Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008‐2018)

Abstract

Objective To determine the influence of oversewing a transverse staple line in functional end‐to‐end stapled intestinal anastomoses (FEESA) in dogs. Study design Retrospective observational study. Sample population Seventy‐seven client‐owned dogs that underwent 78 FEESA reinforced (n = 30) or not reinforced (n = 48) with suture at the transverse staple line. Methods The medical records database was searched and reviewed for dogs that had undergone a FEESA between January 2008 and September 2018. Data were collected regarding signalment, body weight, clinical presentation, indication for surgery, serum albumin, presence of septic peritonitis, previous surgeries, surgical techniques (ie, oversew, crotch suture, omental wrap, omental patch, serosal patch), histopathology results, and postoperative outcome. Results The only differences identified between groups consisted of higher preoperative albumin (2.89 ± 0.56 vs 2.34 ± 0.62 g/dL; P = .006) and lower postoperative dehiscence rate (0/30 vs 7/48; P = .028) in dogs with an oversewn FEESA. Oversewing the FEESA was identified as the significant factor in a model with oversewing and preoperative albumin fit to the outcome of dehiscence (oversew P = .010, albumin P = .761). The location of the dehiscence was specified in four of seven dogs, all along the transverse staple line. Patterns used for oversew were unspecified (n = 11), simple continuous (8), Cushing (4), simple interrupted (2), cruciate (1), interrupted horizontal mattress (1), and Lembert (1). Conclusion Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence. Clinical significance Our results provide evidence to support additional investigation of suture reinforcement (oversewing) at the transverse staple line of FEESA to reduce postoperative dehiscence.

Initial leak pressures of four anastomosis techniques in cooled cadaveric canine jejunum

“…There was no difference in oversewing the TA line for both the SFEEA and SFEEA‐O groups. In a report describing a recent retrospective study, Sumner et al suggest that an oversew of the TA line was associated with decrease dehiscence rate. These findings may provide evidence to highlight the importance of biologic factors compared with mechanical factors when considering anastomosis techniques.…”

Gastrointestinal thickness, duration, and leak pressure of six intestinal anastomoses in dogs

“…A FEESA is the most commonly used stapled intestinal anastomosis in dogs and is traditionally constructed with a GIA and TA stapler for the vertical and transverse staple lines, respectively 7,10 . Modifications to this technique, including use of a GIA stapler for the transverse staple line (which obviates the requirement to use more than one stapler type) or oversewing of the TA staple line with suture (which facilitates inversion of the everted TA staple line) have been described 23,24 . The staples used by the GIA and TA staplers are color coded according to staple size and have precise indications for use in human surgery.…”

Vertical sleeve gastrectomy lowers kidney SGLT2 expression in the mouse

“…Approximately 60% of the stomach was removed, leaving a tubular remnant. The edges of the stomach were inverted and closed by placing two serosa only sutures, using Lembert pattern 34 . The initial full thickness suture was subsequently removed.…”