FEE is a clinically viable technique.     

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 three different techniques for subcutaneous relocation of the carotid artery in small ruminants

Three surgical techniques for subcutaneous relocation of the carotid artery in small ruminants are compared. A total of 25 sheep and seven goats were used and randomly assigned to three groups. In group A (technique A), the carotid artery was moved subcutaneously and kept there by suturing the tissues on both sides of the jugular vein beneath the relocated artery and the skin above it. In the other two groups the relocated artery was secured into a skin strip (technique B) or a skin fold (technique C). The animals were used for repeated blood sampling over a period of several months. Technique A did not provide good immobilization whilst among the three, technique B provided the least protection of the relocated artery and was the most difficult to perform. It was concluded that technique C was superior to the other two methods in providing better conditions for long-term blood sampling.     

Morphometry of the small intestine in pigs with ileo-rectal anastomosis.

Ileo-rectal anastomosis (IRA), which is frequently used to measure prececal digestibility in pigs, could induce some disturbances of the normal absorptive function. Our aim was to investigate the effects of different IRA surgical procedures on the main histologic characteristics of the small intestine in pigs. The 4 different IRA procedures compared to intact pigs (INT) were the following: either end to end (EE) or end to side (ES) with or without preservation of the ileocecal valve (EEV, EE, ESV, ES respectively). At 147 d after surgery, samples of the wall of the duodenum, jejunum and ileum were taken under anesthesia and histometric examinations were performed on HE- and PAS-colored sections to estimate changes mainly of mucosa and muscle layers. The values recorded for villus length, crypt depth, and whole thickness of the mucosa suggested that the EE procedures disturb the small intestine less than the ES models. A new parameter, called epithelial quotient and calculated as [(villus length/crypt depth)/mitotic index], was proposed to improve the comparisons. According to this quotient, EE procedures did not significantly affect the mucosa of the whole small intestine. An increased density of goblet cells was recorded in all operated pigs along the small intestine, but mainly in the ileum after EE-IRA. The lymphatic follicle area was reduced. These findings, which were in agreement with a reduced mitotic index in the ileum of EE-pigs, indicated a decreased effect of noxious factors on the small intestinal mucosa in IRA-pigs, especially after the EE-IRA procedure. Some atrophic or hypertrophic effects on the muscle layers were related to the absence or preservation of the ileo-cecal valve. Finally it was concluded that i) there was no major disturbance after IRA, and ii) the end to end procedure was most beneficial for the structural integrity of the small intestine.     

Survival after small intestine resection and anastomosis in horses

The authors examined factors influencing survival in 140 horses that recovered from anesthesia after small intestinal resection between 1968 and 1986, using Kaplan-Meier estimated survival curves and the Cox proportional hazards regression model. Seventy-two horses (51%) died during the initial postoperative period, 19 horses (14%) died after discharge from the hospital, 33 horses (24%) were alive, and 16 horses (11%) were classified as censored. Mean age at surgery was 8 years. Horses 15 years of age or older, Arabians and Stallions, were overrepresented in the hospital population. The most common reason for resection was strangulation of bowel through a mesenteric rent. The mean and 50% median survival times were 1540 and 27 days, respectively. Horses admitted after January 1, 1980, had a significantly longer survival than those admitted before that time. Survival was longer after anastomosis of two small intestinal segments than after anastomosis of a small intestinal segment to the cecum; however, the length of bowel resected and the method of anastomosis had no demonstrable influence on survival. Of the variables studied, the heart rates at presentation and 24 hours after surgery were the most accurate predictors of survival.     

Vaginal evisceration of the small intestine in three mares

Three mares were treated for vaginal evisceration of a portion of the small intestine. Evisceration occurred in 2 mares shortly after breeding accidents in which the stallion's penis penetrated the vaginal fornix dorsal to the cervix. The affected bowel was replaced through the laceration, and the vaginal defects were sutured with the mares standing, utilizing epidural anesthesia. One mare recovered without complications, was subsequently bred, and delivered a foal with no difficulty. The other mare developed signs of a strangulating small intestinal obstruction 24 hours after the injury, necessitating exploratory celiotomy. Two meters of small intestine had become devitalized secondary to avulsion of the mesentery and adjacent vascular supply during the evisceration. The affected portion was resected and a jejunocecostomy was performed. Recovery was uncomplicated and 21 months later the mare was 9 months in foal. A third mare was treated unsuccessfully for evisceration of several meters of small intestine through the external urethral orifice after rupture of the urinary bladder.     

Comparison of two techniques for quantitation of encysted cyathostome larvae in the horse

Haustral portions of intestine of 6 horses were isolated by excising the taeniae coli from the cecum and the ventral colon. Uniform 5-cm X 5-cm sections were cut from the haustra and were illuminated from the serosal side with a strong light source (mural transillumination). Cyathostome larvae encysted in the mucosa and submucosa were observed at 15 X magnification and counted. Two separate counts of the larvae in 80 replicates of tissue by the mural transillumination technique (MTT) revealed no significant (P less than 0.05) difference between sample means. Larvae in tissue sections were counted in situ by MTT, and the mucosal scrapings of the tissue sections were digested in pepsin and HCl to determine larval yields for comparison with the MTT counts. Numbers of larvae recovered by pepsin and HCl digestion for 3 and 6 hours were significantly (P less than 0.01) lower than were numbers originally determined by MTT. Larvae recovered by tissue digestion for 3 or 6 hours were examined individually and given objective scores for morphologic damage. Distribution of scores was time-dependent; increased damage to larvae was associated with a longer time of digestion. Individual 4th-stage cyathostome larvae were dissected from cysts in the large intestinal wall and were incubated in water, 0.9% saline solution, 1.1% HCl, or pepsin (7,000 U of activity/ml). Significantly fewer (P less than 0.05) larvae were recovered from all solutions after 3 and 6 hours. The proportion of dissected larvae that were given high scores after exposure to pepsin was significantly (P less than 0.01) greater than were those held in HCl, saline solution, or water for both periods.     

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.