Ex vivo comparison of barbed sutures for pelvic flexure enterotomy in horses

Abstract

Objective To evaluate two different barbed sutures for closure of pelvic flexure enterotomies and compare results achieved with two previously described closure techniques. Study design Ex vivo. Sample population Twenty‐four fresh cadaver adult equine large colons. Methods Cadavers were randomly assigned to four closure groups (n = 6 each group): single‐layer absorbable suture, double‐layer absorbable suture, single‐layer unidirectional barbed suture, or single‐layer bidirectional barbed suture. Construction time, luminal reduction (percentage), bursting pressure, and method of failure were measured. Cost, leakage, exposed suture, and general appearance were recorded. Comparisons were performed with one‐way analysis of variance and post hoc Bonferroni test (P < .05). Results Double‐layer absorbable closure had the highest bursting pressure (mean = 178.5 mm Hg, SD = 9.79, P < .001) but took more time (P = .001) compared with all other groups. The construction time of both barbed suture closures did not differ from the single‐layer closure (P > .06). Bursting strengths of both unidirectional (mean = 91.6 mm Hg, SD = 5.57) and bidirectional (mean = 87.5 mm Hg, SD = 8.69) barbed sutures were lower (P > .006 for both) than those of both single‐ (mean = 117.6 mm Hg, SD = 11.69) and double‐layer (mean = 178.5 mm Hg, SD = 9.79) closures. Unidirectional barbed suture closure had a reduction in lumen diameter (P = .004) compared with bidirectional and single‐layer closures. Conclusion Enterotomy closures with the two different barbed suture patterns were comparable in bursting strength and construction time. However, the barbed suture patterns had lower bursting strength compared with traditional single‐ and double‐layer closures. Unidirectional barbed suture closure also reduced lumen diameter. Clinical significance Closure of a large colon enterotomy with barbed suture patterns may be less secure than single‐ and double‐layer suture closure.

Influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure

“…For canine enterotomy closure, Ehrhart et al, placed the effector at the beginning of the incisional line (0 mm), however, it should be noted that the effector loop in this study was placed intraluminally with only a limited description of how the barbed suture line was initiated. In studies by Duffy et al, 24 and Sinovich et al, 30 investigators placed effector loops at 5 mm from the beginning of the incisional line in dogs and horses, respectively 22,30 . In the present study, mean ILPs in the group 5, 10, and 15 mm were significantly higher than the 0 mm group.…”

Evaluation of barbed suture for celiorrhaphy and subcutaneous closure in bitches with pyometra submitted to ovariohysterectomy

“…Despite barbed sutures being more expensive than its conventional counterparts 10 , three studies have shown that the use of barbed sutures reduced the time in the operating room in patients who have undergone spinal surgery 20 and total knee arthroplasty 21,22 . The same studies reported that the reduction in the time spent in the operating room was associated with a decrease in the final cost of the procedures.…”

Pelvic flexure enterotomy in the horse: A review of current literature

“…One-layer inverting Cushing constructs, investigated ex vivo, had bursting pressures higher than intraluminal colonic pressures recorded in vivo (up to 58 mmHg; Aldrich et al, 2017;Gandini et al, 2013;Sinovich et al, 2020). In two studies, bursting pressures were the same or lower than those of two-layer closures (Aldrich et al, 2017;Gandini et al, 2013;Sinovich et al, 2020). As expected, one-layer closures were faster to perform than two layers in all studies, but luminal diameter reduction was not statistically different between constructs.…”

“…Other described closure techniques include a one‐layer Utrecht (Young et al., 1991), one‐layer Cushing (Aldrich et al., 2017; Gandini et al., 2013), two‐layer with suture reversal (Aldrich et al., 2017), double inverting closure (Doyle et al., 2003), three‐layer closure (Marien et al., 2000; Young et al., 1991), thoracoabdominal stapling device (Ellis et al., 2007; Gandini et al., 2013; Rosser, Brounts, Livesey, & Wiedmeyer, 2012; Rosser, Brounts, Slone, et al., 2012), skin staples (Gandini et al., 2013) and one‐layer seromuscular Cushing with barbed sutures (Sinovich et al., 2020).…”