Intestinal surgery in small animals: historical foundations,current thinking,and future horizons     

Gary W. Ellison DVM  MS  Diplomate ACVS  J. Brad Case DVM  MS  Diplomate ACVS‐SA  Penny J. Regier DVM  MS  Diplomate ACVS‐SA 《Veterinary surgery : VS》2019,48(7):1171-1180

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra‐abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.  相似文献   

Foreword     

DVM  Diplomate  American Veterinary Dental College  Diplomate  American Board Veterinary PractitionersJan Bellows  Guest Editor 《Clinical Techniques in Small Animal Practice》2000,15(4):iv

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Foreword     

BVM  Diplomate ACVECC  ACVIM Nishi Dhupa  Guest Editor 《Clinical Techniques in Small Animal Practice》2000,15(3)

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Foreword     

DVM  Diplomate ACVIM  ACVECCKenneth J. Drobatz  Guest Editor 《Clinical Techniques in Small Animal Practice》2000,15(2)

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Use of Electrocautery Probes in Arthroscopic Removal of Apical Sesamoid Fracture Fragments in 18 Standardbred Horses     

Ludovic Bouré  DMV  MSc  Diplomate ECVS  Diplomate ACVS    Marcel Marcoux  DMV  MSc    Sheila Laverty  MVB  Diplomate ACVS  Diplomate ECVS    Olivier M. Lepage  DMV  PhD  Diplomate ECVS 《Veterinary surgery : VS》1999,28(4):226-232

OBJECTIVE: To develop a technique for arthroscopic excision of apical sesamoid fracture fragments using electrocautery probes. ANIMALS OR SAMPLE POPULATION: A total of 18 Standardbred horses. METHODS: Arthroscopic removal of apical sesamoid fracture fragments using both hook and loop electrocautery probes was performed on 18 Standardbred horses. The fracture fragments were approached using either an ipsilateral (3) or contralateral (15) arthroscopic triangulation technique. Distension of the metacarpo- (metatarso)-phalangeal joints was achieved using a 1.5% glycine solution. Under arthroscopic guidance, both the suspensory and intersesamoidean ligament attachments to the abaxial and the axial margins of the apical fragment were transected using a hook electrocautery probe. Subsequently, the palmar (plantar) soft tissue attachments to the apical fragment were transected with a loop electrocautery probe. Once freed of soft tissue attachments, the apical fragment was removed with Ferris-Smith intervertebral disc rongeur. The arthroscopic portals were closed in a routine manner. RESULTS: Horse ages ranged from 2 to 8 years (median, 2.5 years). Eighteen apical sesamoid fracture fragments were removed from the left (8) and right (8) hind limbs and the left (1) and right (1) forelimbs. Apical fragments occured in 15 lateral and 3 medial proximal sesamoid bones. No major complications occurred during or after surgery. The electrocautery probes permitted an easy and precise dissection of all soft tissue attachments to the apical sesamoid fracture fragments in all horses. Follow-up time was 7 to 44 months (median, 26 months); 10 of 14 horses returned to racing. Seven of nine horses that raced before surgery raced again and three of five that had not raced before surgery, raced afterwards. CONCLUSION: Arthroscopic excision of apical sesamoid fracture fragments can be accomplished arthroscopically using electrocautery probes. CLINICAL RELEVANCE: Arthroscopic electrosurgery is an efficient and safe alternative for intra-articular dissection in horses.  相似文献   

Arthroscopic Subchondral Bone Plate Microfracture Technique Augments Healing of Large Chondral Defects in the Radial Carpal Bone and Medial Femoral Condyle of Horses   总被引：8，自引：0，他引：8  

D.D. Frisbie  DVM  MS  Diplomate ACVS    G.W. Trotter  DVM  MS  Diplomate ACVS    B.E. Powers  DVM  PhD  Diplomate ACVP    W.G. Rodkey  DVM  Diplomate ACVS    J.R. Steadman  MD    R.D. Howard  DVM  PhD  Diplomate ACVS    R.D. Park  DVM  PhD  Diplomate ACVR    C.W. McIlwraith  BVSc  PhD  Diplomate ACVS   《Veterinary surgery : VS》1999,28(4):242-255

