Comparison of three closure methods and two absorbable suture materials for closure of jejunal enterotomy incisions in healthy dogs

The macroscopic and histological appearance of jejunal antimesenteric incisions approximated with two different absorbable suture materials (monofilament versus multifilament) and three closure techniques (appositional single layer, crushing single layer, and double layer) were compared in healthy dogs at 14 or 28 days, postoperatively. No significant differences between the two suture materials were observed for most of the macroscopic or histological variables. However, the monofilament suture material caused significantly more fibrous tissue reaction in the muscular layer of the jejunum than did the multifilament suture material. Of the three enterotomy closure techniques used in this study, the appositional single-layer method proved to be the best. The double-layer closure method caused a significant decrease in the incisional circumference, the relative circumference, and volume of the jejunum, and a significant increase in jejunal wall thickness. Our findings suggest that canine jejunal enterotomy incisions can be closed using an appositional suture pattern with relatively rapidly absorbable monofilament suture material. The use of double-layer suture patterns for closure of jejunal enterotomy incisions should be avoided because the size of the intestinal lumen may be reduced.     

A comparison of 2 different suture patterns for skin closure of canine ovariohysterectomy

The purpose of this study was to compare postoperative wound healing in canine ovariohysterectomy following the use of an absorbable monofilament poliglecaprone 25 suture in 2 different skin closure techniques, the buried continuous subcuticular (BCS) suture pattern and the simple interrupted (SI) suture pattern. These 2 skin closure techniques were evaluated against a nonabsorbable polypropylene monofilament suture in an SI pattern. Wounds were assessed by using a semiquantitative scoring system at 18 to 24 hours and 10 to 14 days, postoperatively. Results indicated that the BCS closure using poliglecaprone 25 demonstrated a higher rate of tissue reactivity initially (18-24 hours postoperatively), as compared with the SI closure using either suture material. By 10 to 14 days postoperatively, poliglecaprone 25 used in a BCS closure was associated with significantly lower wound scores than was the same material used in an SI closure. It was concluded that the BCS closure may effect a better cosmetic appearance to the skin closure in a canine ovariohysterectomy at the time of the recheck appointment. Furthermore, by obviating the need for suture removal, use of the BCS pattern may eliminate the requirement for this return appointment.     

Continuous absorbable suture pattern in the closure of ventral midline abdominal incisions in horses

A retrospective study was performed to evaluate the healing of ventral midline abdominal incisions, closed with a simple continuous suture pattern using absorbable suture material, in 139 horses and foals. Dehiscence and incisional hernia developed separately in two horses. The low incidence of dehiscence and incisional hernia, compared with their reported incidence following the use of interrupted suture repair, leads the authors to recommend this alternative method of abdominal incision closure in horses. The security of closure is not sacrificed and the advantages of a rapid closure are desirable.     

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 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.     

Comparison of single layer staple closure versus double layer hand-sewn closure for equine pelvic flexure enterotomy

Our objective was to compare thoracoabdominal (TA Premium™ 90) stapled enterotomy closure to traditional hand-sewn closure, using time to perform the technique, luminal diameter, and bursting pressure in ex-vivo specimens. The pelvic flexures of 13 client-owned horses were harvested. Each pelvic flexure had 1 enterotomy performed; 6 were closed via staples, 7 closures were hand-sewn. Luminal diameter at the enterotomy site was assessed via contrast radiography performed pre-and post-enterotomy. Bursting pressure of the closure was assessed by continuous manometry during rapid infusion. Time to perform stapled closure was significantly shorter than hand-sewn closure (P < 0.0001). Percent reduction of luminal diameters was significantly decreased in stapled specimens (P = 0.034). There was no significant difference in bursting strength between closure techniques (P = 0.196). In conclusion, stapled enterotomy closure offers statistically significant reduction in closure time and better maintains pre-enterotomy luminal diameter without reducing biomechanical strength, compared to a double layer hand-sewn closure.     

Comparison of absorbable and nonabsorbable sutures for intradermal skin closure in cats

Paired skin incisions were made in 6 cats and closed intradermally with the copolymer of glycolide, ɛ-caprolacton, and trimethylene-carbonate, or polypropylene suture. The macroscopic and histologic appearance of the incisions was compared. Polypropylene suture compared favorably to glycolide, ɛ-caprolacton, and trimethylene-carbonate suture for closure of skin incisions in cats.     

