Francesco Comino

Parallel alternating sliding knots are effective for ligation of mesenteric arteries during resection and anastomosis of the equine jejunum

BackgroundIn literature only one article describes and compares methods of achieving hemostasis in equine mesenteric arteries during jejunal resection and anastomosis, and most textbooks favor ligating-dividing mechanical devices. The latter method cannot always be used, not least because the devices are expensive and in some cases even contra-indicated. Various types of knots, including sliding knots, are widely used to provide hemostasis in laparoscopy.The objective of this study was to compare a triple ligature for mesenteric vessels composed of three sliding knots with a triple ligature composed of a modified transfixing and two surgeon’s knots.MethodsPortions of jejunum with associated mesenteric vessels were collected from 12 horses at a local abattoir. These were divided into 24 specimens containing five mesenteric arteries each. Each artery was closed with a triple ligature. In group A, a surgeon’s knot was used to tie the ligatures (two circumferential and one modified transfixing) while in group B all ligatures (three circumferential) were tied with a parallel alternating sliding knot. Both groups were divided ino two subgroups depending on suture material used (multifilament or monofilament suture material). Time to perform ligatures for every specimen were recorded and compared between groups.After closure, arteries were cannulated and intraluminal pressures were increased until ligature failure. Leaking pressures were recorded and compared between groups.ResultsLigation of mesenteric arteries was significantly faster to perform with sliding knots than with surgeon’s knots, both with monofilament and multifilament suture material. With multifilament suture material, the leaking pressure of sliding knot ligatures was significantly higher than that of surgeon’s knot ligatures. With monofilament suture, there were no statistically significant differences in leaking pressure between ligature methods. Both ligating methods were stronger with monofilament suture material than with multifilament suture material.ConclusionsRegardless of the ligature used, monofilament suture material performed better than multifilament suture material to achieve hemostatic knots. Independently of the suture material, the sliding knot is comparable or better than the surgeon’s knot in providing hemostasis, and is faster to perform.

Ex Vivo Evaluation of Skin Staples for Typhlotomy Closure in Cattle

OBJECTIVE To compare 2 sutured techniques with a skin stapled technique for typhlotomy closure in bovines. STUDY DESIGN Ex-vivo study. SAMPLE POPULATION Bovine fresh cadaveric ceca (n = 27). METHODS Typhlotomies (4 cm in length) were made on the cecal apex and closed with 1 of the following techniques: hand-sewn, 2-layer suture consisting of a continuous, full-thickness layer oversewn with a Cushing layer (Group FC); hand-sewn, double inverting suture consisting of a 1st Cushing layer oversewn with an additional Cushing layer (Group CC); skin staples (Group S). Closure time, bursting pressure, and related costs of each technique were calculated and compared. RESULTS Median (range) construction time for group S was 1.12 (0.49-1.3) min and was significantly shorter than for group FC 5.14 min (3.45-7.44), and for group CC 4.26 min (2.3-5.52) (95% CI 3.342-4.851), (P = .007). There was no significant difference between bursting pressures of group S (91.67 ± 15.41 mmHg, 95% CI 79.82-103.5) compared with group FC (119.4 ± 40.03 mmHg, 95% CI 88.67-150.2) (P = .160) and compared with group CC (103.3 ± 32.31 mmHg, 95% CI 78.5-128.2) (P = .707) CONCLUSION: Hand-sewn techniques are effective but fairly demanding in terms of time. Skin staples are less time-consuming, and resist pressures comparable to those resisted by handsewn techniques. For this reason, an SKS technique may be a valid option for typhlotomy closure in cattle.

