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1.
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   

2.
Angiography during intestinal healing following single-layer inverting, everting, and end-on anastomoses was carried out in 18 calves. Six anastomoses using the same technique were performed in each animal. Six anastomoses, along with one main artery supplying the anastomotic site, were removed from each calf on the first, third, seventh, 15th, 21st, and 28th postoperative days. Angiograms of tubular intestinal segments were obtained after intraarterial infusion of 2–3 ml of sodium iothalamate and lead suspension. Lead-infused intestinal segments were cut open through the mesenteric border to obtain additional angiograms of flat bowel. Angiograms in the early stage of intestinal healing revealed hypervascularity at the cut edges and an avascular zone at the suture line. These changes were more intense with the everting than with the inverting and end-on techniques. The sprouting of vessels at the anastomotic junction and their crossing over started on third postoperative day but were clearly visualized only after the seventh postoperative day. By 15–21 days after operation, anastomotic sites were almost completely revascularized for all techniques. Everted anastomosis elicited more intense vascular response and resulted in earlier vascularization than the other two techniques. No appreciable differences in the pattern of revascularization were observed with inverting and end-on anastomoses. Lead suspension proved to be better than sodium iothalamate for such studies. Angiograms of the open bowel provided more realistic and confirmatory information regarding the sequence of vascular-changes at the suture line.  相似文献   

3.
OBJECTIVE: To evaluate single and double layer end-to-end anastomosis in equine jejunum. STUDY DESIGN: Experimental in vitro study. ANIMALS: Mid-jejunal sections from 12 adult horses without gastrointestinal disease. METHODS: Jejunal end-to-end anastomoses were performed by a continuous Lembert pattern or a simple continuous pattern oversewn with a Cushing pattern. Jejunal segments were distended with fluid at 1 L/min, and intraluminal pressure at failure, and mode of failure were recorded. Bursting pressure and bursting wall tension were calculated. Anastomosis construction time and degree of luminal reduction were recorded. Results- Single layer anastomoses were constructed in less time than 2-layer anastomoses. Both anastomotic techniques resulted in luminal reduction compared with control tissue; however, the reduction was smaller with a 1-layer continuous Lembert anastomosis. No differences were noted in bursting pressure or bursting wall tension between groups. CONCLUSIONS: Anastomosis using a 1-layer continuous Lembert pattern resulted in a larger stoma, was faster to perform, and as strong as a 2-layer anastomosis. CLINICAL RELEVANCE: Use of a 1-layer continuous Lembert pattern for jejunojejunosotomy may be beneficial by decreasing anastomosis time and produce a larger stoma than a 2-layer anastomosis.  相似文献   

4.
OBJECTIVE: To report a technique for closed-bowel 1-layer inverting end-to-end jejunojejunal anastomosis in horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Fresh cadaveric jejunal segments from 12 horses. METHODS: For each bowel segment a 1-layer closed and a 2-layer inverting end-to-end jejunojejunosotomy was created. Anastomosis construction time and anastomotic bursting pressure were measured and compared. RESULTS: Closed-bowel anastomosis was significantly faster to create than a 2-layer technique. Luminal narrowing (<30%) was similar with both techniques and comparable with other inverting techniques. Bursting pressure was significantly higher for the 2-layer technique, although all anastomoses resisted pressures higher than those reported for other jejunojejunal anastomosis techniques. CONCLUSIONS: A 1-layer hand-sewn, closed, inverting jejunojejunosotomy using a modified Doyen clamp was easy and faster to perform, and resulted in functional characteristics similar to, a 2-layer hand-sewn inverting technique. CLINICAL RELEVANCE: A closed, 1-layer inverting technique could be considered for equine jejunal anastomosis but requires in vivo evaluation before recommendation for clinical use.  相似文献   

