Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model

Duffy, Daniel J.; Chang, Yi‐Jen; Moore, George E.

doi:10.1111/vsu.13405

Cited by 8 publications

(28 citation statements)

References 26 publications

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“…Researchers recently evaluated the influence of closure technique using a canine typhlectomy model, 30 and, similarly to our results, cecal segments augmented with a Cushing suture after stapled closure achieved significantly higher ILP and MLP compared with staple use alone or Parker‐Kerr suture patterns. In that same study, SLR resulted in ILP that were 2.8‐fold greater compared with stapled repairs alone 30 . Researchers have demonstrated benefits of SLR in clinical animals after canine functional end‐to‐end stapled anastomosis (FEESA).…”

Section: Discussionsupporting

confidence: 86%

“…In contrast, however, oversewing the staple line with 3-0 Vicryl polyglactin 910 suture significantly increased construct bursting strength. 33 Researchers recently evaluated the influence of closure technique using a canine typhlectomy model, 30 and, similarly to our results, cecal segments augmented with a Cushing suture after stapled closure achieved significantly higher ILP and MLP compared with staple use alone or Parker-Kerr suture patterns. In that same study, SLR resulted in ILP that were 2.8-fold greater compared with stapled repairs alone.…”

Section: Discussionsupporting

confidence: 85%

“…Use of SLR has been evaluated both in man 15‐18 and in animals 30‐32 . In a study in which researchers evaluated incisional leakage after laparoscopic sleeve gastrectomy in man, two factors were found to be protective: surgeon experience and SLR implementation, regardless of reinforcement type used 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Use of SLR has been evaluated both in man [15][16][17][18] and in animals. [30][31][32] In a study in which researchers evaluated incisional leakage after laparoscopic sleeve gastrectomy in man, two factors were found to be protective: surgeon experience and SLR implementation, regardless of Note: Data are mean ± SD. After partial gastrectomy closure with a 90-mm 4.8-mm stapling device alone (group 1), double-layer hand-sewn suture closure (group 2), and a 90-mm 4.8-mm staple closure, followed by a sutured oversew with a Cushing suture pattern (group 3).…”

Section: Discussionmentioning

confidence: 99%

“…In that same study, SLR resulted in ILP that were 2.8-fold greater compared with stapled repairs alone. 30 Researchers have demonstrated benefits of SLR in clinical animals after canine functional end-to-end stapled anastomosis (FEESA). Researchers evaluating the effect of oversewing the transverse staple line after FEESA found that SLR use was associated with reduced postoperative dehiscence.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

et al. 2021

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Objective: To determine the influence of stapling on leakage pressures after canine partial gastrectomy. Study design: Ex vivo study. Sample population: Gastric specimens from 24 adult canine cadavers. Methods: Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90-mm thoracoabdominal stapling device and a 4.8-mm staple cartridge; group 2, hand-sewn double-layer inverting suture closure with 3-0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern. Leakage and pressure testing were performed. Initial leakage pressure (ILP), maximal leakage pressure (MLP), and leakage location were recorded. Significance was set at P < .05. Results: Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2-fold and 2.8-fold, respectively, compared with stapled closures alone (P < .001). Constructs closed with double-layer suture closure reached ILP and MLP 4.5-fold and threefold greater, respectively, compared with those with stapled closures alone (P < .001). Maximal leakage pressure did not differ between groups 2 and 3 (P = .14). Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs. Conclusion: Double-layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques. Reinforcing staple closures with an inverting suture line improved resistance to leakage. Clinical significance: Reinforcing single-layer closure of partial gastrectomies with an inverting Cushing pattern is recommended to improve resistance

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

et al. 2021

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Influence of three different closure techniques on leakage pressures and leakage location following partial cystectomies in normal dogs

Haas

Duffy

Kendall

et al. 2023

Veterinary Medicine & Sci

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Background: Transitional cell carcinoma (TCC) is the most common neoplasia affecting the canine urinary bladder. Partial cystectomy, when used adjuctively with medical management, has been shown to meaningfully extend medial survival time. Surgical stapling devices have a wide variety of uses and advantages over traditional closure methods and, to date, investigation into their use in canine partial cystectomies has not been documented.Objective: To determine the influence of three closure techniques on ex vivo leakage pressures and leakage location following canine partial cystectomy.Methods: Specimens were assigned to one of three closure techniques: simple continuous appositional closure with 3-0 suture, closure with a 60 mm gastrointestinal stapler with a 3.5 mm cartridge, and placement of a Cushing suture to augment the stapled closure, with each group containing 12 specimens. Mean initial leakage pressure (ILP), maximum leakage pressure (MLP), and leakage location at the time that ILP was recorded were compared between groups.Results: Oversewn stapled constructs leaked at significantly higher ILP (28.5 mmHg) than those in the sutured (17 mmHg) or stapled (22.8 mmHg) group, respectively. MLP was greater in the oversewn stapled construct group compared to other groups. Leakage was detected in 97% partial cystectomies, with leakage occurring from the needle holes in 100% of the sutured closure group, from the staple holes in 100% of the stapled only group, and from the incisional line in 83% and from bladder wall rupture in 8% of the augmented staple closure group. All closure methods withstood normal physiologic cystic pressures.Conclusions: Placement of a Cushing suture to augment stapled closures improved the ability of partial cystectomies to sustain higher intravesicular pressures compared with sutured or stapled bladder closures alone. Further in vivo studies are required to determine the clinical significance of these findings and the role of stapling equipment forThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Influence of oversewing the transverse staple line during functional end‐to‐end stapled intestinal anastomoses in dogs

Duffy

Moore

2020

Veterinary Surgery

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ObjectiveTo determine the effect of oversewing the transverse staple line after functional end‐to‐end stapled intestinal anastomoses (FEESA) on canine jejunal leakage pressures.Study designExperimental, ex vivo, randomized study.Sample populationJejunal segments from three adult canine cadavers.MethodsJejunal segments were harvested within 2 hours of euthanasia and anastomosed (24 jejunal segments per group, consisting of two segments per construct with n = 12/ group). Constructs were then randomly assigned to receive FEESA alone, FEESA + Cushing oversew, or FEESA + simple‐continuous oversew of the transverse staple line with 3‐0 polydioxanone. Results for initial leakage pressure (ILP) and maximal leakage pressure (MLP) and initial leakage location (LL) were compared between groups.ResultsMean ILP was 1.8‐fold higher for FEESA + Cushing oversew (62.4 ± 7.8 mm Hg) compared with FEESA alone and FEESA + simple‐continuous oversew (P < .001). Mean MLP were higher for both oversewn techniques compared with FEESA alone (P < .001). Oversewing the transverse staple line with either pattern increased mean MLP by 1.4‐fold compared with FEESA alone. Leakage occurred at the level of the transverse staple line in nonoversewn constructs (P < .001).ConclusionOversewing the transverse staple line after FEESA increased MLP and decreased the occurrence of leakage at this location. Oversewing with a Cushing pattern increased ILP compared with oversew with a simple‐continuous pattern.Clinical significanceOur results provide evidence to support oversewing the transverse staple line after FEESA. Doing so may reduce the occurrence of postoperative dehiscence. These findings warrant additional focused investigation in vivo through a prospective randomized clinical trial.

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Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model

Cited by 8 publications

References 26 publications

Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

Influence of three different closure techniques on leakage pressures and leakage location following partial cystectomies in normal dogs

Influence of oversewing the transverse staple line during functional end‐to‐end stapled intestinal anastomoses in dogs

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