Intraoperative surgeon probe inspection compared to leak testing for detecting gaps in canine jejunal continuous anastomoses: A cadaveric study

Abstract

Objective To compare the detection of gaps in jejunal continuous anastomoses by probing (PT) versus leak testing (LT). Study Design Experimental study. Animals Normal jejunal segments (n = 24) from two fresh canine cadavers. Methods Intestinal segments were randomly selected by four volunteers who created six simple continuous anastomoses: two constructs using standard technique with 2–3 mm suture spacing (ST, 8 total), and four constructs with one 4‐mm gap (IG, 16 total). All 24 anastomoses were examined with PT (1 volunteer) prior to LT (3 volunteers). LT was performed within a maximal peristaltic pressure range (34–54 cmH2O). The presence and location of anastomotic leaks (LA) detected with LT were compared with gaps detected with PT. Results Nineteen out of twenty‐four (79.2%) samples had at least one probe drop, and four out of twenty‐three (17.4%) samples leaked. LT results from one sample were excluded due to iatrogenic suture failure. PT was 100% sensitive (95% CI: 51.01, 100%) with a 100% negative predictive value (95% CI: 56.55, 100%) at detecting gaps compared with LT. The location of all LA was accurately identified with PT and confirmed during LT. Conclusion PT was highly sensitive at detecting gaps compared with LT. All LA were accurately detected by PT. None of the segments negative during PT leaked. Clinical Significance The diagnostic value of PT appears adequate to recognize gaps in cadaveric small intestinal anastomoses. PT offers surgeons an alternative to detect suture gaps that may contribute to postoperative dehiscence of intestinal anastomoses.

Influence of staple line number and configuration on the leakage of small intestinal functional end‐to‐end stapled anastomosis: An ex vivo study

“…Additional limitations to this study include the lack of selection of closed staple height on tissue thickness, lack of histopathological evaluation of intestinal tissues, lack of additional procedures to evaluation staple line integrity (eg probing) 27 , and use of a single, simple interrupted crotch suture to augment the FEESA. 28 In summary, a FEESA constructed with a 3-row linear stapler for the vertical and transverse staple line or transverse staple line alone, using a 1.5 mm closed staple height, increased ILP compared to construct creation using 2-rows. There was no difference in MIP or leakage location between FEESA groups.…”

“…Although small intestinal tissues where harvested immediately after euthanasia and tested within 5 h of harvesting, these tissues likely have varying biomechanical properties compared with live dog small intestine tissues with and without disease. Additional limitations to this study include the lack of selection of closed staple height on tissue thickness, lack of histopathological evaluation of intestinal tissues, lack of additional procedures to evaluation staple line integrity (eg probing) 27 , and use of a single, simple interrupted crotch suture to augment the FEESA 28 …”

Cooled feline intestine and fresh intestine did not differ in enterotomy leak pressure testing or in gross wall thickness measurement

“…Initial leakage locations did not differ (p = .41) between FE and CE. The MIP causes for FE were plateau (16) and catastrophic (4) and MIP causes for CE were plateau (17) and catastrophic (3). The MIP causes did not differ (p = 1.0) between FE and CE.…”

“…Canine cadaveric studies involving the gastrointestinal tract have increased during the past 3 years (2020-2022) [1][2][3][4][5][6][7][8][9] after a novel study 7 was performed by Aeschlimann et al in 2018. This study compared leak testing in frozenthawed, cooled, and fresh porcine jejunal tissue due to its similarity to canine jejunal tissue in order to evaluate the type of tissue that may be more reliable in assessing enterotomy leak pressures. 7 As far as the authors of the current study are aware, it has not yet been established whether fresh or cooled feline cadaveric intestine is sufficient as an ex vivo model for feline intestinal surgery and species differences might exist.…”

“…Canine cadaveric studies involving the gastrointestinal tract have increased during the past 3 years (2020–2022) 1–9 after a novel study 7 was performed by Aeschlimann et al in 2018. This study compared leak testing in frozen–thawed, cooled, and fresh porcine jejunal tissue due to its similarity to canine jejunal tissue in order to evaluate the type of tissue that may be more reliable in assessing enterotomy leak pressures 7 .…”