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1.
Surgical stapling equipment was used to perform an end-to-end colonic anastomosis in 15 cats for the treatment of acquired megacolon. An end-to-end stapling device was passed to the anastomotic site by a trans-cecal approach. Subsequent closure of the cecal incision was accomplished with a thoracoabdominal stapling device. Two cats had hemorrhagic episodes immediately after surgery that required blood transfusions. All 15 cats have had good to excellent health after subtotal colectomy and colocolostomy performed using this stapling technique. Results of this study have demonstrated that "single surgical field" placement of the end-to-end stapling device has the primary advantage of simplicity and a lower chance of contamination compared with (dual field) rectal passage of similar devices. Closure of the cecal access incision is easily performed without reducing the diameter of the large intestinal lumen. The stapling technique provided an efficient and consistent method for anastomosis of the large bowel in cats.  相似文献   

2.
This prospective clinical study evaluated the use, complications, and clinical and ultrasonographic follow-ups of end-to-end intestinal anastomoses with skin staples in naturally occurring diseases in canine small and large intestines. Intestinal anastomoses were performed in 14 dogs and pre-, peri-, and postoperative data were recorded. Postoperative clinical and ultrasound evaluations were performed at regular intervals for 1 year. The mean time taken to construct the anastomosis was 5 min. There were no intraoperative complications. Hemorrhage and colonic stricture were the main postoperative complications. Staple loss occurred in 2 cases. Absence of wall layering and focal wall thickening were observed in all cases at each ultrasonographic follow-up. Hyperechoic fat was observed in all but 1 of the cases at month 1. Nine dogs were alive with normal digestive function at the end of the study. The skin stapler technique enabled rapid construction of consistent anastomoses with inexpensive stapling material.  相似文献   

3.
OBJECTIVES: To evaluate the use of a gastrointestinal anastomosis (GIA) stapling device to perform small intestinal anastomosis in the dog. METHODS: A retrospective study to evaluate the use of a GIA stapling device to perform small intestinal anastomosis in 15 dogs. RESULTS: Reasons for intervention included dehiscence of a previous enterotomy (four of 15), intestinal neoplasia (five of 15), vascular compromise (three of 15), intussusception (two of 15) and foreign body (one of 15). The mean time taken to perform the anastomosis was 7.7 minutes (range five to 12 minutes). No operative complications were recorded and all dogs recovered from the surgery. Major (two dogs) and minor (six dogs) short-term complications of pyrexia and anorexia were recorded in six dogs. In five of these, the cause was considered to be related to a pre-existing peritonitis. One dog was euthanased five months postoperatively for a multi-centric recurrence of intestinal lymphoma. Six month follow-up confirmed an unremarkable and complete recovery in all remaining dogs. No major or minor long-term complications were recorded in any individual. CLINICAL SIGNIFICANCE: A modified stapled functional end-to-end intestinal anastomosis holds merit and should be considered a viable alternative to other stapled and sutured anastomosis techniques.  相似文献   

4.
OBJECTIVE: To describe a novel stapling technique for creation of a complete cecal bypass, without ileal transection in horses. STUDY DESIGN: Experimental study. ANIMALS: Four adult horses. METHODS: Through a ventral median celiotomy, jejunocolostomy was made with an intraluminal anastomosis device (ILA-100) and oversewn with a Cushing pattern to reinforce the staple line. Immediately distal to the anastomosis, 4 rows of staples were applied using a thoracoabdominal stapling device (TA-90) to occlude the lumen of the distal jejunum and proximal ileum. Necropsy exams were performed at least 60 days after surgery. RESULTS: No intraoperative complications occurred. Cecal bypass was functional in all horses at necropsy. The most oral staple line across the ileum partially failed in 1 horse; however cecal bypass was functional. CONCLUSIONS: Complete cecal bypass without ileal transection is a viable alternative to traditional methods of complete cecal bypass. Two sets of staple lines across the ileum are recommended. Longer term follow-up is warranted before clinical use of this technique. CLINICAL RELEVANCE: Cecal bypass without ileal transection is technically simple and effectively bypasses the cecum. It also should intuitively require less time and have a reduced risk of contamination compared with complete cecal bypass with ileal transection.  相似文献   