OBJECTIVE: To evaluate the effect of arthroscopic subchondral bone microfracture on healing of large chondral defects in horses. STUDY DESIGN: Short- (4 months) and long-term (12 months) in vivo experimental chondral defect model. ANIMALS: 10 horses, aged 2 to 5 years. METHODS: Each horse had a 1 cm2 full-thickness chondral defect created in both radial carpal bones and both medial femoral condyles. One carpus and one femoral condyle of each horse had the subchondral bone plate under the defect perforated using an orthopedic awl. All horses were exercised, five horses were evaluated after 4 months and five horses after 12 months. Gross, histologic, and histomorphometric examination of defect sites and repair tissues was performed, as was collagen typing of the repair tissue. RESULTS: On gross observation a greater volume of repair tissue filled treated defects (74%) compared with control defects (45%). Histomorphometry confirmed more repair tissue filling treated defects, but no difference in the relative amounts of different tissue types was observed. There was an increased percentage of type II collagen in treated defects compared with control defects and evidence of earlier bone remodeling as documented by changes in porosity. CONCLUSIONS: In full-thickness chondral defects in exercised horses, treatment with subchondral bone microfracture increased the tissue volume in the defects and the percentage of type II collagen in the tissue filling the defects when compared to nontreated defects. CLINICAL RELEVANCE: No negative effects of the microfracture technique were observed and some of the beneficial effects are the basis for recommending its use in patients cases with exposed subchondral bone.  相似文献   

The Association of Propofol Usage With Postoperative Wound Infection Rate in Clean Wounds: A Retrospective Study     

Eileen Heldmann  MS  VMD    Dorothy Cimino Brown  DVM  Diplomate ACVS    Frances Shofer  PhD 《Veterinary surgery : VS》1999,28(4):256-259

OBJECTIVE: To determine if the use of propofol influences the postoperative infection rate of clean surgical wounds in dogs and cats. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 863 dogs and cats undergoing clean surgical procedures. METHODS: Medical and anesthetic records of surgical cases used as part of a previously described epidemiologic study on postoperative wound infection rates were reviewed. The records of all animals with clean surgical wounds were reviewed to determine if propofol had been used for anesthetic induction or maintenance during the procedure. To determine the effect of propofol use on wound infection rate, data were analyzed using Fisher's exact test, followed by multiple logistic regression to adjust for various factors, including surgery time, time from clipping to surgery, antibiotic usage, coexisting distant infection, endocrine disease, and the use of immunosuppressive drugs in the perioperative period. RESULTS AND CONCLUSIONS: Of 863 dogs and cats with clean surgical wounds, 46 received propofol as part of the anesthetic protocol. A total of 6 of 46 animals (13%) receiving propofol developed postoperative wound infections, compared with 33 of 817 animals (4%) not receiving propofol (P = .014; % difference = 9%; 95% CI = 0.5% to 24%). Adjusting for all other factors evaluated, animals receiving propofol were 3.8 times more likely to develop postoperative wound infections compared to animals not given propofol (95% CI = 1.5-9.9). CLINICAL IMPLICATIONS: Propofol is a lipid-based emulsion capable of supporting microbial growth. Administration of a potentially contaminated solution may contribute to surgical wound infection or other patient morbidity or mortality. Strict aseptic technique in the preparation of the solution and prompt disposal of unused drug are imperative to curtail the potential for extrinsic contamination.  相似文献   

The Effect of Knotting Method on the Structural Properties of Large Diameter Nonabsorbable Monofilament Sutures     

Douglas J. Huber  DVM  MS  Diplomate ABVP    Erick L. Egger  DVM  Diplomate ACVS    Susan P. James  PhD 《Veterinary surgery : VS》1999,28(4):260-267

