Ex vivo comparison of hand-sutured versus circular stapled anastomosis in canine large intestine.

OBJECTIVE: To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand-sewn techniques in dogs. STUDY DESIGN: Ex-vivo study. ANIMALS: Colon from 11 canine cadavers. METHODS: Thirty-two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and 4-0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End-to-End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye-containing solution was first observed to leak from the anastomosis site. RESULTS: Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p = .0313, C4.8mm-BG p = .0131, C3.5mm-G p = .0469, C3.5mm-BG p = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg. CONCLUSION: End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. CLINICAL SIGNIFICANCE: These results provide evidence to support hand-suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.

Ventral femoral head and neck ostectomy: Standard versus novel K-wire guided technique using a premeasured ostectomy angle in canine cadavers.

OBJECTIVE: To assess the accuracy and efficiency of performing ventral FHO (vFHO) after measuring the ideal femoral head and neck ostectomy angle (iFHOA), with and without guidance of a K-wire. To compare the iFHOA to the previously accepted 45° angle to guide vFHOs. STUDY DESIGN: Randomized, controlled, ex vivo study. ANIMALS: Ten mixed-breed canine cadavers. METHODS: A routine un-guided and guided vFHO was performed on each cadaver. A single unmodified ostectomy was performed on all hips. The pre- and postoperative iFHOA and postoperative residual femoral neck were radiographically assessed. Subjective intraoperative palpation and postoperative radiographic ostectomy completeness (OC) scores were assigned. RESULTS: Subjective OC scores (p > .63) did not differ between techniques, and guided vFHOs were as good or better for 7/10 dogs assessed via intraoperative palpation, and 9/10 dogs assessed radiographically. Residual femoral neck measurements were similar in both groups (p > .75). The average iFHOA in this study was 38.5°, with no significant difference between limbs of the same cadaver (p = .34). Guided vFHO took longer (294.5 s, p = .002) than unguided vFHO (166.7 s). CONCLUSION: The mean iFHOA of 38.5° was less than the previously published 45° angulation for vFHOs. Subjectively, use of a K-wire guide improved soft tissue retraction, neck visualization, and confidence in cut angulation. CLINICAL SIGNIFICANCE: Preoperative iFHOA measurement may minimize the risk of inappropriate vFHO angles.

Use of a subcutaneous ureteral bypass device for treatment of bilateral proximal ureteral injury in a 9-month-old cat.

CASE SUMMARY: A 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well. RELEVANCE AND NOVEL INFORMATION: To our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.

Publication Rate and Evidence-Based Evaluation of Abstracts Presented at the American College of Veterinary Surgeon's Annual Meeting.

OBJECTIVE: To document the publication rate of abstracts presented at 10 ACVS conferences and report the time required for publication and level of evidence. STUDY DESIGN: Literature review. METHODS: All scientific abstracts published in the ACVS proceedings from 2001 to 2010 were reviewed. The level of evidence of each abstract was evaluated and scored (1-4). Publication information was determined after a broad bibliographic search through multiple online databases. RESULTS: The overall publication rate for ACVS abstracts (n=1,395) was 66% and 11% were published before conference presentation. The majority of abstracts focused on the dog (35%) or the horse (33%). Most (90%) abstracts were submitted to veterinary-based journals. The median time (interquartile range [IQR]) from abstract presentation to journal submission was 222 days (107-541), from journal submission to acceptance for publication was 122 days (89-185), and from acceptance to publication in a journal was 208 days (151-289). The time from abstract presentation to final publication took 449 days (238-794). Of the abstracts, 4% were of level 1 evidence, 9% level 2, 66% level 3, and 21% level 4. Studies with a higher level of evidence were submitted, accepted, and published quicker than ones with a lower level of evidence. The publication rate was 61%, 71%, 68%, and 65% for level 1, 2, 3, 4 evidence, respectively. CONCLUSION: The publication rate of scientific abstracts presented at the ACVS conferences is comparable to other biomedical conferences. The subject matter is limited in scope and focused mainly on dogs or horses. Most abstracts contained lower level of evidence. Studies with higher levels of evidence were submitted, accepted, and published more timely. However, the publication rate was similar for abstracts of all levels of evidence.