Comparison of gross and histologic tissue responses of skin incisions closed by use of absorbable subcuticular staples, cutaneous metal staples, and polyglactin 910 suture in pigs

OBJECTIVE: To assess gross and histologic tissue responses of skin incisions closed by use of absorbable subcuticular staples, cutaneous metal staples, and polyglactin 910 suture in pigs. ANIMALS: 8 purpose-bred disease-free pigs. PROCEDURE: Pigs were randomly allocated to 1 of 4 groups from which tissues were collected after death on postoperative days (PODs) 7, 14, 21, or 42. In each pig, 4 incisions were made; 1 was closed subcuticularly with 3-0 polyglactin 910 suture, 1 was closed with metal staples, and 2 were closed with absorbable subcuticular staples. Incision sites were grossly evaluated every 3 days after closure. At necropsy, incision sites and surrounding tissues were examined histologically; a histopathologic scoring system was used to quantitate healing and tissue response directed against the closure material. RESULTS: Postoperatively, the metal staples induced a severe inflammatory response, compared with minimal inflammation associated with the suture or absorbable subcuticular staples. Histologic evaluation of incisions on PODs 7, 14, and 21 revealed less severe inflammation associated with absorbable subcuticular staples than that associated with the other materials. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that absorbable subcuticular staples induced a less severe inflammatory response in the early stages of healing in pigs, compared with other commonly used methods of wound closure. Use of absorbable staples potentially combines the benefits of subcuticular closure with the speed and precision of staple placement.     

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.     

Use of skin staples for rapid closure of gastrointestinal incisions in the treatment of canine linear foreign bodies

A technique was developed for closure of gastrotomy and enterotomy incisions using disposable skin staples. The technique was used successfully in three dogs with gastrointestinal linear foreign bodies that required a gastrotomy and one or more enterotomies. The method allows for secure closure of gastrointestinal incisions and minimizes the surgical time in patients requiring multiple gastrointestinal incisions.     

Evaluation of the tensile strengths of four monofilament absorbable suture materials after immersion in canine urine with or without bacteria

OBJECTIVE: To evaluate the tensile strength, elongation, and degradation of 4 monofilament absorbable suture materials that undergo degradation by hydrolysis in specimens of canine urine with various physical characteristics. SAMPLE POPULATION: 4 monofilament absorbable sutures (polydioxanone, poliglecaprone 25, polyglyconate, and glycomer 631). PROCEDURE: Voided urine was collected from 6 healthy dogs, pooled, filter-sterilized, and prepared to provide 5 media: sterile neutral (pH, 7.0), sterile acidic (pH, 6.2), sterile basic (pH, 8.8), Escherichia coli-inoculated, and Proteus mirabilis-inoculated urine. Ten strands of each suture material were immersed in each of the media for 0 to 28 days. Tensile strength and elongation of each suture material were evaluated by use of a texture analyzer on days 0, 1, 3, 7, 10, 14, 21, and 28. RESULTS: Reduction in tensile strength was detected for all materials in all urine specimens over time. Polyglyconate and polydioxanone had superior tensile strengths in sterile neutral and E. coli-inoculated urine, and polydioxanone retained the greatest tensile strength throughout the study period. All suture materials disintegrated before day 7 in P. mirabilis-inoculated urine. CONCLUSIONS AND CLINICAL RELEVANCE: Polydioxanone, polyglyconate, and glycomer 631 may be acceptable for urinary bladder closure in the presence of sterile neutral and E. coli-contaminated urine. Tensile strength of poliglecaprone 25 in urine may be unacceptable by the critical healing time for bladder tissue (14 to 21 days). During bladder surgery, exposure of suture material that degrades via hydrolysis to urine containing Proteus spp should be minimized.     

Mechanical comparison of materials used for extra-capsular stabilisation of the stifle joint in dogs

