Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections.

OBJECTIVE: To report the rate of surgical site infections (SSIs) after clean-contaminated and dirty gastrointestinal surgery in dogs and cats that did and did not receive incisional infiltration of Nocita and report the bacteria isolated. ANIMALS: Client-owned dogs (n = 211) and cats (78). METHODS: Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and the University of Florida Small Animal Hospital between July 1, 2020, and April 1, 2023, were reviewed for surgical procedures, presence of preoperative septic peritonitis, use of Nocita, perioperative antibiotics administered, postoperative antibiotic use, SSI development postoperatively, and aerobic bacteria isolated. RESULTS: 7 of 124 (5.6%) dogs that received Nocita and 9 of 87 (10.2%) that did not receive Nocita developed an SSI. No dogs presenting with septic peritonitis and given Nocita (n = 5) developed an SSI. Two of 55 (3.6%) cats that received Nocita and 1 of 23 (4%) that did not receive Nocita developed an SSI. Multidrug-resistant (MDR) Escherichia coli was the most common aerobic bacteria isolated from SSIs (n = 3), and MDR bacteria were isolated commonly from both groups (4). CLINICAL RELEVANCE: Use of Nocita for gastrointestinal surgery in dogs and cats is not associated with higher rates of SSI than published rates of SSI after gastrointestinal surgery. Use of Nocita in dogs with preoperative septic peritonitis is not associated with the development of SSI. MDR bacteria are commonly isolated via culture from both dogs that received Nocita and those that did not.

Anoplasty and rectovaginal fistula repair in a gilt with atresia ani: A case report.

A 2-year-old female Vietnamese potbellied pig was referred to the Large Animal Teaching Hospital at the Ontario Veterinary College for anoplasty and rectovaginal fistula repair. The presence of atresia ani and rectovaginal fistula had been previously diagnosed. Contrast radiography was used to confirm the diagnosis and determine the position of the fistula and terminal rectum. Under general anesthesia, the urethra was catheterized. An incision was made at the anatomic location of the anus, the rectovaginal fistula was isolated through deep dissection, and a Penrose drain was placed around it for caudal retraction. Transvaginal catheter placement through the fistula and into the rectum assisted with anatomic location. Once the urogenital and gastrointestinal tracts were clearly identified, the fistula was transected as close to the vaginal cavity as possible. The vaginal defect was sutured, and the fistula tract was mobilized 90° and sutured to the skin, creating the anal canal. Postoperative complications included constipation and cystitis. The gilt passed feces 5 d after surgery and was discharged on Day 11 of hospitalization. Normal urination and defecation were observed at the time, and fecal incontinence was resolved. Six months after surgical intervention, the gilt remained continent and no complications were reported. Key clinical message: Anoplasty and rectovaginal fistula repair were completed successfully in a gilt. Preservation of the fistula and its use during anal reconstruction may provide an internal anal sphincter and may be associated with improved continence.

Anoplastie et réparation de la fistule recto-vaginale chez une cochette avec atrésie anale : rapport de cas. Une femelle cochon vietnamien de 2 ans a été référée au Large Animal Teaching Hospital du Ontario Veterinary College pour une anoplastie et réparation d'une fistule recto-vaginale. La présence d'une atrésie anale et d'une fistule recto-vaginale avait déjà été diagnostiquée. Une radiographie de contraste a été utilisée pour confirmer le diagnostic et déterminer la position de la fistule et du rectum terminal. Sous anesthésie générale, l'urètre a été cathétérisé. Une incision a été faite à l'emplacement anatomique de l'anus, la fistule recto-vaginale a été isolée par dissection profonde et un drain de Penrose a été placé autour d'elle pour la rétraction caudale. Le placement d'un cathéter transvaginal à travers la fistule et dans le rectum a aidé avec la localisation anatomique. Une fois les voies urogénitale et gastro-intestinale clairement identifiées, la fistule a été sectionnée aussi près que possible de la cavité vaginale. Le défaut vaginal a été suturé et le trajet de la fistule a été mobilisé à 90° et suturé à la peau, créant le canal anal. Les complications postopératoires incluaient la constipation et la cystite. La cochette a expulsé des matières fécales 5 jours après la chirurgie et a obtenu son congé le 11e jour d'hospitalisation. Une miction et une défécation normales ont été observées à ce moment-là, et l'incontinence fécale a été résolue. Six mois après l'intervention chirurgicale, la cochette présentait encore de la continence urinaire et aucune complication n'a été signalée.Message clinique clé :L'anoplastie et la réparation de la fistule recto-vaginale ont été réalisées avec succès chez une cochette. La préservation de la fistule et son utilisation lors de la reconstruction anale peuvent fournir un sphincter anal interne et peuvent être associées à une meilleure continence.(Traduit par Dr Serge Messier).