OBJECTIVE: To evaluate the effect of knotting method on the mechanical properties of large diameter nonabsorbable monofilament suture materials. STUDY DESIGN: In vitro mechanical evaluation. METHODS: A conventional square knot was compared with the surgeon's knot, sliding half-hitch, and clamped square knot. Knotted suture loops were created in a uniform manner and acutely tensioned to failure (20 mm/min loading rate; n = 20 per knot type for each material). Stiffness, yield, and failure characteristics of USP #2 nylon, #2 polybutester, #2 polypropylene, 27 kg test monofilament nylon fishing line, and 27 kg nylon leader material were evaluated. RESULTS: Compared with a conventional square knot, a surgeon's knot decreased stiffness for #2 polypropylene, 27 kg fishing line, and 27 kg leader (P < .05). A sliding half-hitch weakened all materials except 27 kg leader (P < .05). Clamping the first throw of a square knot increased the stiffness of 27 kg leader loops (P < .05). CONCLUSIONS: Based on clinically relevant parameters (stiffness and yield), knotting method had no effect on #2 nylon and #2 polybutester. The surgeon's knot is not recommended for #2 polypropylene and 27 kg fishing line and leader material. A sliding half-hitch decreased the yield of leader material. Clamping the first throw of a square knot had no adverse effects on acute properties of tested materials; it increased the stiffness for leader material. CLINICAL RELEVANCE: Knotting method does influence the structural properties of suture materials and should be considered when tying knots under tension.  相似文献   

An In Vitro Comparison of Hollow Ground and Trocar Points on Threaded Positive-Profile External Skeletal Fixation Pins in Canine Cadaveric Bone     

Juan M. Marti  LV  Cert SAO  MVM  MRCVS Diplomate ACVS    Simon C. Roe  BVSc  MS  PhD  Diplomate ACVS 《Veterinary surgery : VS》1999,28(4):279-286

OBJECTIVE: To compare the microstructural damage created in bone by pins with lathe-cut and rolled-on threads, and to determine the peak tip temperature and damage created by positive-profile external fixator pins with either hollow ground (HG) or trocar (T) tips during insertion. STUDY DESIGN: An acute, in vitro biomechanical evaluation. SAMPLE POPULATION: Twenty-seven canine tibiae. METHODS: Lathe-cut thread design with T point (LT-T), rolled-on thread design with T point (RT-T), and rolled-on thread design with HG point (RT-HG) pins were evaluated. Twenty pins of each type were inserted under constant drilling pressure into 12 canine tibiae (12 diaphyseal and 8 metaphyseal sites per pin type). Peak pin tip temperature, drilling energy, end-insertional pin torque, and pullout force were measured for each pin. For the histologic study, five pins of each type were inserted into cortical and cancellous sites in 15 additional tibiae. Entry and exit damage, and thread quality were assessed from 100 micron histologic sections by using computer-interfaced videomicroscopy. RESULTS: T-tipped pins reached higher tip temperature in both diaphyseal and metaphyseal bone compared with HG-tipped pins. RT-T pins had higher pullout strength (diaphyseal) and end-insertional torque compared with other combinations. No differences in drilling energy or insertional bone damage was found between the three pin types (P < .05). CONCLUSIONS: T-tipped pins mechanically outperformed HG-tipped pins. Pin tip and thread design did not significantly influence the degree of insertional bone damage. CLINICAL RELEVANCE: T-tipped pins may provide the best compromise between thermal damage and interface friction for maximizing performance of threaded external fixator pins.  相似文献   

Persistent Frenulum of the Epiglottis in Four Foals     

Tom B. Yarbrough  DVM  Diplomate ACVS    ED Voss  DVM    Eric J. Herrgesell  DVM  Diplomate ACVR    Michelle Shaw  DVM 《Veterinary surgery : VS》1999,28(4):287-291

OBJECTIVE: To report the clinical signs and management of 4 foals with persistent frenulum of the epiglottis. STUDY DESIGN: Case report. ANIMALS: Four newborn foals. METHODS: Foals were admitted with a complaint of oronasal reflux after nursing. Variable systemic signs of aspiration pneumonia were evident. Nasal endoscopy confirmed persistent dorsal displacement of the soft palate. Persistent frenulum of the epiglottis, confirmed by oral endoscopic examination, was transected. RESULTS: After surgery, all foals had the epiglottis positioned normally, dorsal to the soft palate. Clinical signs of oronasal reflux resolved by the second nursing attempt in 3 foals, whereas this was difficult to assess in one foal that was nursed intermittently because of the mares behavior. This foal died 2 days later. The other 3 foals have had normal epiglottic function for 2-4 years. CONCLUSIONS: Persistent frenulum of the epiglottis should be considered in foals with oronasal reflux from birth. With appropriate medical and surgical management the prognosis for resolution should be good.  相似文献