5.
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6.
Objectives: To describe stapled 1‐stage functional end‐to‐end intestinal anastomosis for treatment of small intestinal obstruction in dogs and evaluate outcome when the technique is performed by nonexpert surgeons after limited training in the technique. Study Design: Case series. Animals: Dogs (n=30) with intestinal lesions requiring an enterectomy. Methods: Stapled 1‐stage functional end‐to‐end anastomosis and resection using a GIA‐60 and a TA‐55 stapling devices were performed under supervision of senior residents and faculty surgeons by junior surgeons previously trained in the technique on pigs. Procedure duration and technical problems were recorded. Short‐term results were collected during hospitalization and at suture removal. Long‐term outcome was established by clinical and ultrasonographic examinations at least 2 months after surgery and from written questionnaires, completed by owners. Results: Mean±SD procedure duration was 15±12 minutes. Postoperative recovery was uneventful in 25 dogs. One dog had anastomotic leakage, 1 had a localized abscess at the transverse staple line, and 3 dogs developed an incisional abdominal wall abscess. No long‐term complications occurred (follow‐up, 2–32 months). Conclusion: Stapled 1‐stage functional end‐to‐end anastomosis and resection is a fast and safe procedure in the hand of nonexpert but trained surgeons.  相似文献   

7.
Automatic suturing instruments were tested in two ponies and two horses. The TA stapler was used for bowel closure (enterotomies and gut transection) and for end-to-end 'triangulation' anastomoses. The GIA stapler was used for making side-to-side anastomoses. In one horse several enterotomies were made at different stages and the results of suturing by hand and with a stapler were compared. The utility of both types of staplers is discussed in relation to clinical evaluations and macroscopical and microscopical findings post mortem.  相似文献   

8.
Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.  相似文献   

9.
Two suture techniques for tracheal anastomosis after large-segment tracheal resection were compared. Eight cartilages were resected from the trachea of each of 12 dogs; anastomoses with 4-0 polydioxanone suture were created using a simple continuous suture technique in six dogs and a simple interrupted suture technique in six dogs. Surgical time was shorter but apposition of tracheal segments at the time of surgery was less precise with the simple continuous suture technique. The dogs were evaluated for 150 days after surgery. Clinical abnormalities after tracheal resection and anastomosis were not observed. Percent dorsoventral luminal stenosis was calculated by measuring the tracheal lumen diameter on lateral cervical radiographs. Percent luminal stenosis was calculated planimetrically using a computerized digitizing tablet. Anastomotic stenosis was mild in all dogs; however, the mean percent luminal stenosis determined planimetrically was significantly greater for dogs that had the simple continuous suture technique. Planimetric measurements of cross-sectional area made before and after formalin fixation were not significantly different. Radiographic determination of percent dorsoventral luminal stenosis was a poor predictor of diminution of cross-sectional area determined planimetrically.  相似文献   

10.
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   

11.
Intestinal healing and methods of anastomosis   总被引：1，自引：0，他引：1  
Optimal intestinal healing occurs when like layers of the intestinal wall are aligned. Hand-sewn, double-layer, end-to-end anastomosis that apposes the mucosa and produces slight inversion of the seromuscular layer is recommended to minimize adhesion formation and provide reasonable alignment of the intestinal layers. Stapled, everted, triangulated, end-to-end anastomosis is not recommended because of extensive adhesion formation and poor healing of the intestinal layers. The preferred stapled techniques create an inverting, side-to-side stoma between the bowel segments.  相似文献   

12.
To compare the effects of placing enterotomy incisions on or off the antimesenteric teniae and closing the intestinal mucosa as a separate layer, four longitudinal enterotomies were performed in the descending colon of each of six horses by the following techniques: incision through the antimesenteric teniae with one- and two-layer closure, and incision adjacent to the teniae with one- and two-layer closure. The horses were necropsied at day 33 for evidence of obstruction, adhesions, and ultrasonographic determination of the percent reduction in lumen diameter. Histologic and histomorphometric evaluations included: inflammatory response in the mucosal and seromuscular layers, mucosal atrophy or degeneration, alignment of the incision edges, area of fibrosis, and distance between the incised muscle edges. Adhesions were present in 5 of 24 enterotomies. Incisions adjacent to the teniae resulted in narrower lumen diameters than incisions through the teniae. Inflammatory response was greatest in incisions adjacent to the teniae with two-layer closure. Closure of the mucosa as a separate layer had no effect on any of the parameters evaluated. Enterotomies through the antimesenteric teniae were more easily performed, resulted in less hemorrhage, and maintained a larger lumen diameter than those performed adjacent to the teniae.  相似文献   

