Intestinal dehiscence and mortality in cats undergoing gastrointestinal surgery.

OBJECTIVES: The aim of this study was to determine the incidence of and risk factors for both gastrointestinal (GI) incisional dehiscence and mortality in a large cohort of cats undergoing GI surgery. We hypothesized that cats with preoperative septic peritonitis (PSP), systemic inflammatory response syndrome (SIRS) or sepsis would have higher GI dehiscence and mortality rates than unaffected cats. METHODS: A medical records search identified cats with surgically created, full-thickness incisions into their stomach, small intestines or large intestines. Preoperative data, including signalment, clinical signs, comorbidities, surgical history, current medications, presenting physical examination findings, complete blood counts and serum biochemistry values, were collected. It was determined whether or not cats had PSP, SIRS or sepsis at admission. Intraoperative data, final diagnosis and postoperative variables such as vital parameters, bloodwork and (if applicable) the development of GI dehiscence or mortality were noted. Postoperative follow-up of at least 10 days was obtained in survivors. RESULTS: In total, 126 cats were included. One cat developed GI dehiscence following complete resection of a jejunal adenocarcinoma. Twenty-three cats (18.2%) died within 10 days of surgery. Cats with PSP (P = 0.0462) or that developed hypothermia 25-72 h postoperatively (P = 0.0055) had higher odds of mortality in multivariate analysis. Cats with PSP had 6.7-times higher odds of mortality than cats not diagnosed with PSP. CONCLUSIONS AND RELEVANCE: In cats receiving GI surgery, the incidence of GI incisional dehiscence was <1%. Cats with PSP had a higher likelihood of mortality. SIRS was a common finding in cats with septic peritonitis, but was not associated with mortality. Postoperative mortality during the home recovery period might be significant in cats. Future studies evaluating postoperative mortality in cats should consider extending the research period beyond the date of discharge.

Analysis of risk factors associated with complications following mandibulectomy and maxillectomy in dogs.

OBJECTIVE: To provide information about complication rates and the risk factors for complications with mandibulectomy and maxillectomy procedures in dogs. ANIMALS: 459 client-owned dogs that underwent a mandibulectomy or maxillectomy between January 1, 2007, and January 1, 2018. PROCEDURES: Inclusion criteria included a complete medical record that contained an anesthesia record, surgical report, available histopathology results, and results of CBC and serum biochemical analysis before surgery. A minimum follow-up of 90 days after surgery was required. RESULTS: 271 complications occurred in 171 of 459 (37.3%) dogs. Eighteen complications were not given a severity description. Of the remaining 253 complications, most were considered minor (157/253 [62.1%]). Multivariable logistic regression analysis revealed that only increased surgical time had a significant (OR, 1.36; 95% CI, 1.12 to 1.54) association with the occurrence of ≥ 1 complication. For each additional hour of surgery, the odds of complications increased by 36%. Preoperative radiation therapy or chemotherapy increased the odds of incisional dehiscence or oral fistula formation (OR, 3.0; 95% CI, 1.3 to 7.2). Additionally, undergoing maxillectomy, compared with mandibulectomy, increased the odds of incisional dehiscence or oral fistula formation (OR, 1.8; 95% CI, 1.1 to 3.1). Two hundred forty-four of 271 (90.0%) complications occurred in the perioperative period (0 to 3 months after surgery). CONCLUSIONS AND CLINICAL RELEVANCE: Compared with mandibulectomy, performing maxillectomy increased the risk for incisional dehiscence or oral fistula formation. Mandibulectomy and maxillectomy had a moderate risk for a complication.

Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs.