5.
A subtotal colectomy was performed on 12 normal adult cats using an interrupted apposing suture pattern of monofilament polyglyconate (n = 6) or a biofragmentable intestinal anastomosis ring (Valtrac, Davis and Geek Company, Danbury, CT) (n = 6) composed of polyglycolic acid and barium sulfate. Abdominal radiographs were made daily, beginning 10 days after surgery, to determine fragmentation rates of the anastomosis ring. The cats were euthanatized 30 days after surgery, and a gross and histopathological evaluation of anastomotic healing and stricture formation was performed. The technique for implantation of the anastomosis ring was easy to learn and required only two purse string sutures to complete. Intraoperative complications associated with the anastomosis ring were minor, and included problems with purse string suture placement, small serosal tears, and spasms of the colon that reduced the lumenal diameter. There were no intraoperative complications in the cats with sutured anastomoses. Postoperative recovery was uneventful in all cats. The anastomosis rings fragmented 12.2 ± 1.1 days (mean ± standard deviation [SD]) after implantation and passed in the stool 3.8 ± 1.9 days later without clinical signs in five of six cats. There were no statistically significant differences between the time required to perform the anastomosis ( P = .348), postmortem gross anastomosis grades ( P = .088), or percent of lumenal stricture ( P = .178) between the two groups. Histologically, the only significant differences were an increased muscular inversion in the anastomoses performed using the fragmentable ring ( P = .039) and an increased muscular eversion in the sutured anastomoses ( P < .001) compared with normal colonic architecture.  相似文献   

6.
Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were introduced into the tunnels, and the device was fired to create the gastropexy. One dog died of systemic sequelae of GDV during the early postoperative period. None of the remaining 19 dogs developed a recurrence of GDV during follow-up periods ranging from 5 to 43 months. In 11 dogs, the integrity of the gastropexy was evaluated by abdominal ultrasonography and either negative contrast gastrography or double contrast gastrography; in these dogs, the radiographic and/or the ultrasonographic findings were suggestive of an intact gastropexy. There were no complications involving the gastropexy staple line. The results of this study indicate that an effective and consistent permanent gastropexy can be created, using surgical stapling equipment.  相似文献   

7.
OBJECTIVE: To report use of a biofragmentable anastomosis ring (BAR) device in cats with idiopathic megacolon (FIM) and compare outcome after subtotal colectomy with sutured colocolic anastomosis. STUDY DESIGN: Retrospective study. ANIMALS: Nineteen cats with megacolon. METHODS: Medical records (January 1990-January 2004) of cats treated surgically for idiopathic megacolon with sutured (SUT) or BAR anastomosis were retrieved and reviewed. Operative, short- and long-term complications, and survival times were recorded and Kaplan-Meier survival analysis used to assess outcome. RESULTS: There were 11 SUT and 8 BAR cats. One BAR cat had anastomotic dehiscence 36 hours after surgery. Mild serosal tearing during BAR insertion in 6 cats was corrected by suture reinforcement. One SUT cat developed anastomotic stricture at 32 days. Short-term complication rates at 3 and 7 days were 18% and 45% in the SUT group and 25% and 87.5% in the BAR group, respectively (P=.058). Two SUT cats had persistent loose stool consistency and were euthanatized 254 and 1661 days after surgery. One BAR cat had recurrence of constipation which was managed medically. Long-term complication rates were not significantly different between SUT and BAR (P=.61). The 1 and 4-year survival rates were 90% for SUT and 100% for BAR (P=.29). CONCLUSIONS: No difference was detected for short and long-term complication rates and survival times between SUT and BAR groups. CLINICAL RELEVANCE: The BAR device can be used for colocolic anastomosis in cats with idiopathic megacolon. Serosal tearing during BAR insertion was a common intraoperative complication. Regardless of anastomotic technique, survival outcome after colonic resection is excellent for cats with FIM.  相似文献   

8.
An oblique end-to-side anastomosis of one ureter to the contralateral ureter (transureteroureterostomy) may permit salvage of a kidney whose middle or distal ureter is not salvageable by standard repair techniques. This procedure was done with intraoperative magnification and microsurgical techniques in 5 experimental dogs. Animals were euthanized for healing studies at 1, 3 and 5 weeks, and the results correlated with postoperative and preterminal excretory urograms. Healing of the anastomosis was organized by layers and completed both grossly and histologically in all animals at 5 weeks. Ureter function was retained except for short-term, mild, postoperative hydroureter. Potential clinical indications for transureteroureterostomy are: 1) middle or distal ureteral transection due to trauma; 2) delayed recognition of iatrogenic intraoperative severence or ligation; 3) distal ureteral neoplasia; and 4) selected cases of ectopic ureter. Complications include dehiscence, stricture, or the dissemination of infection or neoplasia which would compromise proximal ureters and both kidneys.  相似文献   

9.
Ten animals (8 dogs and 2 cats) with distal rectal lesions were treated by surgically resecting the affected segment of the rectum by the rectal pull-through technique. There were four malignant tumors, three benign tumors, two inflammatory lesions, and one malignant tumor that extended histologically to the margins of a previous surgical excision. Postoperative complications were tenesmus (7 animals), fecal incontinence (4 animals), rectal bleeding (4 animals), and abscess formation (1 animal). Dehiscence and stricture were not observed. The four animals with malignant tumors survived less than 12 months after surgery. One of the four animals still living has persistent fecal incontinence. The rectal pull-through technique is described and illustrated.  相似文献   

