Performance time and leak pressure of hand-sewn and skin staple intestinal anastomoses and enterotomies in cadaveric cats.

OBJECTIVE: To compare time to construct completion and leak testing between hand-sewn and skin staple anastomoses and enterotomies in cats. STUDY DESIGN: Ex vivo, randomized study. ANIMALS: Fresh feline cadavers (n = 20). METHODS: Jejunal segments (8 cm) were harvested and tested on the same day as euthanasia. From each cadaver, one segment was randomly assigned to control (C), hand-sewn enterotomy (HSE), and skin staple enterotomy (SSE) groups, and two segments were randomly assigned to hand-sewn anastomosis (HSA) and skin staple anastomosis (SSA) groups. Construct completion time, initial leak pressure (ILP), and maximum intraluminal pressure were compared. Leakage location was reported. RESULTS: Mean time (s) ± SD was longer (p < .001) for HSA (317.0 ± 50.9) than SSA (160.8 ± 13.1) and for HSE (172.0 ± 36.5) than SSE (20.3 ± 5.0). ILP (mean ± SD) for C (600.0 mmHg ±0.0) was higher (p < .001) than all constructs. ILP (mean ± SD) for SSA (124.2 mmHg ±83.7) was not different (p = .49) than HSA (86.1 ± 51.9), but HSE (200.3 ± 114.7) was higher (p < .001) than SSE (32.2 ± 39.7). Immediate leakage from the center of enterotomy closure was observed in 7/20 SSE. CONCLUSIONS: HSA construct completion took twice as long as SSA with no difference in intraluminal pressures. Although HSE construct completion took 8x as long as SSE, HSE had higher intraluminal pressures. CLINICAL SIGNIFICANCE: In cats, SSA may be an alternative to HSA for intestinal anastomosis, but SSE is not recommended as an alternative to HSE for intestinal enterotomy closure.

Gastrointestinal thickness, duration, and leak pressure of five intestinal anastomosis techniques in cats.

OBJECTIVE: To compare time to construct completion and resistance to leakage for five intestinal anastomosis techniques in cats and to report normal feline gastrointestinal thickness. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Grossly normal intestinal segments (n = 120) from 10 fresh cat cadavers. METHODS: A total of 8 cm segments of fresh feline cadaveric intestine were collected, and mural thickness was recorded. Segments were randomly allocated between a control group (n = 20 segments) and five treatment groups (20 segments/group with 2 segments/construct = 10 constructs per group): (1) hand-sewn anastomosis - simple interrupted (HSA-SI), (2) hand-sewn anastomosis - simple continuous (HSA-SC), (3) functional end-to-end stapled anastomosis (FEESA), (4) functional end-to-end stapled anastomosis with oversew (FEESA-O), (5) skin stapled anastomosis (SS). Time to construct completion, leakage location, initial leak pressure (ILP), and maximum intraluminal pressure (MIP) were compared. RESULTS: Mean mural thickness ± SD (mm) for the stomach, duodenum, jejunum, and ileum were 1.66 ± 0.28, 2.05 ± 0.18, 2.28 ± 0.30, and 2.11 ± 0.39, respectively. ILPs (mean ± SD) for HSA-SI (165 ± 122 mmHg), HSA-SC (149 ± 83), FEESA-O (63 ± 25, FEESA (84 ± 59), SS (77 ± 56), and control segments (>500) were compared. There was no statistically significant difference in ILP (p > .08) or MIP (p > .084) between any treatment groups. Nonoversewn FEESAs were 2.4 times faster to perform compared to oversewn FEESA and SS groups, and 4.7 times faster than HSA (p < .001). CONCLUSION: All anastomosis techniques provide resistance to leakage that is supraphysiological to that of the normal maximum intraluminal pressure. HSA take longer to complete than stapled anastomoses. CLINICAL SIGNIFICANCE: All anastomotic techniques may be appropriate in cats. Hand-sewn anastomoses result in a longer surgical time.

Dorsal-to-palmar branch neuroanastomosis in horses undergoing palmar digital neurectomy does not reduce neuroma formation or improve outcome.

