Influence of barbed suture oversew of the transverse staple line during functional end‐to‐end stapled anastomosis in a canine jejunal enterectomy model

Abstract

To evaluate the influence of barbed suture oversew of the transverse staple line during functional end-to-end stapled anastomosis (FEESA) in dogs. Study design: Randomized, experimental, ex vivo.Animals or sample population: Grossly normal jejunal segments from 14 adult canine cadavers.Methods: Ninety-eight jejunal segments (n = 14/FEESA group, n = 14 controls) were harvested and randomly assigned to a control group, FEESA + monofilament suture oversew, FEESA + unidirectional barbed suture oversew or FEESA + bidirectional barbed suture oversew. Oversew techniques were performed using a Cushing suture pattern. Initial (ILP) and maximum leakage pressure (MLP), repair time (s), and location of observed leakage were recorded.Results: No differences were detected in ILP (p = .439) or MLP (p = .644) respectively between experimental groups. Repairs times using barbed suture were 18% faster (25 s faster; p < .001) compared to monofilament suture.There was no difference between barbed suture types (p = .697). Mean ILP (p < .001) and MLP (p < .0001) were 6.6x and 5.1x greater respectively in the control group. Leakage location occurred predominately at the crotch of the FEESA in all groups. Conclusion: FEESAs closed with a transverse staple line oversew using barbed suture, regardless of barb orientation, were completed faster and resulted in similar resistance to anastomotic leakage compared to monofilament suture. Clinical significance: Oversewing the transverse staple line following FEESA using barbed suture offers similar resistance to anastomotic leakage, and may

Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies

“…28 Experimental studies demonstrate that oversewing successfully increases leakage pressures following stapled gastrointestinal anastomoses; however, the authors believe that the size of the canine small intestine limits the ability to perform oversewing techniques following a simple enterotomy. 29,30 The fact that oversewing did increase leakage pressures experimentally and this has then been associated with a reduction in the incidence of intestinal dehiscence clinically, supports the general theory that interventions, such as cyanoacrylate, which increases leakage pressures experimentally may result in a reduction in dehiscence and leakage clinically. A similar experimental study did not find a significant difference in leakage pressures when stapled gastrointestinal anastomoses were oversewn with a Cushing pattern; however, the combination did yield the highest leak pressures from the constructs tested.…”

“…Oversewing is another reinforcement technique that has been shown to be effective in reducing the incidence of postoperative dehiscence following gastrointestinal surgery in dogs 28 . Experimental studies demonstrate that oversewing successfully increases leakage pressures following stapled gastrointestinal anastomoses; however, the authors believe that the size of the canine small intestine limits the ability to perform oversewing techniques following a simple enterotomy 29,30 . The fact that oversewing did increase leakage pressures experimentally and this has then been associated with a reduction in the incidence of intestinal dehiscence clinically, supports the general theory that interventions, such as cyanoacrylate, which increases leakage pressures experimentally may result in a reduction in dehiscence and leakage clinically.…”