Biomechanical evaluation of three adjunctive methods of orthopedic tension band-wire fixation to augment simulated patella tendon repairs in dogs.

OBJECTIVE: To evaluate the effects of three adjunctive methods of tension band wire fixation (TBWF) on the biomechanical properties, gap formation, and failure mode in simulated canine patella tendon rupture (RPT). STUDY DESIGN: Randomized, ex vivo. SAMPLE POPULATION: Paired hindlimbs from 32 dog cadavers. METHODS: Patellar tendons (PTs) and associated bone-muscle-tendon units were harvested. Each PT was transected then sutured using a core locking loop and simple continuous epitendinous pattern. Each hindlimb was randomly assigned to one of three groups (n = 18 hindlimbs/group) using 18 gauge 316 L wire, anchored to the tibial crest distally, to perform transpatellar, suprapatellar, or combined tension band-wire (TBW) augmentation. Ten hindlimbs were utilized as control specimens. Yield, peak, and failure loads, stiffness, loads to 1 and 3 mm gap formation, and failure mode were evaluated. RESULTS: Combined transpatellar and suprapatellar TBW augmentation was superior to transpatellar or suprapatellar groups alone. Yield (p = .0008), peak (p = .004), and failure loads (p = .005) were greater for the combined group than for the transpatellar (p = .048) and suprapatellar groups (p = .01) respectively. There was no difference regarding the occurrence of 1 or 3 mm gap formation (1 mm, p = .05; 3 mm, p = .06); however, loads required to cause gap formation were greater in the combined group (p = .036). Mode of failure differed between techniques used for PT augmentation (p < .001). CONCLUSION: Combined transpatellar and suprapatellar adjunctive TBW augmentation for simulated PT repairs was biomechanically superior to either transpatellar or suprapatellar TBWF alone. CLINICAL SIGNIFICANCE: Combined suprapatellar and transpatellar TBWF may offer a viable surgical option for increased repair-site strength and greater loads to gap formation. Further studies investigating alternative techniques and materials for RPT repair augmentation are warranted.

Point-of-care viscoelastic coagulation assessment in healthy dogs during the perianesthetic period.

BACKGROUND: The viscoelastic coagulation monitor (VCM Vet) is a novel, portable device that provides a global assessment of hemostasis. The study aims were to evaluate serial viscoelastic analysis during the perianesthetic period in healthy dogs and to compare the agreement between two VCM Vet devices. Twenty healthy dogs undergoing orthopedic surgery were enrolled. Whole blood samples were collected from an intravenous catheter at four time points: baseline, 15 min after premedication, 60 min after inhalant initiation, and 60 min after inhalant termination. Viscoelastic tests were performed in duplicate on different devices, providing: clot time (CT; seconds), clot formation time (CFT; seconds), alpha angle (α; degrees), amplitude (units) at 10 (A10) and 20 (A20) minutes post clot time, maximum clot firmness (MCF; units), and lysis index (%) at 30 (Li30) and 45 (Li45) minutes post maximum clot formation. RESULTS: One hundred sixty samples were analyzed. The speed of CT and CFT significantly decreased an average of 25.5 s (95% confidence interval [CI]15.9-35.0) and 6.9 s (95% CI 3.1-10.7) per time point, respectively. There were no significant changes in clot strength or lysis variables. The Bland-Altman style plot shows an acceptable rate of agreement for all variables with intra-class correlation ranging from 0.64-0.94. CONCLUSION: The rate of clot formation (CT and CFT) decreased over the perianesthetic period in healthy dogs undergoing surgery. These changes were small and occurred without changes in clot strength or fibrinolysis rate, thus were not clinically relevant. There was clinically acceptable consistency between devices.

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

OBJECTIVE: 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 be associated with decreased surgical times in dogs compared to monofilament suture. Further studies are necessary to determine the benefits of barbed suture use in both open and laparoscopic gastrointestinal surgical applications following FEESA in dogs.

Effect of calcanean bone-tunnel orientation for teno-osseous repair in a canine common calcanean tendon avulsion model.