OBJECTIVE: Chronic foot pain, a common cause of forelimb lameness, can be treated by palmar digital neurectomy (PDN). Complications include neuroma formation and lameness recurrence. In humans, neuroanastomoses are performed to prevent neuroma formation. The aim of the study was to evaluate the outcome of horses undergoing dorsal-to-palmar branch neuroanastomosis following PDN. STUDY DESIGN: Retrospective case series. ANIMALS: Eighty-five horses with PDN and dorsal-to-palmar branch neuroanastomosis. METHODS: Medical records for horses undergoing this procedure at two hospitals between 2015 and 2020 were reviewed. Palmar and dorsal nerve branches of the PDN were transected and end-to-end neuroanastomosis was performed by apposition of the perineurium. Follow-up was obtained from medical records and telephone interviews. Success was defined as resolution of lameness for at least one year. RESULTS: Lameness resolved following surgery in 81/85 (95%) horses with 57/84 (68%) sound at one year. Postoperative complications occurred in 19/85 (22%) cases. The main limitations of the study were an incomplete data set, inaccurate owner recall, and variations in procedure. CONCLUSION: Compared to previous studies, this technique resulted in similar numbers of horses sound immediately after surgery, a comparable rate of postoperative neuroma formation but a higher recurrence of lameness rate at 1 year postoperatively. CLINICAL SIGNIFICANCE: End-to-end neuroanastomosis of the dorsal and palmar branches of the PDN does not reduce the rate of neuroma formation in horses. Long-term outcome was less favorable compared to previously reported PDN techniques.

Ex vivo evaluation of a technique for equine jejunocecal anastomosis using radiofrequency thermofusion and a Cushing oversew.

OBJECTIVE: To describe a technique for a side-to-side jejunocecal anastomosis in horses using radiofrequency thermofusion (TF) of the intestines supported by a Cushing oversew and to compare this anastomosis to handsewn and stapled techniques. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Intestinal tracts from 24 slaughtered horses. METHODS: A radiofrequency device was used to perform a jejunocecal anastomosis (Group RFA). The construction time and bursting pressure of this construct were compared with those of a hand-sewn double layer (Group HS) and stapled anastomoses (Group ST) without oversew of the staple line. Histology was also performed for the TF anastomoses to evaluate the extent of the thermal damage. RESULTS: The median (range) construction time (min) for the TF (15.8 [14.4-16.8]) was not significantly different from that for the HS (25.5 [24.2-26.3]) and ST (10.8 [9.7-12.5]) groups (p = .07). The construction time for ST was shorter than that for HS group (p < .001). The average (standard deviation) bursting pressure (mmHg) for HS (153.1 +/- 17.5) was higher than that for RFA (76 +/- 15) and ST groups (48 +/- 13; p < .001). The bursting pressure of the RFA was higher than that of the ST anastomoses (p = .001). The thermal damage caused by the device was within the suture oversew in the deeper layers, whereas it extended a few mm beyond the suture line in the serosa. CONCLUSION: Radiofrequency assisted anastomoses provide similar construction times to current techniques and have a higher bursting pressure than ST anastomoses. CLINICAL SIGNIFICANCE: Radiofrequency-assisted anastomoses with a suture oversew demonstrated comparable bursting pressures to ST anastomoses. The use of the radiofrequency device on the intestine is extra label and causes serosal tissue damage, which may increase the risk of adhesions.

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study.

OBJECTIVE: To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. STUDY DESIGN: Experimental, ex-vivo, randomized study. ANIMALS: A total of 24 male canine bladders with the urethra. METHODS: Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. RESULTS: The median suturing time was 12.70 minutes (range: 7.50-16.10 min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p = .236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p = .012). CONCLUSION: Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. CLINICAL SIGNIFICANCE: A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.

Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses.

OBJECTIVE: To compare single-layer anastomoses (modified continuous Lembert [mod-CL] and modified-interrupted Lembert [mod-IL]) and a 2-layer simple continuous anastomosis (2 L; seromuscular and mucosal) for jejunojejunal anastomoses in equine cadavers and to compare ex vivo to in vivo time to complete the anastomosis and stoma size with a mod-IL pattern. STUDY DESIGN: Measurements in jejunum from cadaver and anesthetized horses. ANIMALS: Ten live horses and 18 equine cadavers. METHODS: Time to complete anastomosis, bursting pressures (BP), leakage sites, and anastomotic index (size ratio of anastomotic lumen to control lumen) were recorded. Time to completion and lumen size were compared between in vivo and ex vivo mod-IL patterns. RESULTS: The mod-CL pattern was fastest (8.44 ± 1.30 min, p < .05), and the 2 L pattern was slower (17.07 ± 2.0 min) than the mod-CL and mod-IL (p < .05). The anastomotic index exceeded 100 and did not differ between patterns. Segments reached higher bursting pressures when anastomosed with mod-IL (145.94 ± 24.18 mm Hg) than mod-CL (p < .05). In vivo closure was approximately 8 minutes slower than ex vivo, and with a smaller anastomotic index. CONCLUSIONS: All anastomoses increased lumen size over control segments ex vivo. Lumen size after placement of a mod-IL was greater ex vivo than in vivo, and completion was slower in vivo than ex vivo. [Corrections added on 26 Dec 2022, after online publication: added "ex vivo" to the first line of Conclusions in the Abstract.] CLINICAL SIGNIFICANCE: Slower and smaller anastomoses should be anticipated in vivo compared to ex vivo results. Anastomoses with a mod-IL pattern appear clinically advantageous, producing a comparable lumen size in less time than 2 L.