OBJECTIVE: To quantify the relative risk of intestinal dehiscence in dogs undergoing intestinal resection and anastomosis (IRA), compared with enterotomy, for surgical management of small intestinal foreign bodies, and to evaluate the association between nasogastric tube placement for early enteral nutrition (EEN) and hospitalization time. ANIMALS: 211 dogs undergoing 227 surgeries for intestinal foreign body removal. PROCEDURES: Medical records were reviewed for dogs undergoing a single-site sutured enterotomy or IRA for foreign body intestinal obstruction between May 2008 and April 2018. Multivariable logistic regression was used to quantify the association between surgical procedure and dehiscence. Multiple linear regression was used to quantify the association of nasogastric tube placement with total hospitalization time. RESULTS: Dehiscence rates were 3.8% (7/183) and 18.2% (8/44) for enterotomy and IRA, respectively. Overall dehiscence rate for all surgeries was 6.6% (15/227). The odds of intestinal dehiscence for IRA were 6.09 times (95% CI, 1.89 to 19.58) the odds for enterotomy. An American Society of Anesthesiologists score > 3 (OR, 4.49; 95% CI, 1.43 to 14.11) and an older age (OR, 1.02 [95% CI, 1.01 to 1.02] for each 1-month increase in age) were significantly associated with greater odds of intestinal dehiscence, regardless of surgical procedure. Placement of a nasogastric tube was not associated with intestinal dehiscence or decreased total hospitalization time when controlling for the year of surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Patients undergoing IRA were at a significantly higher risk of intestinal dehiscence, compared with patients undergoing enterotomy. Although this finding should not be used to recommend enterotomy over IRA, this information may be useful in guiding owner expectations and postoperative monitoring.

A Review of Normal Intestinal Healing, Intestinal Anastomosis, and the Pathophysiology and Treatment of Intestinal Dehiscence in Foreign Body Obstructions in Dogs.

Small intestinal anastomoses are commonly performed in veterinary medicine following resection of diseased or devitalized intestinal tissue. Traditionally, suture has been employed to anastomose intestinal ends. However, use of intestinal staplers has become increasingly popular due to the ability to produce a rapid anastomosis with purported superior healing properties. Under normal conditions, intestinal healing occurs in three phases: inflammatory, proliferative, and maturation. Dehiscence, a devastating consequence of intestinal anastomosis surgery, most often occurs during the inflammatory phase of healing where the biomechanical strength of the anastomosis is almost entirely dependent on the anastomotic technique (suture or staple line). The resulting septic peritonitis is associated with a staggering morbidity rate upwards of 85% secondary to the severe systemic aberrations and financial burden induced by septic peritonitis and requirement of a second surgery, respectively. Intraoperative and postoperative consideration of the multifactorial nature of dehiscence is required for successful patient management to mitigate recurrence. Moreover, intensive postoperative critical care management is necessitated and includes antibiotic and fluid therapy, vasopressor or colloidal support, and monitoring of the patient's fluid balance and cardiovascular status. An understanding of anastomotic techniques and their relation to intestinal healing will facilitate intraoperative decision-making and may minimize the occurrence of postoperative dehiscence.

Wound leakage rates of ex vivo uniplanar versus biplanar phacoemulsification clear corneal incisions in dogs.

OBJECTIVE: The purpose of this study was to compare the leakage rates of perilimbal uniplanar and biplanar clear corneal incisions in dogs when subjected to increased intraocular pressure (IOP) both from within the eye and via external pressure. PROCEDURE: Uniplanar clear corneal incisions were created in eight freshly enucleated canine eyes using a 3.2 mm straight slit knife while 8 fellow eyes received a biplanar clear corneal incision consisting of an approximately 300 µm deep groove followed by a 3.2 mm straight slit knife entry into the anterior chamber. Both wounds were reapposed using three simple interrupted 8-0 polyglactin 910 sutures. Eyes were cannulated with two 25 g needles: One connected to a pressure transducer, and the other connected to a reservoir of isotonic saline. The IOP at which the wound leaked was recorded when the intraocular pressure was increased internally by raising the height of the fluid bag, and again when the cornea was externally compressed. Kaplan-Meier survival curves compared incision types for each method of increasing IOP and were evaluated using Mantel-Cox log-rank analysis. RESULTS: Both wound types resisted leakage at IOP in the physiologically achievable range and no significant differences were observed between clear corneal incisions when pressure was applied externally (P = .353) or was increased from within the globe (P = .615). CONCLUSION: Ex vivo uniplanar and biplanar clear corneal incisions in dogs are equally strong, with no significant differences in leakage rates when IOP is increased internally or externally.

Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs.

OBJECTIVE: To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients. ANIMALS: 90 dogs. PROCEDURES: Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests). RESULTS: Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized. CONCLUSIONS AND CLINICAL RELEVANCE: Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.