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

REASONS FOR PERFORMING STUDY In equine castration, application of a ligature on the spermatic cord to prevent complications such as haemorrhage and evisceration has been reported with controversial results. Characteristics of commonly used knots have not been studied. OBJECTIVES To compare the modified transfixing and giant knots and the emasculator in open and closed equine castration techniques. STUDY DESIGN Ex vivo experiment. METHODS A total of 144 testicles were randomly assigned to 2 groups for open or closed castration. Both groups were divided into 3 subgroups of 18 specimens each: emasculator only, emasculator plus giant knot and emasculator plus transfixing knot and the open castration group also contained 2 further subgroups of 18 testicles each: giant knot only and transfixing knot only. The length of suture material used was measured for each knot and the leaking pressure of the testicular artery measured using dye injection. In the closed castration group, parietal tunic tensile strength was measured with a tensiometer. RESULTS Leaking pressure was higher in open compared with closed castration, with no significant difference among subgroups. In the closed castration group, minimum leaking pressure for the emasculator plus transfixing knot and emasculator only subgroups were close to standard physiological arterial pressures. The giant knot required less suture material than the transfixing knot. Parietal tunic tensile strength was higher when ligatures were applied. CONCLUSIONS The giant and transfixing knot techniques have comparable haemostatic capability and parietal tunic tensile strength, but the giant knot requires less suture material. In open castration, using the emasculator alone may produce adequate haemostasis. In closed castration, using the giant knot in combination with the emasculator increases the bursting pressure and possibly reduces the incidence of haemorrhage. In closed castration, application of a ligature may reduce the risk of evisceration.

Closure of a recurrent bladder rupture in a calf by means of a peritoneal flap: a case report

An 11-month old, Piedmontese bullock was admitted to the Department of Veterinary Science, Uni- versity of Turin, for urolithiasis and suspected uroperitoneum owing to urinary bladder rupture. A first episode of uroperitoneum had been treated surgically one week previously. On admission, the animal underwent physical and haematological examination, followed by transabdominal ultrasonography and biochemical screening. Clinical and laboratory findings confirmed the recurrence of uroperitoneum, possibly secondary to the previously failed surgical approach. During surgery, urine leakage from the previously treated tear was clearly visible, together with a large necrotic area surrounding the tear. To close the defect, we created a peritoneal flap. For tissue approximation we used a continuous barbed suture material, which obviated the need for knots to secure the leading and terminal ends of the suture. Postoperative monitoring included transabdominal ultrasonography and biochemical profile tests, performed at 10 and 30 days after surgery. Two months after discharge, a telephone follow-up confirmed the positive outcome of the procedure. The creation of a peritoneal flap allows for effective sealing of a bladder tear with necrotic edges. The use of barbed suture greatly simplifies the entire procedure.

The Surgeon's View: Comparison of Two Digital Video Recording Systems in Veterinary Surgery

Video recording and photography during surgical procedures are useful in veterinary medicine for several reasons, including legal, educational, and archival purposes. Many systems are available, such as hand cameras, light-mounted cameras, and head cameras. We chose a reasonably priced head camera that is among the smallest video cameras available. To best describe its possible uses and advantages, we recorded video and images of eight different surgical cases and procedures, both in hospital and field settings. All procedures were recorded both with a head-mounted camera and a commercial hand-held photo camera. Then sixteen volunteers (eight senior clinicians and eight final-year students) completed an evaluation questionnaire. Both cameras produced high-quality photographs and videos, but observers rated the head camera significantly better regarding point of view and their understanding of the surgical operation. The head camera was considered significantly more useful in teaching surgical procedures. Interestingly, senior clinicians tended to assign generally lower scores compared to students. The head camera we tested is an effective, easy-to-use tool for recording surgeries and various veterinary procedures in all situations, with no need for assistance from a dedicated operator. It can be a valuable aid for veterinarians working in all fields of the profession and a useful tool for veterinary surgical education.

Evaluation of various hemostatic knot configurations performed by veterinary students