Colonic Hamartomatous Ganglioneuromatosis in a 4 Mo Old Puppy.

A 4 mo old male goldendoodle puppy was evaluated for chronic hematochezia with a history of recurrent rectal prolapse and tenesmus. A colo-colonic intussusception was diagnosed via abdominal imaging. Surgery was elected to reduce the intussusception, wherein a colonic mass was discovered. Colonic resection and anastomosis was performed, and the tissue were submitted for histopathological examination. The puppy was diagnosed with colonic hamartomatous ganglioneuromatosis based on the presence of markedly hyperplastic submucosal and myenteric plexi with infiltration and expansion of the mucosa and submucosa by Schwann cells and neuronal cell bodies. Ganglioneuromatosis is a rarely reported entity in the veterinary literature, and limited clinical follow up data is available for described cases. In humans, ganglioneuromatosis is associated with a PTEN genetic mutation, which confers increased susceptibility to the development of neoplasia of endocrine organs. Approximately 1 yr after the operation, this puppy appeared clinically normal with no abnormalities on repeated imaging. This case report describes the clinical presentation, surgical treatment, and histologic features of colonic hamartomatous ganglioneuromatosis with 1 yr postoperative clinical follow up data in a dog. Although uncommon, ganglioneuromatosis should be considered as a differential diagnosis list as a cause of gastrointestinal masses in puppies and young dogs.

Subtotal Cervical Esophagectomy and Anastomosis in an Ostrich (Struthio camelus domesticus).

An adult, female, captive ostrich (Struthio camelus domesticus) was referred to a veterinary teaching hospital for a 2-week history of lethargy and a mass effect in the proximal cervical region. Physical examination revealed a fistula in the middle cervical esophagus surrounded by devitalized and necrotic tissue; feed material was found leaking from the site. Cervical radiography identified an esophageal stricture with anterior dilation due to the accumulation of feed. After receiving supportive care for 48 hours, the patient's overall status improved, allowing partial esophagectomy and resection of the affected tissues with end-to-end anastomosis. Postoperative management included fasting for 24 hours, followed by the administration of a liquid hand-rearing formula prepared with commercially available ostrich feed and administered via a feeding tube for 15 days. Proper healing of the surgical site was confirmed by esophagoscopy using a flexible endoscope 17 days after surgery. The ostrich was discharged after 27 days, with no complications recorded within the 180 days of the follow-up period. Partial cervical esophagectomy with end-to-end anastomosis along with pre- and postoperative management provided a successful outcome for the treatment of a fistulated esophageal stricture in a captive ostrich, resulting in full recovery without surgical complications.

Influence of staple line number and configuration on the leakage of small intestinal functional end-to-end stapled anastomosis: An ex vivo study.