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

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.

Bilateral caudal maxillectomy for resection of tumors crossing palatal midline and use of the angularis oris axial pattern flap for primary closure or dehiscence repair in two dogs.

OBJECTIVE: To describe the technique and outcomes for bilateral caudal maxillectomy for resection of large caudal maxillary tumors crossing palatal midline in two dogs. STUDY DESIGN: Clinical case report. ANIMALS: Two client-owned dogs. METHODS: Two client-owned dogs with primary caudal maxillary tumors, a poorly differentiated sarcoma, and a multilobulated osteochondrosarcoma. Bilateral caudal maxillectomies were performed for curative-intent resection of these tumors. The angularis oris axial pattern flap was used for primary closure in one dog and for dehiscence repair in the other. RESULTS: Both tumors were resected with complete histologic margins. The defects were closed with local buccal mucosal flaps, with or without a unilateral angularis oris flap. Esophagostomy tubes were placed at time of surgery to bypass oral feeding. Incisional dehiscence and subsequent oronasal fistula formation occurred as a postoperative complication in both dogs (3 and 10 days, respectively). Both were successfully repaired with a combination of local buccal mucosal flaps and the angularis oris flap. Both dogs had good functional outcome and quality of life after recovery from revision surgery. CONCLUSION: Bilateral caudal maxillectomy allowed resection of caudal maxillary tumors crossing palatal midline, with good function and quality of life after recovery in 2 dogs. CLINICAL SIGNIFICANCE: Good outcomes including complete resections are achievable with bilateral caudal maxillectomy despite complications. Local mucosal and axial pattern flaps can be used for dehiscence repair.

Temporary end-on colostomy as a treatment for anastomotic dehiscence after a transanal rectal pull-through procedure in a dog.

OBJECTIVE: To describe a temporary end-on colostomy to treat the dehiscence of a transanal rectal pull-through in a dog. STUDY DESIGN: Case report ANIMAL: A 7-year-old intact female Australian shepherd dog that was treated for a rectal adenocarcinoma with a transanal rectal pull-through. METHODS: Partial dehiscence of the previous end-to-end colorectal anastomosis and formation of a perianal sinus tract were diagnosed 4 days after surgery. A pararectal approach was used to revise the surgery with debridement of the sinus tract, rectal wall reconstruction with single interrupted sutures, and placement of a passive drain. Dehiscence occurred 2 days later. The colon was transected cranial to the pelvic brim, and each stump was oversewn prior to salvage temporary end-on colostomy. Postoperative care included analgesia, antibiotic therapy, and local care of the perineal/perianal area and colostomy site. After 90 days, the perineal/perianal sinus tract had healed, the colostomy was eliminated, and an end-to-end anastomosis of the colon was performed. RESULTS: Management of postoperative complications focused on dermatitis of the stoma and perineal/perianal area, stoma incontinence, and perineal/perianal medications of the sinus tract. One year after the final surgery, the dog had occasional episodes of fecal incontinence and a good quality of life without other complications. CONCLUSION: Use of a temporary end-on colostomy prior to revision surgery led to a satisfactory outcome but required long and challenging postoperative management. CLINICAL SIGNIFICANCE: Temporary end-on colostomy may be an option to manage dehiscence and potential recurrent stenosis after transanal rectal pull-through in dogs.

Intra-abdominal complications following intestinal anastomoses by suture and staple techniques in dogs.