10.
A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.  相似文献   

11.
Objective —To describe an alternative technique for large colon resection and anastomosis in horses.
Study Design —Retrospective study of clinical patients.
Animal Population —37 horses that had ventral midline celiotomies between July 1, 1990, and July 1, 1994.
Methods —Large colon resection and anastomosis was performed using a modification of previously described techniques. Modifications include mesocolon ligation with a stapling device and an end-to-end apposition of the right ventral and right dorsal colon.
Results —Twenty-one of the 37 horses were discharged from the hospital without complications. Two horses were euthanatized immediately after recovery from anesthesia because of hindlimb fracture. Fourteen horses were euthanatized in the initial postoperative period because of persistent endotoxemia and abdominal pain.
Conclusions —The described technique is a safe, reliable method for large colon resection and anastomosis in horses.
Clinical Relevance —The described technique is fairly simple to perform and requires less surgical time compared with other techniques.  相似文献   

12.
Surgical stapling devices in veterinary medicine: a review   总被引：1，自引：1，他引：0  
Objectives— To review indications, benefits, and complications of surgical stapling in animals.
Study Design— Literature review.
Results— Benefits and complications of surgical stapling depend on the procedure performed. Use of surgical staplers does not improve wound strength but may decrease surgical time.
Clinical Relevance— In patients at significant risk for intraoperative contamination or morbidity from prolonged anesthesia time, use of stapling devices should be considered.  相似文献   

13.
Objective— To describe an unusual long-term complication of circular end-to-end anastomosis (CEEA) stapling in a dog.
Study Design— Clinical case report.
Animal— An 11-year-old, female neutered, Labrador Retriever.
Methods— The dog was referred for clinical signs of bowel obstruction. An enterectomy was performed 2 years before presentation using a CEEA stapling device. Palpation, plain radiographs, and ultrasound of the abdomen confirmed the presence of a mass in the bowel, causing obstruction, and requiring surgical approach.
Results— An exploratory celiotomy revealed a 5 cm mass in the jejunum, involving the site of the previous surgery. The mass was removed by enterectomy. Dissection of the mass revealed the presence of many staples at the previous enterectomy site, and a trichobezoar entangled in the exposed parts of the staples.
Conclusions— An enterectomy was required to treat an intestinal obstruction caused by a trichobezoar entangled in a CEEA-stapled anastomosis.
Clinical Relevance— Development of trichobezoar and subsequent bowel obstruction should be considered an unusual but potential long-term complication of CEEA-stapled anastomosis.  相似文献   

14.
Fourteen horses with cecal impaction were treated by cecocolic anastomosis. In nine horses, the anastomosis followed enterotomy and evacuation of the cecal contents, and in two horses it followed saline infusion and massage of the cecum. In three horses, the anastomosis was the only surgical procedure performed. Cecocolic anastomosis was performed between the lateral and dorsal cecal teniae, and the lateral and medial free teniae of the right ventral colon. The anastomosis was hand sutured in five horses. In all other horses, the GIA surgical stapling instrument was used in combination with hand sutured seromuscular layer closures and became the preferred surgical technique. The anastomosis allowed an alternative route for the transit of ingesta from the cecum to the right ventral colon.
Twelve of the 14 horses survived 2 months or longer after surgery (short-term survival rate, 86%) and 10 horses survived 12 months or longer after surgery (long-term survival rate, 71%). Early postoperative complications included mild abdominal pain (6 horses), wound infections (3 horses), fatal peritonitis (2 horses), and large colon distention necessitating reoperation (2 horses).  相似文献   

15.
OBJECTIVE: To compare functional indices of end-to-end (EEA) jejunojejunal anastomosis using skin staples in horses with a 2-layer inverting hand-sewn technique. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Jejunal segments from 8 fresh equine cadavers. METHODS: For each bowel segment, 2 EEA anastomoses were created: one 2-layer hand-sewn and one 1-layer using skin staples. Time for anastomosis creation was recorded and compared. Lumen diameter of each anastomosis was measured on digital radiographs after intraluminal instillation of contrast medium and inflation of the jejunal segments to 14 mm Hg. Anastomotic indices (a compensated measure of stoma diameter) and bursting pressure were determined. RESULTS: EEA jejunal anastomosis using skin staples was significantly faster than use of a 2-layer hand-sewn technique. Anastomotic index, a measure of lumen size, was significantly larger with the skin-staple technique; however, the bursting pressure of stapled anastomoses was significantly less than for the hand-sewn technique, but the values were well above those reported for other anastomotic techniques. CONCLUSIONS: An anastomotic technique using skin staples was easy to learn and perform, effective and faster, and mechanically comparable with a hand-sewn 2-layer technique. CLINICAL RELEVANCE: The staple technique could be beneficial in equine gastrointestinal surgery by reducing anastomosis time, although further in vivo studies are needed to establish clinical safety.  相似文献   

16.
Objectives: To report experience with laparoscopic‐assisted intestinal resection and anastomosis for treatment of discrete intestinal masses using a novel wound retraction device. Study Design: Case series. Animals: Dogs (n=2) and cats (6). Methods: Dogs and cats with discrete intestinal masses identified by ultrasonography without evidence of intestinal perforation or peritonitis, were included. A 2 portal technique was used; 1 portal was enlarged for insertion of the wound retraction device through which the intestine was examined as thoroughly as possible. The diseased portion of the intestine was exteriorized through the wound retractor and resection and anastomosis of the intestinal mass performed. Results: Of the 8 animals, laparoscopic‐assisted intestinal resection and anastomosis through the wound retractor was performed in 2 dogs and 3 cats. In 3 cats, based on either location or extent of the lesion, 2 were converted to laparoscopic‐assisted intestinal biopsies and 1 to an open colocolostomy. No other intra‐ or perioperative complications were encountered and all animals survived to discharge. Conclusions: Laparoscopic‐assisted intestinal resection and anastomosis can be performed in select canine and feline patients with modestly sized, discrete intestinal masses.  相似文献   

17.
Surgical stapling for repair of a rectal tear in a horse   总被引：1，自引：0，他引：1  
A grade-4 rectal tear in a mare was successfully repaired per rectum, using a surgical stapling device. The mare had only minor postoperative complications. This technique has some advantages over previously described procedures, but should be reserved for use in selected cases.  相似文献   

18.
Surgical stapling equipment was used to perform open antiperistaltic side-to-side ("functional end-to-end") entero-anastomoses in 20 dogs and 4 cats. Twenty-one anastomoses healed uneventfully. Seven animals with severe bacterial peritonitis required open peritoneal drainage and delayed abdominal closure. There was postoperative leakage at the anastomotic site in two dogs and a localized abscess at the staple line in one cat. No long-term complications occurred in follow-up periods of 3 to 29 months.  相似文献   

19.
An inverting, triangulated, stapled, end-to-end anastomosis technique was evaluated in the jejunum of four horses. None of the horses showed evidence of gastrointestinal disturbance after surgery; however, stricture and adhesion formation were pronounced in three animals examined 10 days, one month, and two months after surgery. The animal examined four months after surgery had no adhesions present at the anastomosis, and only mild narrowing of the intestinal lumen. Histologic examination of the anastomoses showed lack of a normal mucosal lining in some examined sections up to two months postsurgery. While mucosal and serosal continuity were eventually reestablished, this was not true of the muscularis, the ends of which were joined by fibrous tissue. Gaps in the staple line and malalignment of staples were present in the animal examined four months after surgery, indicating migration and/or loss of the staples from the anastomosis. The inverting, triangulated staple technique had little or no apparent advantages over previously reported results with similar everting techniques. The severity of adhesions observed with the inverting technique suggests that the adhesions observed with the similar everting technique may not be due solely to the everted nature of the anastomosis.  相似文献   

20.
Three intrapelvic urethral anastomosis techniques were performed on 12 mature male dogs to compare the degree of stricture. The intrapelvic urethra was transected 1 cm caudal to the prostate, and anastomosis was performed using either suturing of the urethra over an indwelling catheter, suturing of the urethra without an indwelling catheter, or apposition of the urethra without sutures over an indwelling catheter. Postoperatively, the dogs were evaluated using clinical urination patterns, biochemical tests, radiography, and pathology. Three of four suture-catheter dogs and one of four catheter-only dogs had normal urinary patterns. Stricture (25-84%) with urethral dilation or fistulas tracts was visible on retrograde, positive contrast urethrograms of 3 of 12 intact dogs 20 weeks after surgery, and on all 12 excised lower urinary tracts. Suture-catheter dogs subjectively had the least amount of stricture. All eight dogs (1 suture-catheter dog, 4 suture-only dogs, and 3 catheter-only dogs) with severe stricture (greater than 60% lumen diameter reduction) had histopathologic signs of chronic, inflammatory urinary tract disease, including four with chronic, ascending lymphocytic pyelonephritis. Hydroureter and hydronephrosis developed in two catheter-only dogs. Complete urethral transection resulted in some degree of stricture, regardless of technique used for anastomosis. Urethral anastomosis over an indwelling catheter appeared to result in a lesser degree of stricture and clinical and histopathologic derangement.  相似文献   

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