OBJECTIVE: To determine the influence of bone-tunnel anchoring technique on teno-osseous repair of the common calcanean tendon (CCT) in dogs. STUDY DESIGN: Randomized, ex vivo, biomechanical. POPULATION: Forty-two skeletally mature canine hindlimbs. METHODS: Canine hindlimbs were dissected to produce a model simulating avulsion of the CCT and accessory tendons from the calcaneus. Hindlimbs were randomized to 1 of 3 anchoring techniques (n = 14/group): a single transverse tunnel (TT), vertical tunnels (VT), or modified bone tunnels (MT) for teno-osseous repair in a 3-loop-pulley (3LP) pattern using 0 USP polypropylene. Yield, peak and failure loads, construct stiffness, loads to produce a 3 mm teno-osseous gap, and failure modes were compared between groups. RESULTS: The only difference detected consisted of TT constructs yielding at loads 25% higher than MT constructs (P = .027). CONCLUSION: Although yield loads were lower in MT constructs than other groups, the bone-tunnel anchoring techniques tested here did not appear to influence the biomechanical properties or gapping characteristics of teno-osseous repairs in this canine CCT avulsion model. CLINICAL SIGNIFICANCE: All drilling techniques and bone-tunnel orientations tested in the study reported here offer viable options to reattach the CCT to the calcaneus. Surgeons should evaluate how bone-tunnel orientation may affect placement of adjunctive fixation methods to stabilize the talocrural joint after primary CCT repair in dogs.

Influence of crotch suture augmentation on leakage pressure and leakage location during functional end-to-end stapled anastomoses in dogs.

OBJECTIVE: To determine the influence of anastomotic crotch suture augmentation on leakage pressures and leakage location following intestinal functional end-to-end stapled anastomosis (FEESA) in dogs. STUDY DESIGN: Ex vivo, randomized, experimental. SAMPLE POPULATION: Chilled jejunal segments from 3 adult dogs. METHODS: Jejunal specimens were tested within 24 hours of collection. A FEESA was performed and randomly assigned to 1 of 4 treatment groups (n = 12/group): (1) no crotch suture (NCS); (2) simple interrupted crotch suture (SICS); (3) two simple interrupted crotch sutures (TCS) placed laterally on opposing jejunal limbs; (4) simple continuous crotch suture (SCCS) augmentation. Crotch sutures were performed using 3-0 USP polydioxanone. Initial (ILP) and maximal (MLP) leakage pressures (Mean ± SD mm Hg) and leakage location were recorded and compared between groups. RESULTS: Initial leakage pressure was greater after placement of TCS (37.8 ± 6.4, P < .039) and SCCS (47.6 ± 11.0, P < .002) than NCS (27.1 ± 2.5) and SICS (33.0 ± 6.0). Maximal leakage pressure was greater in specimens including SICS, TCS, and SCCS than those without crotch suture augmentation (P < .043). Leakage occurred at the anastomotic crotch in 8/12 NCS, 6/12 SICS, 11/12 TCS, and 12/12 SCCS constructs (P < .001). CONCLUSION: Augmentation of FEESA with TCS and SCCS increased ILP and decreased the occurrence of leakage from the anastomotic crotch, while all methods of anastomotic crotch augmentation increased MLP. CLINICAL SIGNIFICANCE: Augmenting the FEESA with crotch suture(s) improved the resistance of the jejunal anastomosis to leakage in normal cadaveric segments. Placing 2 crotch sutures or use of a simple continuous pattern for anastomotic augmentation appeared to be superior to the placement of a single suture.

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

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 to leakage. In vivo investigation is warranted to evaluate influence of closure technique on gastric healing, postoperative stasis, ischemic injury, and postoperative dehiscence.

Influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure.

OBJECTIVE: To evaluate the influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure. STUDY DESIGN: Randomized, experimental, cadaveric. ANIMALS OR SAMPLE POPULATION: Grossly normal jejunal segments from three canine cadavers. METHODS: Jejunal segments were harvested and randomly assigned based upon effector loop location from the beginning of the incisional line. Groups (n = 12/group) included 0 mm, 5 mm, 10 mm, 15 mm, and intact controls (n = 6/group), repaired using a 3-0 unidirectional barbed suture in a simple continuous pattern. Initial leakage pressure (ILP), maximum intraluminal pressure (MIP), repair time, and leakage location were recorded. RESULTS: Mean ILP for 0 mm group (24.42 ± 8.43 mmHg) was lower (p ≤ .001) compared to all experimental groups with ILP ~40% lower. There was no difference in MIP among experimental groups (p = .239). Repair time increased (p < .0001) as the distance of the effector loop increased ≥5 mm from the beginning of the incisional line. Leakage location differed among groups (p < .001) with leakage in the 0 mm group from the incisional line (75%), compared to leakage from predominantly from the suture holes in other groups, respectively. CONCLUSION: Effector loop location influenced ILP and leakage location. Effector loops placed at the beginning of the incisional line (0 mm) decreased ILP compared to loops placed at 5, 10, and 15 mm. CLINICAL SIGNIFICANCE: Effector loop location using a unidirectional barbed suture should be placed ≥5 mm from beginning of the incisional line for enterotomy closure. Further in vivo studies are necessary to determine the clinical significance of these findings.

