Gessica Giusto

In vitro description of a new technique for stapled side-to-side jejunocecal anastomosis in horses and CT scan anatomical comparison with other techniques

BackgroundStapled jejunocecal anastomoses are commonly performed in equine abdominal surgery. They carry higher complication rates compared to handsewn techniques. In human surgery various causes likely to lead to failure of stapled techniques have been evaluated, including staple line failure. Recently Freeman proposed a technique to perform a stapled jejunocecal anastomosis in horses while avoiding blind pouch formation. The aim of this study is to describe a method for stapled side-to-side jejunocecal anastomosis in horses and to compare it with other techniques with computed tomography to assess stomal area, shape and blind pouch size.MethodsIntestinal specimens comprising the cecum, ileum and jejunum from 18 horses were collected and were divided into three groups. In Group S a standard stapled side-to-side jejunocecal anastomosis was performed. In Group F the anastomosis was performed using a modified technique proposed by Freeman. In Group G the anastomosis was performed with a modified technique proposed by the authors. Inflated bowel segments were CT scanned to obtain a MultiPlanar Reconstruction of the stoma and afferent small intestine before calculating the cross-sectional area of each of these regions. The ratio of the measured areas was compared between the three techniques. The volume of the blind-end pouch was measured and its ratio with the intestinal area compared between techniques. The cecum was opened and the length of the stoma measured with a caliper and compared to the intended initial length.ResultsThe stomal/intestinal area ratio was not significantly different between techniques.No statistically significant difference was found in the stomal ideal/real perimeter ratio.There was no statistically significant difference in the intended/real stomal length ratio, and all techniques featured an increase in stomal length ranging from 2 to 12 %. Blind pouch formation was a consistent finding in Group S and was virtually absent in Groups F and G.ConclusionsBoth the Freeman and the new (G) technique were comparable to the standard technique in terms of stomal area, stomal shape and difference in stomal elongation. They consistently produced a smaller blind pouch and allowed easier placement of the staplers.

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.

Evaluation of antimicrobial activity of Italian honey for wound healing application in veterinary medicine.

INTRODUCTION Honey as a topical treatment for infected wounds dates back to ancient times. However, few studies have been reported concerning the medical properties of Italian honey. In this study, the microbial contamination, the antimicrobial activity and the antibiotic residues of 6 different varieties of Piedmont honeys were evaluated. The antimicrobial activity of honeys was tested by agar well diffusion method and 1 honey for each variety has been selected and tested by broth micro-dilution test to determine Minimum Inhibitory Concentrations (MICs) and evaluated by Minimum Bactericidal Concentrations (MBCs). The honeys with a high level of antibacterial activity were analyzed for the presence of tetracyclines, sulfonamides and macrolide residues. The agar well diffusion method showed the greatest antimicrobial activity for honeydew, chestnut and lime tree honeys. The MICs and MBCs identified the close similarity to the medical manuka honey of honeydew, polyfloral and chestnut honey. The levels of antibiotic residues on these honeys were below the limit of quantification. Based on our results the Italian variety of honeydew showed the best antimicrobial activity and can be considered for the treatment of infected wounds in animals.

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.

Effects of staple size, tissue thickness, and precompression time on staple shape in side-to-side jejunocecal anastomosis in specimens obtained from healthy horses at an abattoir.

OBJECTIVE To determine effects of staple size, precompression time, and tissue thickness on staple shape and tissue approximation in side-to-side jejunocecal anastomosis in equine specimens. SAMPLE Cecum, ileum, and jejunum specimens obtained from 18 healthy horses at an abattoir. PROCEDURES Specimens were allotted into 2 groups. Anastomoses were stapled with 4.8-or 3.8-mm staples. Precompression time was 15 seconds for both groups. Staple lines were cut into proximal, middle, and distal sections. Thickness of intestinal walls was measured with a calibrated tissue micrometer, photographs were obtained, and intestinal tissues were digested. An investigator measured staples and assessed the shape of staples on high-definition digital images. Number of optimally shaped staples and staple height were compared among sections and between groups. RESULTS Use of 4.8-mm staples resulted in poor approximation of tissues in the distal sections of anastomoses. The percentage of optimally shaped staples was 538 of 551 (97.6%) and 616 of 634 (97.2%) for 4.8- and 3.8-mm staples, respectively. The percentage of optimally shaped staples did not differ significantly between groups for the same sections. There was a lower percentage of optimally shaped staples in the distal sections than in the proximal and middle sections of each group. Mean staple height did not differ significantly among sections of each group. CONCLUSIONS AND CLINICAL RELEVANCE Use of 3.8-mm staples with an adequate precompression time for jejunocecal anastomosis in horses resulted in proper staple shape. These findings could be used to improve the technique and outcome for stapled jejunocecal anastomoses in horses.