Prognostic indicators for survival in surgically managed small intestinal obstruction in pet rabbits: 141 presentations (2011-2021).

OBJECTIVE: To determine prognostic relevance of various patient factors and intraoperative variables associated with surgical management of small intestinal obstruction in pet rabbits. ANIMALS: 114 pet rabbits with 141 presentations of small intestinal obstruction treated surgically between June 2011 and December 2021. METHODS: In a retrospective observational study design, medical records were reviewed for rabbits with small intestinal obstruction that had undergone surgical intervention. Data were collected on variables of interest and outcome (survival to hospital discharge). Univariable and multivariable logistic regression analyses were performed to identify variables associated with survival. RESULTS: Overall survival was 75.2% (106/141). Specifically, 95.7% (22/23) of presentations involving rabbits < 25 months survived. The odds of survival on univariable modeling were significantly lower in presentations of rabbits > 72 months compared with those < 25 months (OR, 0.05; 95% CI, 0.01 to 0.40; P = .005). Rectal temperature, clinicopathologic findings, etiology of obstruction, presence of full-thickness gastrointestinal wall injury, and previous small intestinal obstruction surgery did not show significant effects on survival. In a multivariable model that controlled for plasma potassium and calculated plasma osmolarity and tonicity, the odds of survival in presentations of rabbits > 72 months were 95% lower than those < 25 months (OR, 0.05; 95% CI, 0.01 to 0.50; P = .012). CLINICAL RELEVANCE: Surgical intervention should be considered a suitable treatment option for small intestinal obstruction in rabbits < 72 months and carried a good prognosis. The most common etiology was consistent with a compressed hair pellet, and extraluminal digital manipulation into the cecum was a successful surgical technique in most presentations.

Partial volvulus, entrapment, and extraluminal obstruction of the jejunum in a cat.

A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been performed at 9 mo of age to remove a foreign body. Due to inconclusive findings on abdominal imaging, an exploratory laparotomy was done. An adhesion at the root of the mesentery, likely associated with the previous surgery, had resulted in partial volvulus, entrapment, and extraluminal obstruction of the jejunum. Transection of the adhesion allowed repositioning of the bowel without the need for resection. The cat was discharged from the hospital 7 d postoperatively. Adhesions have not previously been reported to cause small bowel volvulus in cats. Key clinical message: Abdominal adhesions as a cause of clinical disease in cats have apparently not been reported. This case report demonstrates how malposition of the gastrointestinal tract, secondary to adhesions, should be included as a differential diagnosis for feline patients presenting with acute abdomens. Previous abdominal surgery is a risk factor for development of adhesions. This case emphasized the importance of Halsted's principles of surgery to reduce the risk of postoperative adhesions, even in species not predisposed to forming adhesions.

Volvulus partiel, piégeage et obstruction extraluminale du jéjunum chez un chat. Une chatte à poil court, stérilisée et âgée de 2 ans a été présentée en choc hypovolémique compensé après 24 h d'anorexie, de vomissements et de léthargie. Une entérotomie avait été réalisée à 9 mo d'âge pour retirer un corps étranger. Étant donné les trouvailles d'imagerie abdominales non-concluantes, une laparotomie exploratoire a été effectuée. Une adhérence à la base du mésentère, probablement associée à la chirurgie antérieure, avait entraîné un volvulus partiel, un piégeage et une obstruction extraluminale du jéjunum. Une transection de l'adhérence a permis un repositionnement de l'intestin sans le besoin d'une résection. Le chat a obtenu son congé de l'hôpital 7 j postchirurgie. Des adhérences n'avaient pas encore été rapportées comme pouvant causer un volvulus du petit intestin chez les chats.Message clinique clé :Des adhérences abdominales comme cause de maladie clinique chez les chats ne semble pas avoir déjà été rapportées. Le présent cas montre comment le mauvais positionnement du tractus gastro-intestinal, secondaire à des adhérences, devrait être inclus dans la liste des diagnostics différentiels chez les patients félins présentés avec un abdomen aigu. Une chirurgie abdominale antérieure est un facteur de risque pour le développement d'adhérences. Le cas présent souligne l'importance du principe d'Halsted de chirurgie de réduire les risques d'adhérences post-opératoires, même si l'espèce n'est pas prédisposée à former des adhérences.(Traduit par Dr Serge Messier).