OBJECTIVE: To determine the influence of the staple line configuration on the leakage of small intestinal functional end-to-end stapled anastomosis (FEESA). STUDY DESIGN: Experimental, ex vivo, randomized study. SAMPLE POPULATION: Jejunal segments (N = 72) from 10 mature, canine cadavers. METHODS: Jejunal segments (10 cm) were randomly assigned to a control group (8 segments) and 4 FEESA groups (16 segments/group (8 constructs/group)), according to the number of rows of staples used in the vertical (V) and transverse lines (T), respectively: Control, 2-row V/2-row T (2V/2T), 2-row V/3-row T (2V/3T), 3-row V/2-row T (3V/2T), 3-row V/3-row T (3V/3T). Initial leak pressure (ILP), maximum intraluminal pressure (MIP), and initial leakage location (ILL) were compared. RESULTS: The ILP (mean ± SD) for control segments, 2V/2T, 2V/3T, 3V/2T and 3V/3T were 321.38 ± 34.59, 32.88 ± 7.36, 50.13 ± 10.46, 34.38 ± 11.78, 69.88 ± 21.23 mmHg, respectively. All FEESAs initially leaked at lower pressures than intact segments. The only other differences detected between groups consisted of ILPs that were higher when FEESAs were closed with 3V/3T (69.88 ± 21.23 mmHg) than 2V/2T (32.88 ± 7.36, P < .001). Initial leakage occurred predominantly from the transverse staple line rather than the anastomotic crotch (P < .001). CONCLUSION: Placing 3 rows of staples in the transverse line (with or without a third row in the vertical staple line) improved resistance to leakage of FEESAs in normal cadaveric specimens. CLINICAL SIGNIFICANCE: The addition of a third row of staples in the transverse line (with or without a third row in the vertical staple line) in FEESAs should be further investigated as a strategy to reduce intestinal leakage clinically.

Ex vivo comparison of different thoracoabdominal stapler sizes for typhlectomy in canine cadavers.

OBJECTIVE: To determine the influence of staple size on leakage pressure of typhlectomy sites in canine cadavers. STUDY DESIGN: Randomized, experimental cadaveric study. ANIMALS: Twenty-four fresh canine cadavers. METHODS: Ileocecocolic segments were exteriorized following right paracostal laparotomy after euthanasia. Cecal base length and wall thickness were measured. Each cecum was randomly assigned to 1 of 3 groups (TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm). The cecal base was stapled and the cecum was removed. A 10 cm segment including the stapled cecal excision site was tested for initial leak pressure. RESULTS: The mean ± standard deviation body weights across the groups were 18.7 ± 6.1 kg, 16.2 ± 7.5 kg, and 14.2 ± 5.5 kg for the TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm groups, respectively (P = .48). There were no differences for mean cecal base length or wall thickness. Mean initial leak pressure (ILP) across groups was 182 ± 111 mmHg (TA 30 V3 2.5 mm), 112 ± 57 mmHg (TA 60 3.5 mm), and 77 ± 60 mmHg (TA 60 4.8 mm) (P = .78). CONCLUSION: Each stapler size that was evaluated resulted in a mean ILP in excess of typical intraluminal pressures under normal circumstances. There were no differences among groups. CLINICAL SIGNIFICANCE: The results of this cadaveric study support the use of any of the stapler sizes evaluated in similarly sized dogs. A prospective study is needed to be able to correlate stapler size and clinical outcome.

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.

Influence of age on resistance to distraction after tracheal anastomoses in dogs: An ex vivo study.

OBJECTIVE: To determine the influence of age on the ability of tracheal anastomoses to sustain distraction in dogs. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Cadaveric canine tracheae (n = 16). METHODS: Tracheae were harvested from the cadavers of 8 immature and 8 adult dogs. Each trachea underwent end-to-end annular ligament anastomosis with a simple continuous pattern with 2-0 polypropylene on a taper cut needle. The constructs were tested to failure in distraction, with a tensiometer set at a drop head speed of 50 mm/min, as determined by preliminary testing. Failure was defined by tissue pullthrough or suture material failure. The force and elongation at failure were compared between age groups. RESULTS: The median age was 5.5 months (4-7.5 months) in immature dogs and 8.25 years in adult dogs (2-18 years) Tracheal anastomoses failed at lower forces (44.91 ± 59.03 N) but sustained more elongation (39.75 ± 5.45%) in immature dogs than in adult dogs (149.31 ± 45.36 N, P = .007 and 30.57 ± 7.19%, P = .0012, respectively). Tissue apposition was not achieved in 4 specimens each in immature and adult dogs, respectively. CONCLUSIONS: The technique used for tracheal anastomoses in this study failed at lower loads but sustained more elongation when performed in immature dogs. CLINICAL SIGNIFICANCE: Immature dogs may be able to withstand longer tracheal resection than adult dogs but reinforcement techniques seem mandatory to improve resistance to tension. Alternative anastomosis techniques should be considered to improve tissue apposition.

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.

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue.

