Intra-abdominal complications following intestinal anastomoses by suture and staple techniques in dogs

Abstract

OBJECTIVE To compare the incidence of intra-abdominal complications in dogs following resection and functional end-to-end stapled anastomosis (FEESA) versus anastomosis with an end-to-end sutured technique for treatment of enteric lesions. DESIGN Multicenter, retrospective descriptive cohort study. ANIMALS 180 dogs. PROCEDURES Medical records of dogs undergoing intestinal resection and anastomosis at 3 nonaffiliated private practice specialty centers were retrospectively reviewed. Preoperative clinical variables, indication for surgery, surgical technique (sutured end-to-end anastomosis vs FEESA), and evidence of postoperative anastomosis site leakage (dehiscence) were recorded. Variables of interest were analyzed for associations with dehiscence. RESULTS Dehiscence rates of sutured and stapled anastomoses were 12 of 93 (13%) and 4 of 87 (5%), respectively; odds of postoperative dehiscence were significantly lower for dogs with FEESAs than for dogs with sutured anastomoses (OR, 0.28; 95% confidence interval, 0.09 to 0.94). Among dogs that underwent surgery for treatment of intestinal dehiscence after surgery at another facility, subsequent dehiscence developed in 3 of 5 with sutured anastomoses and 0 of 11 with stapled anastomoses. Dehiscence rates varied significantly among clinics. No other variable was associated with risk of dehiscence. Eleven of 16 dogs with dehiscence were euthanized without additional surgery. Impaction at the anastomosis site was identified months or years after surgery in 3 dogs (4 anastomosis sites) that had FEESAs. CONCLUSIONS AND CLINICAL RELEVANCE Odds for dehiscence were significantly greater for sutured end-to-end anastomoses than FEESAs, and dogs undergoing surgery for previous dehiscence were significantly more likely to experience a subsequent dehiscence with a sutured anastomosis. However, variability of procedure types and dehiscence rates among clinics suggested further research is needed to confirm these findings. Obstruction at the anastomosis site was identified as a potential long-term complication of FEESA.

Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008‐2018)

“…The dehiscence rate for the nonoversewn FEESA (14.6%) is in line with previously reported dehiscence rates (0%‐13%) in stapled intestinal anastomoses . Risk factors previously reported for postoperative dehiscence include preoperative peritonitis and hypoalbuminemia with a serum albumin of less than 2.5 g/dL .…”

“…In one study on intestinal anastomoses, intestinal foreign bodies were found to increase risk of postoperative dehiscence, while in another study evaluating risk factors for septic peritonitis in dogs undergoing gastrointestinal surgery, diagnosis of a foreign body was a preoperative protective factor against postoperative death . Two more recent studies did not provide evidence that preoperative peritonitis, foreign bodies, or hypoalbuminemia were risk factors for dehiscence . In 2013, Snowden et al identified inflammatory bowel disease, intraoperative hypotension, and location of the anastomosis (large intestine) to be risk factors for dehiscence.…”

“…The advantages of this technique compared with sutured techniques include short surgical time, consistent staple placement, minimal tissue trauma, preservation of blood supply, and the ability to accommodate for lumen disparity . A potential major complication of intestinal resection and anastomosis is leakage at the anastomosis site, which is associated with high morbidity and mortality . Stapled anastomosis leakage rates in dogs are 0% to 13%, with the highest risk for leakage at 3‐5 days after surgery, during the inflammatory stage of wound healing .…”

“…[1][2][3][4] A potential major complication of intestinal resection and anastomosis is leakage at the anastomosis site, which is associated with high morbidity and mortality. 5,6 Stapled anastomosis leakage rates in dogs are 0% to 13%, 1,2,[4][5][6][7][8] with the highest risk for leakage at 3-5 days after surgery, during the inflammatory stage of wound healing. 9 While there are some conflicting reports, preexisting peritonitis, intestinal foreign bodies, serum albumin less than 2.5 g/dL, inflammatory bowel disease, location of anastomosis, and intraoperative hypotension have all been reported as risk factors for anastomosis site dehiscence.…”

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

“…No significant difference was found in dehiscence rates between hand‐sewn anastomosis (16%) and stapled anastomosis (11%) in a recent retrospective study in dogs, but a significant difference was found in surgery duration, with a mean duration of 140 minutes for hand‐sewn anastomosis and 108 minutes for stapled anastomosis . In another study, the odds for dehiscence were significantly greater for sutured anastomosis (13%) than for stapled anastomosis (5%), and dogs that had surgery for intestinal dehiscence were more likely to have a subsequent dehiscence with a hand‐sewn anastomosis . There are a number of proposed advantages of the stapled technique compared with sutured techniques, including short surgical time, consistent staple placement, minimal tissue trauma, preserved blood supply, ease of use for inexperienced surgeons, and the ability to accommodate for lumen disparity .…”