OBJECTIVE To compare the incidence of intra-abdominal complications in dogs following resection and functional end-to-end stapled anastomosis (FEESA) versus anastomosis with an end-to-end sutured technique for treatment of enteric lesions. DESIGN Multicenter, retrospective descriptive cohort study. ANIMALS 180 dogs. PROCEDURES Medical records of dogs undergoing intestinal resection and anastomosis at 3 nonaffiliated private practice specialty centers were retrospectively reviewed. Preoperative clinical variables, indication for surgery, surgical technique (sutured end-to-end anastomosis vs FEESA), and evidence of postoperative anastomosis site leakage (dehiscence) were recorded. Variables of interest were analyzed for associations with dehiscence. RESULTS Dehiscence rates of sutured and stapled anastomoses were 12 of 93 (13%) and 4 of 87 (5%), respectively; odds of postoperative dehiscence were significantly lower for dogs with FEESAs than for dogs with sutured anastomoses (OR, 0.28; 95% confidence interval, 0.09 to 0.94). Among dogs that underwent surgery for treatment of intestinal dehiscence after surgery at another facility, subsequent dehiscence developed in 3 of 5 with sutured anastomoses and 0 of 11 with stapled anastomoses. Dehiscence rates varied significantly among clinics. No other variable was associated with risk of dehiscence. Eleven of 16 dogs with dehiscence were euthanized without additional surgery. Impaction at the anastomosis site was identified months or years after surgery in 3 dogs (4 anastomosis sites) that had FEESAs. CONCLUSIONS AND CLINICAL RELEVANCE Odds for dehiscence were significantly greater for sutured end-to-end anastomoses than FEESAs, and dogs undergoing surgery for previous dehiscence were significantly more likely to experience a subsequent dehiscence with a sutured anastomosis. However, variability of procedure types and dehiscence rates among clinics suggested further research is needed to confirm these findings. Obstruction at the anastomosis site was identified as a potential long-term complication of FEESA.

Closure of gastrointestinal incisions using skin staples alone and in combination with suture in 29 cats.

OBJECTIVE: To report the use of skin staples alone, and in combination with sutures, for closure of gastrointestinal incisions in cats and to describe outcomes. MATERIALS AND METHODS: Retrospective study of cats that underwent gastrotomy, jejunotomy, jejunal or colonic anastomosis using skin staples alone or in combination with sutures to close the enteric wounds at one referral hospital between 2001 and 2016. Data regarding patient signalment, duration of clinical signs, indication for surgery, diagnosis, haematological and biochemical values, surgical time, procedure, complications and outcome were collected. All the gastrotomies and some of the large intestine incisions were closed in a hybrid technique using two layers (monofilament suture and skin staples). All the small intestine and some of the large intestinal incisions were closed in a single layer using skin staples. RESULTS: Twenty-nine cats were included in the study. Indications for surgery included foreign body (14/29), neoplasia (6/29) and idiopathic megacolon (9/29). Overall, 26 of 29 (~90%) of cases survived to discharge. One cat had postoperative cardiopulmonary arrest, and 2/29 cats were euthanased at the owner's request. There was no evidence of incisional dehiscence in any case. CLINICAL SIGNIFICANCE: Skin staplers are safe, reliable, affordable and effective for closure of gastrointestinal incisions in cats. We found skin staples can be a useful tool in closure of gastrotomies and large intestinal resection and anastomosis procedures in cats.

Disposable skin staplers for closure of linear gastrointestinal incisions in dogs.

OBJECTIVE: To report the clinical features and outcomes of linear gastrointestinal incisions closed with skin staples in dogs. STUDY DESIGN: Historical cohort study. ANIMALS: 333 client-owned dogs. METHODS: Medical records from 1 private referral hospital were searched for dogs that underwent gastrointestinal surgery between November 1999 and October 2015. Cases were included if skin staplers were used to close linear gastrointestinal incisions. Information regarding preoperative, surgical, and postoperative factors was collected. RESULTS: Complications were diagnosed in 8 of 245 (3.27%) dogs, including 3 of 245 (1.22%) dogs that died or were euthanized, 3 of 245 (1.22%) dogs with incisional dehiscence, and 2 of 245 (0.81%) dogs with attachment of a linear foreign body to the staples at the intestinal lumen. Dehiscence was noted at the enterotomy sites in 3 dogs at a mean time of 44 hours after surgery (SD ± 6.93). Two dogs presented with another linear foreign body that was attached to the staples in the intestinal lumen at postoperative days 24 and 42. The risk factors associated with incisional dehiscence included multiple gastrointestinal incisions performed in 1 surgery (χ2 , P < .001) and the presence of a linear foreign body (χ2 , P = .02253). No associations were detected between dogs' age, sex, weight, surgery time, indication for surgical intervention, surgery location in the gastrointestinal tract, or surgeon experience and incisional dehiscence. CONCLUSION: Skin staplers provide safe and effective closure of gastrotomies, enterotomies, and colonotomies in dogs. This method is reliable, efficient, and affordable in the hands of veterinary surgeons with varying skill levels.