13.
Hand sutured end-to-end (EE) and stapled side-to-side (SS) small intestinal anastomoses were performed in 10 healthy adult horses. In five SS anastomoses, staple lines on the blind ends of the jejunum were inverted (SSI) and in five they were not (SSNI). Five EE anastomoses were sutured with polydioxanone and five were sutured with polyglyconate. All horses were euthanatized on day 30. Intra-abdominal adhesions were graded (0-4), and stomal areas were calculated from contrast radiographs made with the bowel distended. Histopathology scores for the anastomoses were based on the degree of inflammation (0-3), fibrosis (0-3), and alignment and healing of intestinal layers (0-3). Mean surgery times +/- standard deviations for EE, SSI, and SSNI techniques were 33.9 +/- 5.4, 36.2 +/- 5.6, and 29.6 +/- 5.9 minutes, respectively. Mean and median stomal areas were 9.4 +/- 5.5 and 8.9 cm2 for EE anastomoses and 17.2 +/- 16.5 and 12.1 cm2 for SS anastomoses. Intra-abdominal adhesions developed in three horses, one of which had clinical signs of colic. Mean histopathology scores for EE and SS anastomoses were 4.8 +/- 2.0 (median = 5) and 4.4 +/- 1.8 (median = 4), respectively. There were no statistically significant differences in surgery times, intra-abdominal adhesion scores, stomal areas, or histopathology scores between small intestinal EE and SS anastomoses in these horses.  相似文献   

14.
Paired incisions (n = 6 pairs) were made in the jejunum of each of 8 Holstein cows. Pairs consisted of 2-cm transverse incisions, 35 cm apart, at the antimesenteric region and at the mesenteric region. Bursting-wall tension was used to test mechanical strength, and cellular and vascular events of healing were evaluated using histologic examination and microangiography. Healing was evaluated at postoperative hour (POH) 48 in 4 of the cows (group 1) and at POH 96 in the remaining 4 (group 2). Evidence of leakage of intestinal contents was not found in any of the cows. At POH 48 and 96, bursting-wall tension was significantly (P less than 0.001) greater in the intestinal segments with antimesenteric incisions than in those segments with mesenteric incisions. Disruption of normal vasculature was seen at mesenteric and antimesenteric sites; ingrowth of vessels, reformation of vascular plexuses, and development of collateral circulation were observed at POH 96. Granulation tissue was observed at POH 96 at the antimesenteric and mesenteric sites, and early stages of mucosal reepithelialization were seen in several sections at POH 48. Better apposition of tissue layers was seen in antimesenteric incisions, but mucosal eversion was evident in several mesenteric incisions. Some sections examined from cows at POH 96 had complete bridging of mucosa, submucosa, and muscularis layers at the antimesenteric location. Inflammatory cells were observed along the incision and at the mucosal and serosal surfaces in many of the sections. Deposition of new collagen was not appreciable in any section at POH 48 or 96.  相似文献   

15.
OBJECTIVE: To compare a double-layer inverting anastomosis with a single-layer appositional anastomosis, coated with either 1% sodium carboxymethylcellulose (SCMC) or 0.4% sodium hyaluronate (HA) solutions, in the small intestine of horses with respect to anastomotic healing and adhesion formation. ANIMALS: 18 adult horses. PROCEDURE: Midline celiotomy and end-to-end jejunal anastomoses were performed. In control group horses (n = 6), a double-layer inverting anastomosis coated with sterile lactated Ringer's solution was performed. In treatment group horses, a single-layer appositional anastomosis was performed that was coated with 1% carboxymethylcellulose solution (SAA + SCMC group horses, 6) or 0.4% hyaluronate solution (SAA + HA group horses, 6). An additional 500 mL of the respective treatment solution was applied to the jejunal serosal surface, and 2 jejunal serosal abrasion sites were created. Horses were euthanatized 10 days after surgery. Anastomoses and abdominal adhesions were evaluated grossly. Anastomotic healing was evaluated on the basis of bursting wall tension. RESULTS: Bursting wall tension was significantly greater in SAA + SCMC group horses, compared with control group horses. All intestinal segments failed at a point distant to the anastomosis. Significantly fewer adhesions were found at the abrasion sites of SAA + HA group horses, compared with control group horses. No differences were found in adhesion formation at the anastomotic sites among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Coating a single-layer appositional jejunal anastomosis with SCMC or HA solutions does not adversely affect anastomotic healing. Application of 0.4% HA solution to the serosal surface of the jejunum significantly decreases the incidence of experimentally induced intra-abdominal adhesion formation in horses.  相似文献   