Biomechanical evaluation of a novel barbed suture pattern with epitendinous suture augmentation in a canine flexor tendon model.

OBJECTIVE: To determine the effect of a novel barbed suture pattern (NBSP) compared to a three-loop-pulley (3LP) with and without epitendinous suture (ES) augmentation on the biomechanical strength and gap formation of repaired canine tendons. STUDY DESIGN: Ex vivo, cadaveric, randomized, experimental study. SAMPLE POPULATION: Forty, adult superficial digital flexor tendons (SDFT). METHODS: SDFT were randomly assigned to one of four groups (n = 10/group). Sharp tenotomy was performed and repaired with 3LP, NBSP, 3LP + ES, and NBSP + ES. Constructs were tested to failure while evaluating yield, peak, and failure loads, loads at 1 and 3 mm gap formation, and failure mode. RESULTS: Constructs augmented with ES sustained 80% greater yield (p < .001), peak (p < .001), and failure (p < .001) loads, with no difference between 3LP + ES and NBSP + ES constructs regarding peak (p = .614), and failure forces (p = .865). Loads resulting in 1 and 3 mm gap formation were greater when constructs were augmented with an ES (p ≤ .003). Failure mode differed between groups (p < .001), occurring predominantly due to suture pull-through in 3LP and NBSP groups compared to tissue failure distant to the repair site in ES augmented constructs. CONCLUSION: Tendons repaired with the NBSP used in this study resisted similar forces as those repaired with 3LP. Augmentation with an ES improved the biomechanical properties of repaired constructs, including resistance to gap formation. CLINICAL RELEVANCE: The NBSP repair tested here may be advantageous over monofilament suture repair as it uses a similar-sized barbed core suture but eliminates the requirement for knot tying.

Biomechanical analysis of accessory tendon graft augmentation for primary gastrocnemius tendon reconstruction in dogs.

OBJECTIVE: To evaluate the effect of accessory tendon graft (ATG) augmentation as an adjunct to a core locking-loop (LL) and epitendinous suture (ES) repair in a gastrocnemius tendon (GT) model. STUDY DESIGN: Randomized, ex vivo, biomechanical. POPULATION: Twenty-two canine GT musculotendinous constructs. METHODS: GT repair constructs were randomly divided into two groups (n = 10/group). After transection, paired GT were repaired with LL + ES alone or with concurrent ATG augmentation. Yield, peak and failure loads, tensile loads required to create 1 and 3 mm gapping, and failure modes were evaluated. Four GT were used as intact controls for validation of testing methodology. ATG constructs were compared to LL + ES and control specimens. RESULTS: Yield (p < .0001), peak (p = .0001) and failure loads (p = .0003) were greater when ATG was used for repair. Greater force was required to cause 1 mm (p = .0001) and 3 mm (p = .0002) gap formation in the ATG group, however, the frequency of gap formation did not differ between groups. All repaired constructs failed exclusively by suture pull-through. CONCLUSION: Autologous ATG augmentation as an adjunct to primary GT repair increased yield, peak and failure forces by approximately 1.6×, 1.9×, 1.8× respectively and required 2.1× greater force to cause 1 and 3 mm formation respectively compared to LL + ES repairs alone. CLINICAL SIGNIFICANCE: ATG augmentation should be considered as an autologous method to support and strengthen the primary GT repair. These results justify studies to determine the effect of ATG on clinical function following graft harvest in dogs.

Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele.