OBJECTIVE: To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue. STUDY DESIGN: Cadaveric ex vivo study. STUDY POPULATION: Twenty-eight canine bladders with urethra. METHODS: Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded. RESULTS: Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P = .94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P = .96). The distribution of the site of leakage was similar between groups (P = .381). CONCLUSION: Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing. CLINICAL SIGNIFICANCE: This study represents the first step toward laparoscopic radical prostatectomy in dogs.

Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat.

OBJECTIVE: To report a surgical technique for pancreaticoduodenostomy and its outcomes in a cat. ANIMALS: A 14-year-old domestic cat. STUDY DESIGN: Case report. METHODS: A cat was referred to our hospital with a large abdominal mass. On ultrasonographic examination, this mass was identified as a large fluid-filled cavity in place of the right pancreatic duct and involved the pancreatic and accessory pancreatic ducts. A small echoic cavity was observed in the left pancreatic lobe. Serous fluid was collected from the large cavity. On cytology, the small cavity was consistent with an abscess. A partial left pancreatectomy was performed to remove the abscess. The large cavity was excised with the remnant of the right pancreatic lobe and body. After ligation of the pancreatic ducts, the left pancreatic duct was isolated and an end-to-side pancreaticoduodenostomy was performed. RESULTS: The cat recovered without complications. Histological examination was consistent with chronic pancreatitis and peripheral inflammation. No evidence of postoperative pancreatic insufficiency was detected on clinical examination or laboratory findings. A focal ampulla-like dilation of the pancreatic duct was noted on ultrasonography, with no other complications at the anastomosis. The cat presented 225 days postoperatively with respiratory distress. Multiple nodules were identified throughout the lung parenchyma on radiographs. Abnormalities on ultrasonographic examination included an enlarged liver infiltrated with nodules. Due to poor prognosis, the cat was euthanized. Final histopathological diagnosis was diffuse carcinoma. CONCLUSION: Pancreaticoduodenostomy restored pancreaticointestinal continuity after extensive pancreatectomy involving the pancreatic ducts and resulted in long-term survival in the cat reported here.

Idiopathic anomalous congenital band causing small intestinal obstruction in a 5-month-old dog.

A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature. Key clinical message: Developmental abnormalities should be included in the differential list for younger patients with signs suggestive of gastrointestinal obstruction.

Anneau congénital anormal idiopathique provoquant une occlusion de l'intestin grêle chez un chien de 5 mois. Un Labrador retriever intact mâle âgé de 5 mois a été présenté avec une histoire de 24 heures d'anorexie et de vomissements. L'imagerie abdominale a révélé la présence d'une obstruction mécanique du jéjunum et d'un épanchement péritonéal. L'évaluation cytologique et la culture de l'épanchement avant la chirurgie ont identifié un exsudat suppuré avec des bactéries compatibles avec une péritonite septique et suspectées d'être liées à la lésion intestinale. Une laparotomie exploratoire a été réalisée et un segment de jéjunum était sévèrement resserré sur toute sa circonférence par une bande de tissu fibreux de couleur blanc-cassé. La résection et l'anastomose du segment étranglé du jéjunum et l'excision de la bande constrictive ont permis la résolution des signes cliniques. Le chien s'est complètement rétabli. L'évaluation histologique a révélé que la bande était composée de tissu musculaire fibrovasculaire et lisse, compatible avec une bande congénitale anormale idiopathique. Aucune autre lésion gastro-intestinale n'a été observée, ni grossièrement à la chirurgie ni histologiquement dans le segment réséqué de l'intestin. A notre connaissance, une structure similaire n'a pas été rapportée dans la littérature vétérinaire.Message clinique clé :Les anomalies du développement doivent être incluses dans la liste différentielle des patients plus jeunes présentant des signes évoquant une occlusion gastro-intestinale.(Traduit par Dr Serge Messier).

A case of colonic-colonic intussusception in a dog secondary to lymphoma treated with colonic resection and anastomosis.

A 2-year-old castrated male Great Dane crossbreed dog was presented with a history of diarrhea and suspected intussusception. Abdominal ultrasound revealed a colonic-colonic intussusception. The gastrointestinal tract was explored, and an approximately 5-cm intussusception was discovered mid-colon. All other gastrointestinal structures were normal in appearance. The intussusception could not be reduced manually. A colonic resection and anastomosis were performed together with a left-sided incisional colopexy. The dog recovered from surgery and histopathology revealed the intussusception to be secondary to large cell transmural lymphoma. Sections from the surgical margins revealed proliferation of fibrovascular tissue along the serosal surface segmentally, but no neoplastic cells were identified. The dog was subsequently treated with chemotherapy consisting of doxorubicin and prednisone. No evidence of disease recurrence was noted on ultrasound 9 months after surgery. Approximately 2 years after surgery, the dog is noted to be clinically normal at home with no abnormal findings on physical examination. A complete blood (cell) count and chemistry obtained at this time revealed no significant abnormalities besides mild azotemia. Additional restaging was declined by the owner.