Post-operative outcomes of surgical and chemical castration with zinc gluconate in dogs presenting to veterinary field clinics.

The objective of this study was to characterize post-operative outcomes of chemical castration as compared to surgical castration performed by existing municipal field clinics. Fifty-four healthy adult male dogs underwent chemical castration with zinc gluconate solution and 55 healthy adult male dogs underwent surgical castration in veterinary field clinics. Dogs in each group were evaluated for swelling, inflammation, and ulceration (chemical castration) or dehiscence (surgical castration) at Days 3, 7, and 14 following castration. More surgically castrated dogs required medical intervention than chemically castrated dogs (P=0.0328); the number of dogs requiring surgical repair within each group did not differ (P=0.3421). Seven chemically castrated dogs and 22 surgically castrated dogs experienced swelling, inflammation, and/or ulceration; all were managed medically. Two chemically castrated dogs experienced scrotal ulceration requiring surgical castration at Days 3 and 7. One surgically castrated dog experienced partial incisional dehiscence requiring surgical repair at Day 3. Our results suggest that chemical castration of dogs in field clinics is a feasible alternative to surgical castration, but proper follow-up care should be ensured for at least 7days post-procedurally.

Axial Pattern Flaps.

Axial pattern flaps are based on a direct cutaneous artery and vein supplying a segment of skin. They provide a large, robust option for large wound closure. Many different axial pattern flaps have been described to provide options for closure of wounds located from the nose to the tail. All axial pattern flaps require good surgical technique and careful attention to detail while developing of the flap.

The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors.

OBJECTIVES: The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. METHODS: Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. RESULTS: Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. CLINICAL SIGNIFICANCE: Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence.

Use of cryopoor plasma for albumin replacement and continuous antimicrobial infusion for treatment of septic peritonitis in a dog.

OBJECTIVE: To report the successful management of a dog with septic peritonitis and septic shock secondary to enterectomy dehiscence using novel techniques for identification of intestinal dehiscence and for septic shock treatment. CASE SUMMARY: A 5-year-old castrated male Bernese Mountain Dog presented for lethargy 6 days following enterotomy for foreign body obstruction. Septic peritonitis was identified due to dehiscence of the enterotomy site, and resection and anastomosis were performed using a gastrointestinal anastomosis and thoracoabdominal stapling device. Postoperatively the patient experienced severe hypotension, which responded to norepinephrine constant rate infusion (CRI) after failing to improve with fluid therapy or dopamine CRI. Further treatment included antimicrobial CRI and supportive care including careful fluid therapy. Due to low effective circulating volume paired with intersititial fluid overload and large volume abdominal effusion, fluid therapy consisted of a combination of human serum albumin, canine albumin, synthetic colloids, and isotonic crystalloids. Cryopoor plasma (CPP) was used as a source of canine albumin and intravascular volume. On Day 4, food dye was given through a nasogastric tube due to suspicion of dehiscence of the anastomosis site. Dehiscence was confirmed during abdominal exploratory, and a second resection and anastomosis was performed. Abdominal partial closure with vacuum-assisted closure device was performed. Supportive care was continued with CPP CRI and imipenem CRI. Planned relaparotomy to change the vacuum-assisted closure device was performed 48 hours later, with abdominal closure 96 hours after anastomosis. The patient was discharged on Day 15. Recheck 12 months later was normal. NEW OR UNIQUE INFORMATION PROVIDED: This case includes novel techniques such food dye via nasogastric tube to identify anastomosis dehiscence, use of CPP as a source of canine albumin, and antimicrobial CRI in a dog with septic peritonitis.

Corneal grafting for the treatment of full-thickness corneal defects in dogs: a review of 50 cases.