Objective The mechanical properties of three materials (No. 2 polypropylene, No. 5 polybutilate-coated multifilament polyester and 18, 27 and 36 kg test monofilament nylon leader material) commonly used for extra-capsular stabilisation of the stifle in dogs with cranial cruciate ligament insufficiency were determined. The ability of No. 5 polybutilate-coated multifilament polyester and 36 kg test monofilament nylon leader material, when placed as extra-capsular sutures, to mitigate cranial drawer was evaluated in hindlimbs of cadavers. Design An in vitro mechanical study. Animals Seven pairs of hindlimbs harvested from adult greyhound dogs recently euthanased for other reasons. Procedure Samples of each material, including samples of 27 kg test leader material that had been sterilised by one of three methods (ethylene oxide, one or five cycles in an autoclave), were loaded to determine tensile and stress relaxation properties. The effect of cyclic loading on a No. 5 polybutilate-coated multifilament polyester and 36 kg test leader material was also determined. Using the harvested hindlimbs, cranial drawer was measured before and after transection of the cranial cruciate ligament and on the first and twelfth cycle following extra-capsular stabilisation with either No. 5 polybu-tilate-coated multifilament suture or 36 kg test leader material. Results Leader material was found to have the most suitable mechanical characteristics for use as extracapsular stabilisation of the cranial cruciate ligament deficient stifle. Of the sterilisation methods, ethylene oxide was found to have the least detrimental effects on the handling and material characteristics of the leader material. Stifles stabilised with 36 kg test leader material had significantly less drawer than those stabilised with No. 5 polybutilate-coated multifilament polyester suture. Clinical implications Monofilament nylon leader material would appear to have suitable mechanical properties for extra-capsular stabilisation of the cranial cruciate ligament deficient stifle. If possible the material should be sterilised using ethylene oxide.     

Cystotomy practices and complications among general small animal practitioners in Ontario, Canada

Cystotomy is a common surgical procedure in small animal veterinary medicine, yet common pre-, intra-, and post-operative practices have not been described. This survey evaluated cystotomy practices of 106 veterinarians in Ontario. The majority of respondents reported practices consistent with standard recommendations, but some deficiencies in antimicrobial and analgesic use, as well as intra- and post-operative practices, were identified. Some factors associated with the likelihood that practitioners reported recurrent urolithiasis or urinary tract infection are contrary to typical recommendations, such as the association of the use of absorbable, multifilament suture or a dorsal (versus ventral) incision and a lesser likelihood of reporting post-operative urinary tract infections. While care must be taken interpreting these statistical associations, the results suggest that objective assessment of common cystotomy recommendations (use of monofilament, absorbable suture) is required. Re-assessment of certain peri-operative practices, such as analgesic and antimicrobial administration, and post-operative testing, is required for a minority of practitioners.     

Difference in incisional complications following exploratory celiotomies using antibacterial‐coated suture material for subcutaneous closure: Prospective randomised study in 100 horses

Reasons for performing study: Incisional complications are a major post operative challenge following ventral midline exploratory celiotomy for abdominal pain in horses. They lead to discomfort, prolonged hospitalisation, longer recovery times and increased cost; therefore, investigation of preventative procedures are warranted. Objectives: To determine the clinical effect of antibacterial (triclosan) coated 2‐0 polyglactin 910 suture material on the likelihood of incisional infections when used for closure of subcutaneous tissue following ventral midline celiotomies in horses. Methods: One hundred horses undergoing exploratory celiotomy assigned at random to one of 2 groups. In the control group coated 2‐0 polyglactin 910 (Vicryl) was used for apposition of the subcutaneous tissue in a simple continuous pattern and, in the study group, antibacterial (triclosan) coated 2‐0 polyglactin 910 suture material (Vicryl Plus) was used. Post operatively an elastic adhesive abdominal bandage was applied, changed and the incision was inspected by a clinician blinded to the study protocol at 24–36 h and 6–9 days post operatively. Outcomes of interest were evidence of incisional pain, incisional oedema, sheath/udder oedema, incisional drainage, hernia formation and dehiscence. Results: Antibacterial‐coated suture material did not decrease the likelihood of incisional complications in 100 horses. Conclusions: A beneficial effect on ventral midline incisions in 100 horses was not evident by using antibacterial‐coated suture material. Potential relevance: Lack of effectiveness of antibacterial‐coated suture material in equine ventral midline closure after exploratory celiotomy and the observed potential adverse effects suggest that further clinical investigations are needed before using such material routinely on horses.     

Comparison of polyglactin-910 and polydioxanone for closure of the linea alba following caudal ventral midline laparotomy in sheep

This study compared incisional complications after ventral midline laparotomy using 2 absorbable suture materials for apposition of the linea alba in sheep. The linea alba of 93 yearling sheep was sutured by 3 veterinarians in a simple continuous pattern using either polyglactin 910 (PG910; group PG) or polydioxanone (PDS; group PD). A blinded observer assessed surgical sites at the time of suture removal. Multivariate logistic regression was used to assess the association between incisional complications and variables (suture material used, veterinarian, skin suture removal time). The odds of incisional complications did not vary significantly with the type of suture material used (P = 0.11), veterinarian (P = 0.61) or skin suture removal time (P = 0.36). Most incisional complications were cutaneous suture sinus formation. Either PG910 or PDS may be used for linea alba closure in sheep.     