Un cas d'intussusception colon-colon chez un chien secondaire à un lymphome traité par résection c olonique et anastomose. Un grand danois croisé mâle castré âgé de 2 ans a été présenté avec des antécédents de diarrhée et une suspicion d'intussusception. L'échographie abdominale a révélé une intussusception colon-colon. Le tractus gastro-intestinal a été exploré et une intussusception d'environ 5 cm a été découverte au milieu du côlon. Toutes les autres structures gastro-intestinales avaient un aspect normal. L'intussusception n'a pas pu être réduite manuellement. Une résection colonique et une anastomose ont été réalisées avec une colopexie incisionnelle du côté gauche. Le chien a récupéré de la chirurgie et de l'histopathologie a révélé que l'intussusception était secondaire à un lymphome transmural à grandes cellules. Des sections des marges chirurgicales ont révélé une prolifération de tissu fibrovasculaire le long de la surface séreuse de manière segmentaire, mais aucune cellule néoplasique n'a été identifiée. Le chien a ensuite été traité par une chimiothérapie composée de doxorubicine et de prednisone. Aucun signe de récidive de la maladie n'a été noté à l'échographie 9 mois après la chirurgie. Environ 2 ans après la chirurgie, le chien est cliniquement normal à la maison sans résultats anormaux à l'examen physique. Une numération sanguine (cellule) complète et l'analyse chimique obtenues à ce moment n'ont révélé aucune anomalie significative outre une légère azotémie. Une nouvelle restadification a été refusée par le propriétaire.(Traduit par Dr Serge Messier).

Surgical Repair of a Complete Transverse Tracheal Rupture in a Mallard Duck (Anas platyrhynchos).

An adult male mallard duck (Anas platyrhynchos) of unknown age was presented for acute intermittent respiratory distress that resolved when at rest. The duck had no history or evidence of trauma and had never been intubated. Radiographic imaging revealed a 1-cm tracheal defect at the level of the sixth vertebra. Surgical correction of the defect was pursued, during which a complete transverse tracheal rupture of unknown origin was identified. The separated tracheal sections were successfully anastomosed without resection of any tracheal rings. Tracheoscopy performed 2 months after the surgical procedure revealed healthy mucosa at the anastomosis site with a slight narrowing of the tracheal lumen.

Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments.

BACKGROUND: Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis 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 (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792). CONCLUSIONS: The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications.

Perforations of tri-layer nitrile-latex and natural rubber latex gloves during ex-vivo equine intestinal anastomoses.

OBJECTIVE: To compare perforation rates between tri-layer nitrile-latex and natural rubber latex surgical gloves after single-layer end-to-end jejunojejunal anastomoses in equine cadavers. STUDY DESIGN: Prospective randomized ex-vivo study. SAMPLE POPULATION: Pairs of surgical gloves (n = 46) worn during jejunojejunal anastomoses. METHODS: Tri-layer nitrile-latex and rubber latex pairs of gloves were equally but randomly allocated to a right-handed surgeon performing 46 single-layer end-to-end jejunojejunal anastomoses on cadaveric material. Number and location of perforations were determined with the water leak test after each procedure. Ten unused pairs of both glove types were tested as controls. RESULTS: At least one perforation occurred in 41% (19/46) of the pairs of gloves. Glove perforations were present in 22% (5/23; 95% CI: 9-42) of tri-layer glove pairs and 61% (14/23; 95% CI: 41-78) of the rubber glove pairs. The odds of glove perforation were 5.6 times (p = .009, 95% CI: 1.5-20.5) lower when tri-layer rather than rubber gloves were used. The duration of procedure did not affect the risk of glove perforation (p = .679). No perforations were observed in the unused gloves. CONCLUSION: Perforations were less common when the surgeon wore tri-layer nitrile-latex gloves rather than to the natural rubber latex gloves tested in this study. CLINICAL RELEVANCE: Tri-layer nitrile-latex gloves were more resistant to perforations in experimental settings; further studies may confirm that they are also superior in a clinical setting.