16.
The biofragmentable Anastomosis Ring (BAR) is a mechanical device composed of absorbable material and creates an inverting, atraumatic compressive anastomosis with no foreign material at the anastomotic site after healing. The aim of the present experimental study was to assess the safety of oesophagoscopy in early days after oesophageal anastomoses performed with the BAR and to follow-up the healing of BAR anastomoses by in vivo endoscopy and autopsy examination. Thirty mongrel dogs divided into subgroups according to the time-points of endoscopy and autopsy (4th, 7th, 14th, 28th day) were used. There was no significant difference in the healing of anastomoses performed under or above the tracheal bifurcation. Pleural adhesions helped to cover and seal small subclinical leaks. The mortality was 13.3% (4 dogs) and the overall leakage rate 14.3%. We looked for bleeding, haematoma, erosion, ulceration and granulation tissue in the anastomosis. Due to the high mechanical strength of these anastomoses, oesophagoscopy was a safe, easy and feasible method for follow-up BAR intrathoracic anastomoses, with no significant difference between the number of lesions found with endoscopy as compared to the autopsy data. The overall sensitivity of oesophagoscopy to discover mucosal lesions was 73.1%. Endoscopy had no complications, therefore it is a useful method of follow-up and may help predict the normal or compromised healing of oesophageal anastomoses.  相似文献   

17.
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   

18.
Colonic anastomoses were performed on two groups of 13 dogs each. Epidural anesthesia and general anesthesia were performed in one group and general anesthesia only in the other. Intraoperatively, the epidural-general anesthesia dogs tended to bleed less, making the anastomosis less difficult. Histologic comparisons showed healing to be more advanced in the epidural-general anesthesia dogs compared to the general anesthesia dogs 24 hours and 7 days postoperatively. Differences were not noticed 14 and 28 days postoperatively. Bursting pressures were determined 24 hours after surgery. Differences between the groups were not noticed. Leakage occurred at 72% of the pressure determined to cause leakage in normal colons.  相似文献   

19.
OBJECTIVE: To compare bursting strength, time of construction, and cost of a closed one-stage, stapled functional end-to-end jejunojejunostomy (FEE) with a stapled side-to-side jejunojejunostomy (STS). STUDY DESIGN: Experimental, randomized block design. ANIMALS: Seven adult horses without gastrointestinal disease. METHODS: The jejunum was isolated, and three FEE, three STS, and three control segments were created in each horse using a randomized block design. Anastomosis time was recorded. The intraluminal pressure at failure and mode of failure were recorded. Length at failure was measured on digitized images. Bursting pressure (BP), bursting wall tension (BWT), anastomosis time, and cost were compared. RESULTS: Control jejunal segments were stronger (P < or = .0001) in bursting strength and bursting wall tension (P < or = .0001) than either anastomosis type; no difference was found between anastomosis types for either variable. Functional end-to-end jejunojejunostomy was significantly quicker and less costly than STS (P < or = .0001). CONCLUSIONS: Mechanically there were no significant differences between the FEE and STS techniques. The FEE technique maintained the physiologic direction of peristalsis of the segments, required less tissue manipulation, and was faster and more economical to create. CLINICAL RELEVANCE: The FEE is a clinically viable technique.  相似文献   

20.
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   

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