Radiographic features of suspected suture‐associated cystic calculi in dogs

This retrospective case series describes the radiographic features of suspected suture‐associated cystic calculi in six dogs with a history of at least one or multiple prior cystotomies. One of the dogs presented twice. Suspected suture‐associated cystic calculi were multifocal, short, predominantly linear mineral opacities localized in the center of the urinary bladder on abdominal radiographs. One patient (n = 1) presented with multifocal round, pin point, and linear radiopaque calculi. The calculi were all calcium oxalate in composition. On gross examination, the calculi had a hollow center. Six cystotomies used monofilament absorbable suture material (polydioxanone [n = 4] or poliglecaprone 25 [n = 1]) in prior cystotomies. Suture material in two of the cases was unknown. Suspected suture‐associated cystic calculi are a rare occurrence in veterinary medicine but should be considered in dogs that have a history of prior cystotomy, hollow core on gross analysis, and radiographic evidence of mineral opaque, predominantly linear, cystic calculi.     

Comparison between barbed and conventional sutures for longitudinal thelotomy closure in an ex-vivo bovine model

Objective To determine differences in suture time and bursting strength on a longitudinal thelotomy closure using innovative barbed versus conventional smooth suture materials.Sample population Twenty-four teats from 6 udders of culled beef cows.Study design Experimental ex-vivo surgical study.Methods Thelotomies (length: 2 cm) were performed on every teat and randomly allocated to closure with either a 3-0 bidirectional barbed suture for both mucosa and connective layers or a conventional 3-layer suture, using 3-0 smooth polydioxanone. For both groups, skin was closed with 2-0 polypropylene monofilament suture. Duration of suturing time for inner layers and bursting strength of the repair were recorded and compared.Results Suturing was faster with barbed versus conventional sutures (527.7 ± 64.5 versus 727.1 ± 60.7 s, respectively; P < 0.0001). However, bursting strength was not significantly different between the 2 types of sutures.Conclusion Using the barbed suture significantly reduced the time required to suture the mucosa and conjunctiva layers, with no significant difference between sutures in their bursting strength.Clinical significance Bidirectional barbed suture material is suitable for closure of thelotomies in cattle.     

Intracorporeal suture closure of the internal inguinal and vaginal rings in foals and horses

Objective— To report a technique for repair or prevention of inguinal hernia in horses using intracorporeal suture closure of the internal inguinal and vaginal rings.
Study Design— Case series.
Animals— Foals (n=6) and geldings (n=2).
Methods— After selection of a peri-umbilical telescope portal, instrument portals were made unilaterally or bilaterally, as needed. Herniated viscera was reduced, castration (foals) or spermatic cord remnant transection at the internal inguinal ring (adults) performed, and then simple interrupted intracorporeal sutures of synthetic absorbable suture material were used to close the internal inguinal and vaginal rings.
Results— There was no recurrence of inguinal hernia. Postoperative morbidity was minimal and cosmetic outcome was comparable to that achieved with conventional, open techniques.
Conclusion— Laparoscopic, primary closure of the internal inguinal ring by use of intracorporeal sutures provides a secure barrier to herniation and costs considerably less than using endoscopic staples.
Clinical Relevance— Laparoscopic suture closure of the internal inguinal and vaginal rings provides safe and effective repair of inguinal hernia in horses.     

Closure of Abdominal Incisions Using A Continuous Polypropylene Suture: Clinical Experience in 550 Dogs and Cats

Closure of midline abdominal wall incisions in 469 dogs and 81 cats following various intraabdominal procedures was accomplished by using a single layer, simple continuous pattern with monofilament polypropylene. Skin was closed using simple interrupted nonabsorbable sutures. Weight of the patients ranged from 1 kg to 80 kg. Length of the incision ranged from 3 cm to 55 cm. There was one dehiscence (0.18%) and no incisional hernias. Results indicate the technique is a dependable, time saving method of abdominal closure.     

Intestinal surgery in small animals: historical foundations,current thinking,and future horizons

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra‐abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.