Clinical outcomes of the use of unidirectional barbed sutures in gastrointestinal surgery for dogs and cats: A retrospective study.

OBJECTIVE: To report the clinical outcomes of gastrointestinal surgery using unidirectional barbed sutures in single-layer appositional closure in dogs and cats. STUDY DESIGN: Retrospective and descriptive study. SAMPLE POPULATION: Twenty-six client-owned dogs; three client-owned cats. METHODS: Medical records of dogs and cats that received gastrointestinal surgery closed with unidirectional barbed sutures were reviewed to collect information on signalment, physical examinations, diagnostics, surgical procedures, and complications. Short- and long-term follow-up information was collected from the medical records, the owners, or the referring veterinarians. RESULTS: Six gastrotomies, 21 enterotomies, and nine enterectomies were closed with a simple continuous pattern with unidirectional barbed glycomer 631 sutures. Nine dogs had multiple surgical sites closed with unidirectional barbed sutures. None of the cases in the study developed leakage, dehiscence, or septic peritonitis during the 14-day short-term follow up. Long-term follow up information was collected for 19 patients. The median long-term follow-up time was 1076 days (range: 20-2179 days). Two dogs had intestinal obstruction due to strictures at the surgical site 20 and 27 days after surgery. Both were resolved with an enterectomy of the original surgical site. CONCLUSION: Unidirectional barbed suture was not associated with a risk of leakage or dehiscence after gastrointestinal surgery in dogs and cats. However, strictures may develop in the long term. CLINICAL SIGNIFICANCE: Unidirectional barbed sutures can be used during gastrointestinal surgery in client-owned dogs and cats. Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary.

A quantitative evaluation of the effect of foreign body obstruction and enterectomy technique on canine small intestinal microvascular health.

OBJECTIVE: To investigate sidestream dark field (SDF) videomicroscopy as an objective measure of intestinal viability and determine the effects of enterectomy techniques on intestinal microvasculature in dogs with foreign body obstructions. STUDY DESIGN: Prospective, randomized, clinical trial. ANIMALS: A total of 24 dogs with an intestinal foreign body obstruction and 30 systemically healthy dogs. METHODS: An SDF videomicroscope imaged the microvasculature at the site of the foreign body. Subjectively viable intestine received an enterotomy whereas nonviable intestine received an enterectomy using a handsewn (4-0 polydioxanone, simple continuous) or a functional end-to-end stapled technique (GIA 60 blue, TA 60 green) was used on an alternating basis. The microvasculature adjacent to the enterectomy was interrogated. Quantitative measures of microvascular health were calculated for each site and compared with healthy dogs. RESULTS: Microvascular density (mean ± SD) at the site of obstruction (140.84 ± 77.40) was lower than healthy controls (251.72 ± 97.10, p < .01). There was no difference in microvascular parameters (density or perfused boundary region, PBR) between obstructed dogs with subjectively viable and nonviable intestine (p > .14). The density (p = .66) and PBR of microvessels (p = .76) adjacent to the sutured enterectomy or TA green staple line did not differ. CONCLUSION: Sidestream dark field videomicroscopy can identify obstructed intestine and quantitate the severity of microvascular compromise. Handsewn and stapled enterectomies equally preserve perfusion. CLINICAL SIGNIFICANCE: Stapled enterectomies do not lead to greater vascular compromise than handsewn enterectomies.

Surgical removal of intestinal foreign bodies using a laparotomy-assisted endoscopic approach in dogs and cats and comparison with enterotomy.