OBJECTIVE: To determine the influence of normograde (NG) versus retrograde (RG) catheterization of the cystic duct and common bile duct (CBD) in dogs with gallbladder mucoceles (GBM) treated with open cholecystectomy. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n = 117) with GBM. METHODS: Medical records were reviewed for signalment, history, clinical laboratory and diagnostic imaging findings, details of surgery including catheterization method, complications, and outcome. Long-term follow-up data were obtained by telephone or electronic communication. Relationships between catheterization method and clinical variables and outcome were evaluated. RESULTS: Dogs catheterized RG were more likely to experience any postoperative complication (p = .0004) including persistence of gastrointestinal signs (p = .0003). Survival to discharge and long-term survival did not differ by group (p = .23 and p = .49). Total bilirubin (TB) decreased by 70.3% after NG catheterization compared to 39.1% after RG catheterization (p = .03) and increased in 14.9% dogs catheterized NG and 38.0% dogs catheterized RG (p = .004). The presence of a diplomate surgeon at surgery resulted in decreased incidences of any perioperative or postoperative complication (p = .003 and p = .05). CONCLUSION: Retrograde catheterization was associated with more postoperative concerns than NG catheterization, but similar survival times. Surgery should be performed by diplomates experienced in biliary surgery to minimize complications. CLINICAL SIGNIFICANCE: Although both NG and RG techniques to catheterize the cystic duct and CBD are options for treatment of GBM with low mortality, results of this study provide some evidence to recommend NG over RG catheterization.

Ex vivo evaluation of novel core tenorrhaphy patterns in dogs.

OBJECTIVE: To compare the biomechanical properties and gapping characteristics of four novel tenorrhaphy patterns in a canine flexor tendon model. STUDY DESIGN: Ex vivo, randomized, biomechanical study. SAMPLE POPULATION: Superficial digital flexor tendons of 60 forelimbs (30 dogs). METHODS: Each tendon was transected 25 mm distal to its musculotendinous junction prior to tenorrhaphy with 2-0 polypropylene. Repair patterns included the three-loop pulley (3LP, control), exposed double-cross-lock (ExDCrL), embedded double-cross-lock (EmDCrL), triple-circle-lock (TCiL), and Modified-Tang patterns (MTang) were randomly assigned to each experimental group (n = 12/group). Yield, peak, and failure loads, gap formation and failure modes were compared. RESULTS: Tendons repaired with ExDCrL (p < .0001), EmDCrL (p < .0001), and MTang (p < .0001) sustained yield, peak, and failure loads ~2.2x, ~2.0x, and ~1.9x, respectively, greater than those repaired with 3LP. Loads to 1 and 3 mm gapping were also higher for ExDCrL (p < .0001), EmDCrL (p < .0004), and MTang constructs (p < .0017) compared to 3LP. Although TCiL constructs sustained higher loads, their resistance to gap formation did not differ from that of 3LP repairs. Failure mode differed between groups (p < .0001), EmDCrL, ExDCrL, MTang, and TCiL constructs failing predominantly by suture breakage compared to 3LP repairs that failed by suture pull-through. CONCLUSION: Use of novel patterns ExDCrL, EmDCrL, and MTang improved resistance to loads and gap formation and were biomechanically superior compared to 3LP in healthy canine tendon repairs. CLINICAL SIGNIFICANCE: These results justify in vivo evaluation of ExDCrL, EmDCrL, or MTang pattern for tenorrhaphy in dogs.

Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: A multi-institutional retrospective study.

OBJECTIVE: To determine whether catheterization of the common bile duct (CBD) is associated with outcome in dogs undergoing cholecystectomy for gallbladder mucocele and to determine whether this association is modified by the catheterization method. STUDY DESIGN: Multi-institutional retrospective cohort study. ANIMALS: Dogs (n = 252) that underwent cholecystectomy for gallbladder mucocele. METHODS: Dogs were identified via electronic medical record review at four veterinary teaching hospitals. Baseline dog characteristics, surgical findings, and methods including normograde vs retrograde CBD catheterization, intraoperative outcomes, and postoperative outcomes and complications were recorded. Variables were compared between dogs with and without catheterization. RESULTS: Catheterized dogs had higher American Society of Anesthesiologists scores (P = .04), higher total bilirubin (P = .01), and were more likely to have dilated CBD at the time of surgery (P < .01). Incidence of major and minor intraoperative complications was similar between the two groups. Surgical time was longer for the catheterized group (P = .01). The overall incidence of postoperative complications was similar between the groups; however, postoperative pancreatitis was associated with performing CBD catheterization (P = .01). This association was retained as an independent association in a multivariable model that addressed baseline group differences (P = .04). Likelihood of developing postoperative pancreatitis was not different between normograde and retrograde catheterization (P = .57). CONCLUSION: Catheterization of the CBD was associated with development of postoperative pancreatitis. This was not influenced by the method of catheterization. CLINICAL SIGNIFICANCE: The requirement for catheterization of the CBD during open cholecystectomy in dogs should be carefully considered, particularly in dogs without evidence of biliary obstruction because the procedure may induce postoperative pancreatitis.

Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: A retrospective study by the Society of Veterinary Soft Tissue Surgery.

OBJECTIVE: To evaluate gastrointestinal injury and outcomes between dogs treated with immediate surgical intervention vs those treated with delayed surgical intervention for gastrointestinal foreign body obstruction (GIFBO). STUDY DESIGN: Retrospective cohort study. SAMPLE POPULATION: Client-owned dogs (n = 855) from five referral hospitals. METHODS: Medical records of dogs in which GIFBO had been diagnosed between 2007 and 2017 were reviewed for preoperative management, timing of surgery, intraoperative findings, postoperative management, outcome, and survival. Surgical intervention was classified as immediate when it occurred within 6 hours of presentation and delayed when it occurred >6 hours after presentation. RESULTS: Outcomes did not differ between dogs treated immediately (n = 584) or over 6 hours after presentation (n = 210). Intestinal necrosis and perforations were more common when surgery was delayed (P = .008; P = .019) but became nonsignificant after controlling for preoperative differences. Risk factors for necrosis and perforations included duration of clinical signs, increased lactate, linear foreign material, and timing of surgery. Enterectomies (P = .004) as well as the duration of surgery (P = .004) and anesthesia (P = .001) were increased when surgery was delayed. Immediate surgery was associated with earlier return to feeding (P = .004) and discharge from the hospital (P < .001); (5%) dogs in each group (n = 33 immediate; n = 11 delayed) either had a negative explore or the foreign body was milked aborally into the colon at the time of surgery. CONCLUSION: Although outcomes were not associated with surgical timing, the unadjusted prevalence of gastrointestinal injury and, thus, the requirement for complex surgical procedures was higher in the delayed group. CLINICAL SIGNIFICANCE: Earlier surgical treatment of stabilized dogs with GIFBO may involve fewer complex procedures and accelerate recovery.

Biomechanical properties of canine staphylectomies closed with barbed or smooth suture.

OBJECTIVE: To compare the duration of closure and biomechanical properties of staphylectomies closed with absorbable bidirectional barbed suture or smooth monofilament suture in a simple continuous or interrupted pattern STUDY DESIGN: Ex vivo study SAMPLE POPULATION: Soft palates (n = 60) harvested from mesaticephalic canine cadavers METHODS: One centimeter of tissue was excised from the caudal border of each soft palate, and the oral and nasopharyngeal mucosal surfaces were apposed with 2-0 bidirectional Quill Monoderm knotless closure device barbed suture (Q), 3-0 Monocryl in a simple continuous (MC) pattern, or 3-0 Monocryl in a simple interrupted (MI) pattern (n = 20 per group). Duration of closure was compared between groups. Tissues were tested under tension to failure, and mode of failure data were collected by video capture. RESULTS: Closure time was longer for MI closures than for Q and MC closures, with means of 259.9, 215.4, and 196.7 seconds, respectively (P < .0001). No difference was detected in yield force, force to first tissue rupture, maximum force, and energy required for yield and maximum force between groups. Energy to yield was 190.0, 167.8, and 188.95 N-mm for MI, Q, and MC closures, respectively. CONCLUSION: Biomechanical properties of staphylectomies closed with barbed or smooth sutures did not differ in this cadaveric model. CLINICAL SIGNIFICANCE: Barbed suture can be considered as an alternative for closure of canine staphylectomies. These results provide evidence to justify additional research to evaluate clinical outcomes in dogs undergoing staphylectomy.

Evaluation of concurrent perineal hernia in adult male dogs presenting with nontraumatic, acquired inguinal hernias.

A possible association between the development of nontraumatic, acquired inguinal hernias (NAIH) and perineal hernias (PH) has been postulated in adult dogs. The objective of this study was to evaluate the frequency of concurrent diagnosis of PH in dogs presented with NAIH and determine potential risk factors for concurrent PH and NAIH. Medical records of adult male dogs presented for NAIH to 4 hospitals between 2007 and 2017 were retrospectively reviewed. Twenty-one dogs with NAIH were included, 8 of which had concurrent PH. There were no significant differences between dogs with and without PH; however, among dogs with both conditions, intact dogs (8.1 ± 1.4 years) were younger than neutered dogs (11.7 ± 1.0 years; P = 0.007). Thirty-eight percent of male dogs presenting for NAIH had concurrent PH, indicating that these conditions commonly occur together. Dogs presenting for NAIH should be carefully evaluated for concurrent PH before surgical intervention.