Biomechanical comparison of four technique for pelvic flexure enterotomy closure in horses

OBJECTIVE To compare 4 techniques for pelvic flexure enterotomy closure in horses. STUDY DESIGN Ex-vivo study. SAMPLE POPULATION Cadaveric ascending colon specimens (n = 48 horses). METHODS Pelvic flexure enterotomies of different lengths (5 cm, 10 cm) were performed and closed with 1 of 4 techniques: handsewn 2 layer (HS2); handsewn 1 layer (HS1); skin staples (SKS); or TA90 stapling device (TA90). Time to close each enterotomy, bursting pressure, luminal reduction, and cost were calculated and compared. RESULTS HS2 was significantly more time consuming to perform in the 5 cm group whereas in the 10 cm group, only the HS1 and SKS were faster than the other techniques. Luminal reduction was not different between techniques in either group. HS2 resulted in consistently higher bursting pressure compared with SKS and TA90 in the 5 cm group and compared to all other techniques in the 10 cm group. CONCLUSION The TA90 technique had the lowest bursting pressure and highest cost. The HS2 technique was strongest.Objective To compare 4 techniques for pelvic flexure enterotomy closure in horses. Study Design Ex-vivo study. Sample Population Cadaveric ascending colon specimens (n = 48 horses). Methods Pelvic flexure enterotomies of different lengths (5 cm, 10 cm) were performed and closed with 1 of 4 techniques: handsewn 2 layer (HS2); handsewn 1 layer (HS1); skin staples (SKS); or TA90 stapling device (TA90). Time to close each enterotomy, bursting pressure, luminal reduction, and cost were calculated and compared. Results HS2 was significantly more time consuming to perform in the 5 cm group whereas in the 10 cm group, only the HS1 and SKS were faster than the other techniques. Luminal reduction was not different between techniques in either group. HS2 resulted in consistently higher bursting pressure compared with SKS and TA90 in the 5 cm group and compared to all other techniques in the 10 cm group. Conclusion The TA90 technique had the lowest bursting pressure and highest cost. The HS2 technique was strongest.

Laparoscopic nephrosplenic space ablation with barbed suture in eight horses

CASE DESCRIPTION 8 horses (5 geldings and 3 mares) were evaluated for laparoscopic closure of the nephrosplenic space following a history of recurrent left dorsal displacement of the large colon. CLINICAL FINDINGS All horses underwent a physical examination and routine clinicopathologic testing. Transrectal palpation and transabdominal ultrasonography were performed to exclude the presence of organs in the left paralumbar region. TREATMENT AND OUTCOME A left flank laparoscopic approach with the horses standing was used. A continuous suture was placed in a craniocaudal direction between the renal and splenic capsules with unidirectional barbed suture material. This allowed obliteration of the nephrosplenic space without the need for knots to secure the leading and terminal ends of the suture line. In all horses, transrectal palpation was performed 2 months after surgery; at this time, closure of the caudal part of the nephrosplenic space was evident. In 2 horses, follow-up laparoscopy was performed, and complete closure of the nephrosplenic space was confirmed. Telephone follow-up revealed that none of the horses had any signs of recurrent left dorsal displacement of the large colon. CLINICAL RELEVANCE Results suggested that laparoscopic nephrosplenic space closure with unidirectional barbed suture material could be considered as an option for prevention of left dorsal displacement of the large colon in horses. In the horses of this report, barbed suture material allowed secure ablation of the nephrosplenic space and eliminated the need for intracorporeal knot tying.

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.

A pectin-honey hydrogel prevents postoperative intraperitoneal adhesions in a rat model.

BackgroundAdhesions are a common postoperative surgical complication. Liquid honey has been used intraperitoneally to reduce the incidence of these adhesions. However, solid barriers are considered more effective than liquids in decreasing postoperative intra-abdominal adhesion formation; therefore, a new pectin-honey hydrogel (PHH) was produced and its effectiveness was evaluated in a rat cecal abrasion model.Standardized cecal/peritoneal abrasion was performed through laparotomy in 48 adult Sprague-Dawley rats to induce peritoneal adhesion formation. Rats were randomly assigned to a control (C) and treatment (T) group. In group T, PHHs were placed between the injured peritoneum and cecum. Animals were euthanized on day 15 after surgery. Adhesions were evaluated macroscopically and adhesion scores were recorded and compared between the two groups. Inflammation, fibrosis, and neovascularization were histologically graded and compared between the groups.ResultsIn group C, 17 of 24 (70.8%) animals developed adhesions between the cecum and peritoneum, while in group T only 5 of 24 (20.8%) did (p = 0.0012). In group C, one rat had an adhesion score of 3, sixteen had scores of 2, and seven rats had scores of 0. In group T, four rats had adhesion scores of 2, one rat had an adhesion score of 1 and nineteen have score 0 (p = 0.0003). Significantly lower grades of inflammation, fibrosis, and neovascularization were seen in group T (p = 0.006, p = 0.001, p = 0.002, respectively).ConclusionPHH is a novel absorbable barrier that is effective in preventing intra-abdominal adhesions in a cecal abrasion model in rats.

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.