Sutured End-to-End and Stapled Side-to-Side Jejunal Anastomoses in the Horse

Hand sutured end-to-end (EE) and stapled side-to-side (SS) small intestinal anastomoses were performed in 10 healthy adult horses. In five SS anastomoses, staple lines on the blind ends of the jejunum were inverted (SSI) and in five they were not (SSNI). Five EE anastomoses were sutured with polydioxanone and five were sutured with polyglyconate. All horses were euthanatized on day 30. Intra-abdominal adhesions were graded (0-4), and stomal areas were calculated from contrast radiographs made with the bowel distended. Histopathology scores for the anastomoses were based on the degree of inflammation (0-3), fibrosis (0-3), and alignment and healing of intestinal layers (0-3). Mean surgery times +/- standard deviations for EE, SSI, and SSNI techniques were 33.9 +/- 5.4, 36.2 +/- 5.6, and 29.6 +/- 5.9 minutes, respectively. Mean and median stomal areas were 9.4 +/- 5.5 and 8.9 cm2 for EE anastomoses and 17.2 +/- 16.5 and 12.1 cm2 for SS anastomoses. Intra-abdominal adhesions developed in three horses, one of which had clinical signs of colic. Mean histopathology scores for EE and SS anastomoses were 4.8 +/- 2.0 (median = 5) and 4.4 +/- 1.8 (median = 4), respectively. There were no statistically significant differences in surgery times, intra-abdominal adhesion scores, stomal areas, or histopathology scores between small intestinal EE and SS anastomoses in these horses.     

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.     

Extraluminal,C Shaped Polyethylene Prostheses in Two Ponies with Tracheal Collapse

Objective: To describe the surgical technique, complications, and outcome after use of extraluminal prostheses in 2 ponies with severe tracheal collapse. Study Design: Clinical report. Animals: Ponies (n=2) with severe tracheal collapse. Methods: A ventral median approach was used to expose the trachea from the larynx to the manubrium. Extraluminal, high‐density polyethylene, C‐shaped prostheses were sutured to the dorsal tracheal membrane and tracheal rings to provide external tracheal support. Results: The surgical approach provided good tracheal access and placement of the rings was uncomplicated. Initial estimates of the tracheal diameter from preoperative radiographs resulted in prostheses that were too small at surgery requiring a 2nd surgical procedure in 1 pony. Postoperative complications were coughing, right laryngeal hemiplegia, seroma formation, and antimicrobial induced colitis. Both ponies had marked resolution of clinical abnormalities after surgery. Recurrent esophageal obstruction resulted in euthanasia of 1 pony 3.5 years after surgery. The other pony was doing well 1 year after surgery. Conclusions: Extraluminal support of the trachea resulted in rapid resolution of clinical signs in 2 ponies with tracheal collapse. Clinical Relevance: Extraluminal tracheal prostheses can resolve clinical abnormalities in ponies with severe tracheal collapse.     

Tracheal Anastomosis in the Dog Comparison of Two End-to-End Techniques

Two techniques for tracheal resection and anastomosis were performed and compared in 20 normal dogs. In one technique, cartilage rings were split circumferentially, and the split rings were apposed with simple interrupted sutures that penetrated the annular ligament. In the other technique, the annular ligaments were incised and apposed with simple interrupted sutures placed through the annular ligament and around the adjacent ring. Endoscopy and xeroradiography were used to evaluate the anastomotic sites at 1, 2, 4, and 8 weeks postoperatively. Infection, mucus accumulation, coughing, stridor, or anastomotic separations were not seen. Stenosis of the anastomotic site was observed in 80% of the dogs, due to the intraluminal protrusion of epithelialized fibrous connective tissue. The split cartilage technique was easy to perform and resulted in less dorsoventral stenosis than the annular ligament technique.     

Closed One-Stage Functional End-to-End Jejunojejunostomy in Horses With Use of Linear Stapling Equipment

Objective—To use gastrointestinal linear stapling instrumentation to perform a closed one-stage functional end-to-end jejunojejunostomy in adult horses as an alternative to a stapled side-to-side jejunojejunostomy.
Study Design—Clinical outcome, anatomic and histological architecture, and anastomotic dimensions were determined at 2, 4, 8, 16, and 24 weeks postoperatively. Animals or Sample Population—18 adult horses.
Methods—The anastomosis and peritoneal cavity were inspected for adhesions. The diameter and circumference of the anastomosis and jejunum oral and aboral to the anastomosis were determined from digitized contrast radiographs and linear measurements. Healing of anastomotic sites was evaluated histologically.
Results—Three horses were euthantized in the immediate postoperative period. In the 15 surviving horses, there were no peritoneal adhesions or distortion of the anastomoses and stomas remodeled in an end-to-end fashion. The mean anastomotic staple line (7.48 cm) and mucosa (6.89 cm) diameters were significantly ( P < .05) larger than the mean jejunal diameter oral (6.03 cm) and aboral (6.01 cm) to the anastomosis. The mean anastomotic luminal circumference (13.61 cm) was significantly ( P < .01) larger than the mean oral (11.43 cm) and aboral (11.12 cm) jejunal circumference. Histologically, there was adequate mucosal and muscularis mucosae reapposition with a moderate degree of fibrosis and inflammation.
Conclusions —Closed one-stage functional end-to-end jejunojejunostomy resulted in an acceptable functional anastomosis.
Clinical Relevance —This technique appears to be an acceptable alternative to linearly stapled, side-to-side jejunojejunostomies performed in horses.     