Évaluation d'hernie périnéale concomitante chez des chiens mâles adultes présentant des hernies inguinales acquises non traumatiques. Une association possible entre le développement d'hernies inguinales acquises non traumatiques (NAIH) et les hernies périnéales (PH) a été postulée chez les chiens adultes. L'objectif de cette étude était d'évaluer la fréquence des diagnostics simultanés d'HP chez les chiens présentés avec NAIH et de déterminer les facteurs de risque potentiels de PH et NAIH concomitantes. Les dossiers médicaux de chiens mâles adultes présentés pour NAIH à quatre hôpitaux entre 2007 et 2017 ont été revus rétrospectivement. Vingt et un chiens atteints de NAIH ont été inclus, dont huit avaient une PH concomitante. Il n'y avait aucune différence significative entre les chiens avec et sans PH; cependant, parmi les chiens atteints des deux conditions, les chiens intacts (8,1 ± 1,4 ans) étaient plus jeunes que les chiens castrés (11,7 ± 1,0 ans; P = 0,007). Trente-huit pour cent des chiens mâles se présentant pour NAIH avaient une PH concomitante, ce qui indique que ces conditions se produisent généralement ensemble. Les chiens présentant un NAIH doivent être soigneusement évalués pour une PH concomitante avant une intervention chirurgicale.(Traduit par Dr Serge Messier).

Standalone DBT Group Skills Training Versus Standard (i.e. All Modes) DBT for Borderline Personality Disorder: A Natural Quasi-experiment in Routine Clinical Practice.

We describe a naturally occurring, real-world comparison of outcomes following 6 months in standalone DBT skills training group for adults with Borderline Personality Disorder (BPD) without recent suicidal or severe self-harming behaviours and standard (i.e. all modes) DBT for BPD including patients with recent high-risk behaviours. 34 patients chose standalone skills over waiting for standard DBT and 54 were offered standard DBT. Dropout was higher for standalone skills than standard DBT (38.2% vs. 16.7%). No statistically or clinically significant differences were found among completers between conditions on borderline symptoms, general psychopathology, and suicide ideation. There was a moderate effect for standalone skills on hopelessness and emotion regulation difficulties which may have reflected non-equivalence of treatment groups. Significant methodological factors limit generalisability of findings which offer support for feasibility of standalone DBT skills as an effective alternative to waitlist for standard DBT for at least some patients with BPD in the community.

Influence of oversewing the transverse staple line during functional end-to-end stapled intestinal anastomoses in dogs.

OBJECTIVE: To determine the effect of oversewing the transverse staple line after functional end-to-end stapled intestinal anastomoses (FEESA) on canine jejunal leakage pressures. STUDY DESIGN: Experimental, ex vivo, randomized study. SAMPLE POPULATION: Jejunal segments from three adult canine cadavers. METHODS: Jejunal segments were harvested within 2 hours of euthanasia and anastomosed (24 jejunal segments per group, consisting of two segments per construct with n = 12/ group). Constructs were then randomly assigned to receive FEESA alone, FEESA + Cushing oversew, or FEESA + simple-continuous oversew of the transverse staple line with 3-0 polydioxanone. Results for initial leakage pressure (ILP) and maximal leakage pressure (MLP) and initial leakage location (LL) were compared between groups. RESULTS: Mean ILP was 1.8-fold higher for FEESA + Cushing oversew (62.4 ± 7.8 mm Hg) compared with FEESA alone and FEESA + simple-continuous oversew (P < .001). Mean MLP were higher for both oversewn techniques compared with FEESA alone (P < .001). Oversewing the transverse staple line with either pattern increased mean MLP by 1.4-fold compared with FEESA alone. Leakage occurred at the level of the transverse staple line in nonoversewn constructs (P < .001). CONCLUSION: Oversewing the transverse staple line after FEESA increased MLP and decreased the occurrence of leakage at this location. Oversewing with a Cushing pattern increased ILP compared with oversew with a simple-continuous pattern. CLINICAL SIGNIFICANCE: Our results provide evidence to support oversewing the transverse staple line after FEESA. Doing so may reduce the occurrence of postoperative dehiscence. These findings warrant additional focused investigation in vivo through a prospective randomized clinical trial.