OBJECTIVE To determine the most effective hemostatic knot configuration performed by veterinary students following a brief training session with an experienced surgeon and a subsequent deliberate self-training period. DESIGN Experiment. SAMPLE 24 fourth-year veterinary students with no previous surgical knot-tying experience. PROCEDURES In a 1-hour training session, an experienced surgeon showed veterinary students how to perform 5 hemostatic knot configurations (giant, slip, strangle, surgeons, and transfixing), which they then practiced at home on a hemostasis simulator for 2 weeks. Thereafter, students performed each knot 4 times (twice each with monofilament and multifilament suture) on a hemostasis simulator. An experienced surgeon evaluated the correct execution of knots and measured their effectiveness by use of a manometer to measure vessel pressure distal to the ligature. Each student completed a questionnaire regarding their perceived learning and execution difficulty and sealing security for each knot. Responses were compared among knots and suture materials. RESULTS Overall, students considered the surgeons knot the easiest to learn and the strangle knot the most difficult. The slipknot was also considered the easiest knot to perform, and the giant knot was considered the most difficult. The strangle knot was deemed the most effective in reducing vessel pressure distal to the ligature. CONCLUSIONS AND CLINICAL RELEVANCE The strangle knot was the most effective hemostatic knot in inexperienced hands, although veterinary students considered it more difficult to learn than other, perhaps more commonly taught, knots. Therefore, teaching of the strangle knot should be encouraged in veterinary schools.

Do different characteristics of two emasculators make the difference in equine castration

BACKGROUND The Serra and Reimer emasculators are frequently used in equine orchiectomy. They differ in jaw profile and the mechanism by which they achieve haemostasis. OBJECTIVES To investigate whether the haemostatic capacities of the Reimer and Serra emasculators in open and closed castration differ, to compare the haemostatic capacities of each emasculator in both open and closed castration, and to assess whether the tensile strength of the parietal tunic in closed castration differs according to whether a Reimer or Serra emasculator is used. STUDY DESIGN Ex vivo randomised study. METHODS Eighty equine cadaver testes were randomly assigned to two groups for, respectively, open and closed castration. Each group was divided into two subgroups for castration with a Serra or Reimer castrator, respectively. Testicular artery leaking pressure was measured by dye injection. In closed castration, the tensile strength of the parietal tunic was measured with a tensiometer. RESULTS In open castration, the Reimer emasculator resisted significantly higher pressure (median: 706.1 mmHg; interquartile range [IQR]: 597.6-735.5 mmHg) than the Serra emasculator (median: 349.4 mmHg; IQR: 261.1-468.9 mmHg) (P<0.001), whereas no difference was found in closed castration (Serra emasculator, median: 382.5 mmHg [IQR: 294.2-568.2 mmHg]; Reimer emasculator, median: 419.2 mmHg [IQR: 294.2-616.0 mmHg]). The Reimer emasculator resisted significantly higher pressure in the open (median: 706.1 mmHg; IQR: 597.6-735.5 mmHg) compared with the closed (median: 419.2 mmHg; IQR: 294.2-616.0 mmHg) technique (P = 0.03). Parietal tunic tensile strength did not differ significantly by emasculator (mean ± s.d.: Serra, 12.65 ± 7.35; Reimer, 17.55 ± 11.76). MAIN LIMITATIONS Limitations are inherent to the ex vivo study design. Post-surgery implications were investigated only in the short term and no account was taken of tissue inflammation and oedema, which may influence the integrity of the tissue. CONCLUSIONS These results suggest it may be preferable to use a Reimer emasculator in open castration. In this ex vivo model of closed castration, no differences between the emasculators were observed.

Mesh repair of a large ventral hernia with interposition of omentum in a calf: a case report

A one-month-old, Piedmontese female calf was admitted to the Department of Veterinary Sciences, University of Turin, for repair of a large ventral hernia. A large ventral hernia, approximately 20 cm long and 15 cm large was noticed extending from 3 cm caudal to the umbilicus down to the pubis. At ultrasonography the hernia content was represented by small intestine and omentum and no adhesions to the hernial sac could be detected. The hernial sac was composed by skin only. Because of the large dimensions of the defect and the economic value of the animal, surgical correction was recommended to the owner. A prosthetic implant with a polypropylene mesh was elected due to the dimension of the abdominal defect. The implant was placed intra-abdominally with the interposition of the omentum between the mesh and the underlying viscera. Two and six months after surgery follow-ups were performed and a positive outcome was confirmed. This is the first report of ventral hernia repair in large animals that combines the use of a tension-free polypropylene mesh with the interposition of the omentum between the viscera and the mesh. This procedure is safe, cost-effective and not associated with major complications.