Intussusception in dogs and cats: A review of 36 cases

Intussusception is recognized as a common cause of bowel obstruction in small animals. This study documents the clinical and surgical findings in nine cats and 27 dogs diagnosed as having intussusception. The main purposes of the study were to define the predisposing causes and clinical signs of intussusception and to evaluate various surgical techniques commonly employed in its treatment. No common predisposing cause could be established. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass. The majority of the intussusceptions involved the enterocolic junction. Formation of adhesions was more frequent in cats. Surgical treatments included simple reduction, manual reduction with plication, intestinal resection/anastomosis, and intestinal resection/anastamosis with plication. There was no statistically significant difference (p>0.05) in the recurrence rate of the intussusceptions when the various surgical techniques were compared. Recurrence of an intussusception was not related to either the bowel segment involved or whether a simple reduction, bowel resection, or intestinal plication was performed at the initial surgery.     

A Preliminary Comparison of Lidocaine and Xylazine as Epidural Analgesics in Ponies

Xylazine (0.35 mg/kg) or lidocaine (0.35 mg/kg) was injected into the epidural space of six ponies to compare their effectiveness as epidural analgesics. Each pony received both treatments at 1 week intervals with the order of treatments randomized. Xylazine produced analgesia of significantly longer duration (247 +/- 58 minutes) than that produced by an equal dose of lidocaine (135 +/- 22 minutes). Mild transient ataxia of no clinical significance developed in all ponies with both treatments. Spinal cords were removed from two ponies and examined histologically. No discernible pathologic changes were noted.     

End-to-End Colonic Anastomosis A Comparison of Techniques in Normal Dogs

Colonic resections were repaired in normal dogs by crushing suture, inverting suture, or staple anastomosis techniques. Dogs were sacrificed 2, 4, 7, 10, 14, 21, and 28 days following surgery. Bacterial cultures, breaking strength measurement, adhesion formation, and gross and histopathologic examinations were made. Anastomoses closed by staples showed the least tissue reaction, least neutrophilic infiltration, most mature fibrous connective tissue, most normal arrangement of muscle layers, and fewest numbers of mucoceles and necrotic areas. The staple and crushing anastomosis techniques caused significantly less reduction in luminal radius than did the inverting anastomosis technique. Bacteria were isolated least frequently and adhesions were least severe following staple anastomosis, though these results were not statistically significant. Stapled anastomosis appeared to result in a higher tensile strength of the wounds at the anastomotic sites compared with the other techniques studied.     

Prevention of Intraabdominal Adhesions in Ponies by Low-dose Heparin Therapy

An ischemic bowel model was used to stimulate adhesion formation in eight ponies. Heparin (40 USP u/kg) or saline was administered intravenously at surgery and was continued subcutaneously every 12 hours for 48 hours to evaluate the efficacy of heparin in preventing intraabdominal adhesions. Ponies were euthanatized after 6 weeks, and postmortem examinations were performed. A statistically significant difference was found between the heparin-treated and the control groups. Adhesions developed in three of four control ponies, and adhesions did not develop in three of four heparin-treated ponies. None of the adhesions resulted in clinical disease. In this study, heparin decreased the formation of adhesions in ponies after experimentally induced intestinal ischemia.     

Measurement of the Lateral Thoracic Reflex Latency in Ponies

Lateral thoracic nerve reflex latencies values were measured in ponies using a simple, non-invasive technique. The reflex was elicited using an external triggering hammer attached to an electrodiagnostic unit. The resulting evoked, compound muscle action potentials were recorded with electrodes, which were placed over the 6th ribs or 11th rib level with the axilla. Two superimposed repeats of 4 signal-averaged sweeps of 50 or 100 milliseconds were recorded and the estimated reflex pathway was measured for each subject in order to calculate the reflex latencies and latency velocities. Mean left and right 6th rib peak latencies were not significantly different from each other ( P = .609), but left 6th rib latencies were shorter than those recorded from the 11th rib ( P < .0001), substantiating the existence of an indirect (central) pathway to the reflex. The calculated left and right 6th rib latency velocities were not significantly different from each other ( P = .58) but left 6th rib latency velocities were different from left 11th rib ( P = .009). The calculated latency velocities were within the broad range for corticospinal tract motor conduction velocities and comparable to magnetic motor evoked latency velocities. The use of lateral thoracic reflex latency measurements to objectively identify the site of spinal cord lesions is discussed.     

Failure of Calcium Channel Blockade to Prevent Intra-abdominal Adhesions in Ponies

Intra-abdominal adhesions were created by localized serosal trauma in 11 adult ponies at three locations on the small intestine. Six ponies received verapamil hydrochloride (0.2 mg/ kg) subcutaneously every eight hours for three days, and five ponies received an equal volume of saline solution at the same intervals. The investigators were not informed which treatments the ponies received. Systolic, diastolic, and mean carotid arterial pressures and heart rates were measured six hours before surgery, and then 0.5, 1, 1.5, and 8 hours after the first treatment on each day for three days. One pony was euthanatized on day 13 because of colic, and the other 10 ponies were euthanatized 14 days after surgery. Scoring methods were used to assess the severity of adhesion formation and to grade the histologic appearance of the abraded sites. No significant differences were found for rectal temperature, packed cell volume, total plasma proteins, heart rate, and systolic, diastolic, or mean arterial pressures between control and verapamil-treated ponies. No significant differences were detected between the treatment groups for adhesion scores per abraded site, total adhesion scores per pony, the total number of adhesions per pony, or in the histologic scores.