Ex vivo comparison of the effect of storage temperature on canine intestinal leakage pressures

Duffy, Daniel J.; Chang, Yi‐Jen; Balko, Julie A.; Moore, George E.

doi:10.1111/vsu.13339

Cited by 19 publications

(41 citation statements)

References 18 publications

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“…The external and internal diameter was measured from serosa to serosa and mucosa to mucosa, respectively, by inserting hemostats into the lumen to the level of the box‐lock and spreading the jaws apart, allowing for maximum distension of the intestinal lumen. All jejunal segments were then stored at 4°C in 0.9% NaCl until construct assembly within 24 hours of harvesting; prior studies have provided evidence that cooled jejunal segments have leak pressures comparable to segments tested immediately after harvest 14,15 . All jejunal anastomoses were performed by a single board‐certified veterinary surgeon (P.J.R.).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2020

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Objective: To compare leak pressures and construct completion time of six intestinal anastomoses and report normal canine gastrointestinal thickness. Study design: Experimental study. Animals: Grossly normal jejunal segments (n = 140) from 10 fresh canine cadavers. Methods: Gastrointestinal thickness was recorded. Eight-centimeter cooled canine cadaveric jejunal segments were randomly assigned to a control group (20 segments) and six treatment groups (20 segments/group [10 constructs/ group]): (1) handsewn anastomosis (HSA), (2) functional end-to-end stapled anastomosis (FEESA)-blue thoracoabdominal (TA; FEESA-TAB), (3) FEESAgreen TA (FEESA-TAG), (4) FEESA TA-gastrointestinal anastomosis (GIA), (5) FEESA with suture oversew (FEESA-O), and (6) skin staples (SS). Construct assembly time, initial leak pressure (ILP), maximum intraluminal pressure (MIP), and leakage location were compared. Results: Initial leak pressures (mean ± SD) for control (308.38 ± 115.91 mm Hg), HSA (41.96 ± 15.97), FEESA-TAB (31.71 ± 15.71), FEESA-TAG (27.24 ± 14.11), FEESA-GIA (25.62 ± 11.22), FEESA-O (31.01 ± 17.38), and SS (44.42 ± 28.88) groups were compared. No difference in ILP (P > .24) or MIP (P > .17) was detected between treatment groups. Sutured anastomoses took up to 10 times longer to complete (P = .0025). The stomach, duodenum, jejunum, and ileum mural thicknesses (mean ± SD) were 3.99 ± 0.44 mm, 2.34 ± 0.16, 2.49 ± 0.28, and 2.30 ± 0.31, respectively. Conclusion: The ILP of all anastomoses exceeded maximum intraluminal peristaltic pressures. Stapled anastomoses were faster to complete. Clinical significance: All anastomoses may be considered when performing an intestinal resection and anastomosis, with stapled anastomoses resulting in a shorter surgical time. Canine intestinal thickness may warrant use of a larger staple size. 1 | INTRODUCTION Intestinal resection and anastomosis is a common procedure performed in small animal surgery to remove nonviable or diseased intestines, with a reported incidence of dehiscence between 3% and 28%. 1-6 Currently, anastomoses in small animals are commonly performed with either a traditional handsewn technique or a surgical

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Section: Methodsmentioning

confidence: 99%

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

et al. 2020

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“…All gastric specimens were harvested and tested within 6 hours after euthanasia as previously recommended for ex vivo canine gastrointestinal models. 25 A pilot study was conducted prior to definitive testing to determine the method of gastric collection, partial gastrectomy technique, stapled and/or sutured closure, and intraluminal pressure assessment. All specimens were subjectively indistinguishable regarding gastrointestinal anatomy, overall gastric dimensions, and gastric wall thickness.…”

Section: Specimen Collectionmentioning

confidence: 99%

Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

et al. 2021

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Objective: To determine the influence of stapling on leakage pressures after canine partial gastrectomy. Study design: Ex vivo study. Sample population: Gastric specimens from 24 adult canine cadavers. Methods: Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90-mm thoracoabdominal stapling device and a 4.8-mm staple cartridge; group 2, hand-sewn double-layer inverting suture closure with 3-0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern. Leakage and pressure testing were performed. Initial leakage pressure (ILP), maximal leakage pressure (MLP), and leakage location were recorded. Significance was set at P < .05. Results: Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2-fold and 2.8-fold, respectively, compared with stapled closures alone (P < .001). Constructs closed with double-layer suture closure reached ILP and MLP 4.5-fold and threefold greater, respectively, compared with those with stapled closures alone (P < .001). Maximal leakage pressure did not differ between groups 2 and 3 (P = .14). Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs. Conclusion: Double-layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques. Reinforcing staple closures with an inverting suture line improved resistance to leakage. Clinical significance: Reinforcing single-layer closure of partial gastrectomies with an inverting Cushing pattern is recommended to improve resistance

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“…One study limitation is the use of cadaver material. Therefore this study does not account for the impact that in vivo factors, such as haemorrhage, oedema, development of a brinous seal and perfusion of the anastomosis edges, have on anastomosis technique and post-operative healing (39). Using cadaver material also introduces the risk that tissue autolysis may impact the integrity of jejunal segment(39).…”

Section: Discussionmentioning

confidence: 99%

Effect of Three Different Needle Holders on Gastrointestinal Anastomosis Construction Time and Bursting Pressure in Equine Jejunal Segments

Averay

Galen

Ward

et al. 2021

Preprint

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Background: Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There is a range of different needle holders available, but little is published on their impact on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, and the anastomosis quality (estimated by bursting pressure), and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated.Results: Construction times were not statistically different between groups. Yet, the mean construction time was shortest in Group 2 followed by Group 3, with Group 1 having the longest mean construction time but showing most consistency. Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4. Group 4 and Group 1 were not different. The mean bursting pressure was highest in Group 4, followed by Group 1 and Group 2, with Group 3 having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated.Conclusions: The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. The Frimand needle holder shows promise to be superior for anastomoses in a clinical setting. However, future studies need to confirm these findings.

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Ex vivo comparison of the effect of storage temperature on canine intestinal leakage pressures

Cited by 19 publications

References 18 publications

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

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

Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

Effect of Three Different Needle Holders on Gastrointestinal Anastomosis Construction Time and Bursting Pressure in Equine Jejunal Segments

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