OBJECTIVES: To describe a novel surgical technique for intestinal foreign body removal without enterotomy using a laparotomy-assisted endoscopic approach and compare short-term outcomes to enterotomy. MATERIALS AND METHODS: Medical records of dogs and cats with intestinal foreign bodies that underwent attempted treatment with a laparotomy-assisted endoscopic approach between June 2019 and July 2021 were extracted. The approach consisted in manoeuvring the intestinal foreign body into the stomach during laparotomy and then removing it via a gastroscopy. If the foreign body was unmovable, an enterotomy was performed. RESULTS: Fifty-eight cases were enrolled and foreign bodies were successfully removed in 25 cases using a laparotomy-assisted endoscopic approach. The median distance between the pylorus and the proximal part of the foreign body was 55 cm (range: 0 to 300). The mean surgical time and median endoscopic time were 49 minutes (±sd 12.8) and 5 minutes (range: 2 to 28), respectively. All but two cases were discharged 1 day postoperatively. In 20 cases, the foreign body was not easily movable, and an enterotomy was performed. In three of these cases, conversion to enterotomy was required due to serosal tears that occurred as a consequence of the attempted retrograde manipulation of the foreign body. Foreign body width, length and distance to pylorus were not significantly different between the two techniques. Mean surgical time was significantly shorter for laparotomy-assisted endoscopic approach compared to enterotomy: 49 minutes (±SD 12.8) versus 61.7 minutes (±SD 14.6). CLINICAL SIGNIFICANCE: Surgical removal of intestinal foreign bodies through a laparotomy-assisted endoscopic approach is a feasible technique that offers satisfactory outcomes and shorter surgical time than enterotomy. Retrograde manipulation of the intestinal foreign body may result in serosal tears.

Serial venous lactate measurement following gastrointestinal surgery in horses.

BACKGROUND: Prospective clinical study of blood lactate concentration in horses undergoing colic surgery is needed to determine utility in outcome prediction. OBJECTIVES: To evaluate venous lactate measurements in horses following colic surgery, including immediately after anesthetic recovery and daily throughout hospitalization, as well as to determine if lactate concentrations were significantly higher in horses that developed postoperative complications or did not survive to hospital discharge. METHODS: Horses > 1 year of age undergoing surgery for colic and recovered from general anesthesia were sampled. A portable lactate meter was used to measure venous samples collected immediately following anesthetic recovery and daily throughout hospitalization. Complications arising during hospitalization and survival to hospital discharge were recorded. RESULTS: Fifty one horses were enrolled, ranging in age from 2 to 29 years. Lactate concentration immediately following anesthetic recovery was higher in horses that developed complications during hospitalization (p = 0.046). The odds of developing complications postoperatively were doubled for horses with a venous lactate concentration > 5 mmol/L. Lactate measurements in non-survivors were significantly higher compared to survivors by 96 h postoperatively (p < 0.006). CONCLUSIONS: Higher venous lactate concentrations in the postoperative colic period were associated with an increased risk of complications and death. Results suggest horses with higher venous lactate measurements in recovery are more likely to have postoperative complications, with the odds of developing complications doubled for horses with a venous lactate > 5 mmol/L. Evaluation of venous lactate could provide information on prognosis in the postoperative period for horses with surgical colic.

Laparoscopic colopexy for recurrent rectal prolapse in a Maltese dog.

A 2.5-kg castrated male Maltese dog, suspected to be older than 10 y, was presented with a prolapsed mass at the anus. This had occurred on 2 previous occasions within the last 4 mo and had been managed with manual reduction and purse-string sutures. The rectal prolapse had viable tissue and was reducible but resulted in straining and fecal accumulation. Colopexy (with intracorporeal sutures) was performed laparoscopically using 3 ports; the distal colon was retracted cranially and attached to the abdominal wall with 3 simple interrupted sutures in a single row. The dog recovered uneventfully, had good appetite and normal activity, did not strain, and defecated without issues. There were no wound-healing complications and at 12-month post-operative examination, the patient was in good condition without clinical signs. Based on this case report, laparoscopic colopexy is clinically practical for management of rectal prolapse in small-breed dogs.

Colopexie laparoscopique pour prolapsus rectal récurrent chez un chien maltais. Un chien maltais mâle castré de 2,5 kg, suspecté d'avoir plus de 10 ans, a été présenté avec une masse faisant prolapsus à l'anus. Cela s'était produit à deux reprises au cours des quatre derniers mois et avait été géré avec une réduction manuelle et des sutures en bourse. Le prolapsus rectal avait des tissus viables et était réductible mais a entraîné des efforts et une accumulation fécale. La colopexie (avec sutures intracorporelles) a été réalisée par laparoscopie à l'aide de trois ouvertures; le côlon distal a été rétracté crânialement et attaché à la paroi abdominale avec trois sutures interrompues simples en une seule rangée. Le chien s'est rétabli sans incident, avait un bon appétit et une activité normale, ne s'est pas fatigué et a déféqué sans problème. Il n'y avait pas de complications de cicatrisation et lors de l'examen postopératoire de 12 mois, le patient était en bon état sans signes cliniques. Sur la base de ce rapport de cas, la colopexie laparoscopique est cliniquement pratique pour la gestion du prolapsus rectal chez les chiens de petite race.(Traduit par Dr Serge Messier).

Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008-2019).

OBJECTIVES: To identify and describe the type and frequency of perioperative factors in dogs and cats undergoing pancreatic surgery under referral care. METHODS: Medical records from a small animal surgical referral practice were retrospectively reviewed to identify dogs and cats that underwent pancreatic surgery between 2008 and 2019. Inclusion criteria included complete medical record, histopathology results and follow-up of at least 14 days postoperatively or until death. Variables collected included signalment, history, presenting complaint, preoperative diagnostic results, intraoperative complications, surgical findings/procedures, postoperative complications and histopathology results. Cases were excluded if pertinent information or a histopathology report was missing from the medical record. The frequency of these variables was reported. RESULTS: There were 81 client-owned animals identified that met the inclusion criteria (57 dogs and 24 cats). The most common pancreatic procedure performed in dogs was partial pancreatectomy 63.2% (36/57) and in cats was pancreatic biopsy 62.5% (15/24). The most common histologic diagnosis in dogs was pancreatic islet cell carcinoma 50.9% (29/57) and in cats was pancreatitis 41.7% (10/24). The overall mortality rate was 13.6% (11/81), with a 10.5% (6/57) mortality rate in dogs and a 20.8% (5/24) mortality rate in cats. CLINICAL SIGNIFICANCE: In this series of dogs and cats, pancreatic surgery under referral care carried a low to moderate mortality rate.

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.

Current Concepts in Small Animal Gastrointestinal Surgery.

Both handsewn and stapled anastomosis techniques are performed commonly in veterinary medicine. This article discusses variations and comparisons of these techniques with different suture patterns, suture materials, types of stapling equipment, and staple sizes along with benefits of surgical reinforcement techniques and leak testing. In addition, a minimally invasive surgical approach for gastrointestinal surgery is discussed briefly. This article also briefly highlights current research under way in determining more accurate means of assessing intestinal tissue viability, because determining when and where to resect compromised, and potentially devitalized, intestine is of utmost importance for patient outcomes.

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.

Comparison of liberal and goal-directed fluid therapy after small intestinal surgery for strangulating lesions in horses.

BACKGROUND: There are few guidelines for the appropriate mode of fluid administration during and after colic surgery, and is challenging to reach the right balance while avoiding overhydration. This study aimed to compare goal-directed fluid therapy (GDFT) and 'liberal' fluid regimens (LFRs) in horses undergoing small intestinal surgery. METHODS: Eighteen horses subjected to small intestinal surgery were matched according to the surgical lesion, type of anastomosis, length of resection, and duration of clinical signs. Horses in the LFR group were administered intravenous (IV) fluids for at least 24 h. In the GDFT group, IV fluids were administered only when considered necessary based on clinical parameters. Postoperative reflux (POR), packed cell volume, total protein, heart rate, venous lactate level, complications, and long-term survival rates were compared. RESULTS: Three horses in the LFR and one in the GDFT group developed POR. Horses in the GDFT group had a shorter time interval to first oral water intake and shorter hospitalisation time. Postoperative complication rates and survival were not different between groups. CONCLUSION: Further studies are necessary to set guidelines for the evaluation of hydration status and to plan postoperative fluid administration; however, GDFT may be a valid alternative to liberal fluid therapy after colic surgery.

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.

Evaluation of the sublingual microcirculation with sidestream dark field video microscopy in horses anesthetized for an elective procedure or intestinal surgery.