Effect of partial vs complete circumferential epitendinous suture placement on the biomechanical properties and gap formation of canine cadaveric tendons.

OBJECTIVE: To determine the effect of partial vs complete circumferential epitendinous suture (ES) placement in addition to a core suture on the biomechanical strength and gapping characteristics of repaired canine tendinous constructs. STUDY DESIGN: Ex vivo, biomechanical study. SAMPLE POPULATION: Thirty-six canine superficial digital flexor tendons. METHODS: Superficial digital flexor tendons were randomly assigned to three groups (n = 12), sharply transected and repaired with a core locking-loop suture with Group 1 a partial circumferential ES, 180° on the palmar side; Group 2 a complete circumferential ES, 360° and double knotting technique; or Group 3 a complete circumferential ES, 360° and single knotting technique. After preloading, constructs were distracted to monotonic failure. Failure mode, gap formation, yield, peak, and failure forces were analyzed. RESULTS: Mean yield (group 1 = 68.6 N, group 2 = 106.5 N, group 3 = 114 N, P < .013), peak (group 1 = 92.8 N, group 2 = 134.6 N, group 3 = 147.3 N; P < .001), and failure (group 1 = 88.7 N, group 2 = 133.0 N, group 3 = 145.5 N, P < .001) loads differed between groups. No difference in yield (P = .874), peak (P = .434), or failure load (P = .434) was detected between complete circumferential ES groups. Force to create 1-mm (P < .001) and 3-mm (P < .038) gap formation was greater in specimens with complete vs partial circumferential ES placement. Complete circumferential ES repairs failed primarily by suture pull-through compared with suture breakage in most partial circumferential ES constructs. CONCLUSION: Addition of a complete circumferential ES with a single or double knotting technique increased the biomechanical strength of normal tendon repairs while reducing gap formation compared with partial ES placement alone. CLINICAL SIGNIFICANCE: Complete circumferential ES is recommended over partial ES placement.

Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model.

OBJECTIVE: To determine the influence of three closure techniques on leakage pressures of canine typhlectomies. STUDY DESIGN: Experimental, ex vivo. SAMPLE POPULATION: Grossly normal cecal segments from 24 adult canine cadavers. METHODS: Typhlectomies were assigned to one of three closure techniques: simple continuous closure with a Parker-Kerr pattern with 4-0 polydioxanone (group 1), closure with a 60-mm gastrointestinal stapler loaded with a 3.8-mm staple cartridge (group 2), and placement of a Cushing suture to augment the stapled closure (group 3). The median (range) of initial leakage pressure (ILP) and maximum leakage pressure (MLP) was compared between groups along with leakage location. RESULTS: Typhlectomies in group 3 leaked at higher ILP (310 mm Hg; 188-310) than those in groups 1 (43 mm Hg; 31-80) and 2 (109.5 mm Hg; 68-173; P < .0001). Maximum leakage pressure were greater in group 3 than in other groups (P < .0001). Leakage was detected in 20 of 24 (83%) typhlectomies, located at the incisional line in 13 of 24 (54%) specimens and from suture holes in seven of 24 (29%) specimens. CONCLUSION: Placement of a Cushing suture pattern to augment stapled incisions improved the ability of typhlectomies to sustain pressure compared with sutured or stapled cadaveric specimens alone. CLINICAL SIGNIFICANCE: These results provide evidence to support placement of a Cushing suture pattern to augment the staple line for typhlectomies in dogs, although in vivo studies are required to determine the clinical significance of these findings.

Ex vivo comparison of leakage pressures and leakage location with a novel technique for creation of functional side-to-side canine small intestinal anastomoses.

OBJECTIVE: To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage. STUDY DESIGN: Experimental, ex vivo. SAMPLE POPULATION: Jejunal segments (n = 130) from 10 healthy canine cadavers. METHODS: Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically. RESULTS: Initial leakage pressure was greater in group D than in groups A, B, and C (P < .011). There was a difference in ILL among groups (P = .003). Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D. Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P < .004). Histological examination was consistent with collagenous fusion without cavitation defects. CONCLUSION: Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses. CLINICAL SIGNIFICANCE: Despite the success and feasibility of creating an FSS-SIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.