Comparison of a simple continuous versus simple interrupted suture pattern for the repair of a large, open duodenal defect with a jejunal serosal patch in a canine cadaveric model

Abstract

OBJECTIVE To determine whether jejunal serosal patches could securely seal large, open defects in duodenal segments harvested from canine cadavers and to compare intraluminal pressures at which leakage first occurred and maximal intraluminal pressures for repaired duodenal segments between 2 suture patterns. SAMPLE Duodenal and jejunal segments from 9 canine cadavers. PROCEDURES 20 constructs were created through repair of large, open duodenal defects with circumferential suturing of an intact jejunal segment (jejunal serosal patch). Constructs were randomly assigned to have the serosal patch anastomosed to the duodenal segment by a simple continuous or simple interrupted suture pattern. The pressure at which the first leakage was observed and the maximum pressure obtained during testing were recorded and compared between suture patterns. RESULTS Initial leakage pressure was significantly higher with the simple interrupted pattern (mean ± SD, 68.89 ± 5.62 mm Hg), compared with the simple continuous pattern (59.8 ± 20.03 mm Hg). Maximum intraluminal pressures did not significantly differ between the simple interrupted (91 ± 8.27 mm Hg) and simple continuous patterns (90.7 ± 16.91 mm Hg). All constructs, regardless of suture pattern, withstood supraphysiologic pressures. CONCLUSIONS AND CLINICAL RELEVANCE Jejunal serosal patches adequately sealed large, open duodenal defects and prevented leakage in these constructs. Constructs with simple continuous or simple interrupted suture patterns withstood physiologic and supraphysiologic intraluminal pressures, although constructs with a simple interrupted suture pattern initially leaked at higher pressures. (Am J Vet Res 2020;81:985–991)

Cooled feline intestine and fresh intestine did not differ in enterotomy leak pressure testing or in gross wall thickness measurement

“…The current study reported substantially higher ILPs in fresh and cooled feline intestine in comparison with previous reports of canine intestines 1,6 . This could be due to a slower rate of infusion used in this study (100 mL/h) in comparison with other studies reporting 999 mL/h 1,5,6,12,19 and 900 mL/h, 7,8 thereby allowing the intestine to distend at a lower rate before leakage, but time to leakage was not recorded. During the prestudy pilot testing, 999 mL/h was initially used but leakage occurred and obscured the enterotomy site quickly so that it was challenging to determine the location of leakage reliably.…”

“…Canine cadaveric studies involving the gastrointestinal tract have increased during the past 3 years (2020-2022) [1][2][3][4][5][6][7][8][9] after a novel study 7 was performed by Aeschlimann et al in 2018. This study compared leak testing in frozenthawed, cooled, and fresh porcine jejunal tissue due to its similarity to canine jejunal tissue in order to evaluate the type of tissue that may be more reliable in assessing enterotomy leak pressures. 7 As far as the authors of the current study are aware, it has not yet been established whether fresh or cooled feline cadaveric intestine is sufficient as an ex vivo model for feline intestinal surgery and species differences might exist.…”

“…Canine cadaveric studies involving the gastrointestinal tract have increased during the past 3 years (2020–2022) 1–9 after a novel study 7 was performed by Aeschlimann et al in 2018. This study compared leak testing in frozen–thawed, cooled, and fresh porcine jejunal tissue due to its similarity to canine jejunal tissue in order to evaluate the type of tissue that may be more reliable in assessing enterotomy leak pressures 7 .…”