OBJECTIVE: To compare the sublingual microcirculation between healthy horses anesthetized for elective procedures and horses with colic anesthetized for abdominal surgery and to determine the effect of mean arterial blood pressure (MAP) on the microcirculation. ANIMALS: 9 horses in the elective group and 8 horses in the colic group. PROCEDURES: Sublingual microcirculation was assessed with sidestream dark field video microscopy. Videos were captured at 3 time points during anesthesia. Recorded microvasculature parameters were De Backer score (DBS), total density of perfused vessels (PVD) and small vessels (PVD-S), total proportion of perfused vessels (PPV) and small vessels (PPV-S), vascular flow index (MFI), and heterogeneity index (HI). Blood pressure during hypotensive (MAP < 60 mm Hg) and normotensive (MAP ≥ 60 mm Hg) episodes was also recorded. RESULTS: During normotensive episodes, the elective group had significantly better PPV and PPV-S versus the colic group (median PPV, 76% vs 50%; median PPV-S, 73% vs 51%). In both groups, PPV decreased during anesthesia (elective group, -29%; colic group, -16%) but significantly improved in the elective group 15 minutes before the end of anesthesia (59%). During hypotensive episodes, PVD-S was better preserved in the colic group (11.1 vs 3.8 mm/mm2). No differences were identified for the microcirculatory parameters between normo- and hypotensive episodes in the colic group. CONCLUSIONS AND CLINICAL RELEVANCE: Sublingual microcirculation was better preserved in healthy horses anesthetized for elective procedures than in horses with colic anesthetized for abdominal surgery despite resuscitation maneuvers. Results indicated that the macrocirculation and microcirculation in critically ill horses may be independent.

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.

Outcome following surgery to treat septic peritonitis in 95 cats in the United Kingdom.

OBJECTIVES: To review the cause, management and outcome in cats with septic peritonitis within the United Kingdom (2008 to 2018) and to identify if previously identified prognostic factors were associated with survival in this population. MATERIALS AND METHODS: Clinical records from 10 referral hospitals in United Kingdom were reviewed. Data collected included signalment, clinicopathological data and management techniques. Serum albumin, glucose, lactate and ionised calcium concentration; presence of intraoperative hypotension and correct empirical antibiosis were analysed via logistic regression for association with survival. RESULTS: Ninety-five cats were included. The overall survival rate was 66%. Lethargy (89%) and anorexia (75%) were the most common clinical signs, with abdominal pain and vomiting in 44% and 27% of cases, respectively. Gastro-intestinal leakage was the most common source of contamination. The presence of an abdominal mass on clinical examination was not strongly predictive of the presence of neoplasia on histology and did not confer a worse prognosis. Cats presenting with dehiscence of a previous enterotomy/enterectomy did not have a worse prognosis than those presenting with other aetologies. Intraoperative hypotension (adjusted odds ratio 0.173, 95% confidence intervals 0.034 to 0.866, P=0.033) was associated with non-survival. Cats that survived beyond 1 day postoperatively had an improved likelihood of survival (87.5%). All cats that survived beyond 6 days were successfully discharged. CLINICAL SIGNIFICANCE: This study describes the largest group of cats with septic peritonitis with an overall survival rate of 66%. The presence of an abdominal mass on clinical examination or having dehiscence of a previous gastrointestinal surgery did not confer a worse prognosis.

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008-2019).

OBJECTIVE: To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine. ANIMALS: 131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA). PROCEDURES: Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up. RESULTS: Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques. CONCLUSIONS AND CLINICAL RELEVANCE: Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

Assessment of biomarkers influencing treatment success on small intestinal lymphoma in dogs.

This study aimed to determine a reliable therapeutic biomarker for localized small intestinal lymphoma (SIL) in dogs based on clinical and histopathological features. We retrospectively investigated 84 dogs with localized SIL, including 36 dogs receiving surgery and 48 dogs receiving chemotherapy. The dogs receiving surgery were divided into two subgroups: 18 dogs (group 1) with overall survival (OS) <120 days (median OS) and 18 dogs (group 2) with OS ≥120 days. Correspondingly, the dogs receiving chemotherapy were divided into 24 dogs (group 3) with OS <98 days (median OS) and 24 dogs (group 4) with OS ≥98 days. Clinical, haematological, histopathological and immunohistochemical analyses were comparatively evaluated among the four subgroups. There was no significant difference in OS between the surgery and chemotherapy groups. In dogs receiving surgery, the rate of Ki67-positive cells was significantly increased in group 1 compared to group 2 and showed no significant difference between groups 3 and 4. In dogs receiving chemotherapy, the rate of O6-methylguanine-DNA methyltransferase (MGMT) was significantly higher in group 3 than in group 4 and showed no significant difference between groups 1 and 2. Additionally, our data showed that OS in dogs with higher Ki67 expression might be significantly increased by chemotherapy than by surgery, that of those with higher MGMT expression might be significantly increased by surgery than by chemotherapy, and Ki67 and MGMT were independent of each other. Indices of Ki67 and MGMT are suggested therapeutic biomarkers to determine the optimal first-line treatment for localized SIL in dogs.