OBJECTIVE: To describe corneal grafting for the treatment of full-thickness corneal defects in dogs and to determine its effectiveness in preserving vision. METHODS: A review of the medical records of dogs that underwent corneal grafting following corneal perforations (≥3 mm) at the VTH-UAB from 2002 to 2012 was carried out. RESULTS: Fifty dogs of different breed, age and gender were included. Brachycephalic breeds were overrepresented (37/50;74%). All cases were unilateral, with euryblepharon being the most common concurrent ocular abnormality (20/50;40%). Full-thickness penetrating keratoplasties (FTPK) were performed in 21/50 eyes (42%) and lamellar keratoplasties (LK) in 29/50 eyes (58%). Frozen grafts (FroG) were used in 43/50 eyes (86%) and fresh homologous grafts (FreHoG) in 7/50 (14%). Of the former group, 26 were homologous (FroHoG:60%) and 17 heterologous (FroHeG:40%). A combination of topical medication (antibiotics, corticosteroids, cycloplegics, and 0.2% cyclosporine A) and systemic mycophenolate mofetil was administered. Median follow-up time was 200 days. Postsurgical complications included wound dehiscence (6/50;12%) and glaucoma (4/50;8%). Clinical signs of graft rejection were diagnosed as follows: FroHoG (13/26;50%), FroHeG (11/17;65%), FreHoG (4/7;57%), FTPK (12/21;57%), and LK (16/29;55%). Medical treatment successfully controlled graft rejection in 11/28 eyes (39%). Good anatomical outcome was achieved in 86% (43/50), of which 95% (41/43) were visual at last examination, with moderate opacification to complete transparency of the graft present in 48.2%. CONCLUSIONS: Corneal grafting is an effective surgical treatment for full-thickness corneal defects in dogs. If graft rejection is present, additional medical or surgical therapy may be necessary, achieving a highly satisfactory visual outcome.

The use of disposable skin staples for intestinal resection and anastomosis in 63 dogs: 2000 to 2014.

OBJECTIVE: To describe the use of disposable skin staples for intestinal resection and anastomosis in dogs and report associated dehiscence and mortality rates. METHODS: Retrospective evaluation of medical records of dogs that underwent intestinal resection and anastomosis using disposable skin staples between 2000 and 2014. Data regarding patient signalment, indication for surgery, location of the resection and anastomosis, number of procedures performed, evidence of peritonitis at the time of surgery, surgeon qualifications, dehiscence, and mortality were obtained from the medical records. Mortality was defined as failure to survive beyond 10 days following resection and anastomosis. RESULTS: The overall mortality rate of patients undergoing intestinal resection and anastomosis was 12·7% (8/63). The most common indication for resection and anastomosis was neoplasia (20/63 [31·7%]), followed by foreign body removal (19/63 [30·2%]). The overall dehiscence rate was 4·8% (3/63). No difference in mortality associated with indication for surgery, whether multiple procedures were performed, surgeon qualifications, or evidence of peritonitis at the time of surgery was identified. CLINICAL SIGNIFICANCE: In this retrospective study, the overall mortality and dehiscence rates using disposable skin staples were similar to previously reported outcomes following resection and anastomosis.

Successful management of jejunojejunal anastomosis dehiscence by extra-abdominal exteriorization and bandaging in a cat with septic peritonitis.

Duodenal and jejunal resections were performed in a cat with septic peritonitis due to small intestinal perforations by a linear foreign body. Three days later jejunal resection and anastomosis were repeated due to dehiscence of the anastomosis site. This segment of intestine was exteriorized through the body wall and managed with bandages for 5 days before it was surgically replaced into the abdomen. The cat made a full recovery.

Gestion réussie d'une déhiscence d'une anastomose jéjunojéjunale par l'extériorisation extraabdominale et des pansements chez un chat atteint de péritonite septique. Des résections duodénale et jéjunale ont été réalisées chez un chat atteint de péritonite septique en raison de petites perforations intestinales par un corps étranger linéaire. Trois jours plus tard, la résection jéjunale et l'anastomose ont été répétées en raison d'une déhiscence du site de l'anastomose. Ce segment de l'intestin était extériorisé au travers de la paroi du corps et il a été géré à l'aide de pansements pendant 5 jours jusqu'à ce qu'il soit replacé dans l'abdomen par une chirurgie. Le chat s'est complètement rétabli.(Traduit par Isabelle Vallières).

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

OBJECTIVE: To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. STUDY DESIGN: Historical cohort study. SAMPLE POPULATION: Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. METHODS: Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. RESULTS: Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). CONCLUSION: No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure.