Parallel alternating sliding knots are effective for ligation of mesenteric arteries during resection and anastomosis of the equine jejunum

Abstract

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.

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

“…Finally, the catheter was connected to a 50 ml syringe d and an analogue manometer e with the aid of a 3-way inlet tubing, thus forming a closed system [7,14,15] (Supplementary Item 3). The remaining segment of cord or testicular artery was subjected to further testing.…”

“…The artery was proximally sealed using mosquito forceps with 2 pieces of latex tube around its jaws (Supplementary Item 2). Finally, the catheter was connected to a 50 ml syringe d and an analogue manometer e with the aid of a 3-way inlet tubing, thus forming a closed system [7,14,15] (Supplementary Item 3). A fluid stain composed of 0.9% saline solution and methylene blue was slowly injected, increasing the intraluminal pressure of the testicular artery.…”

“…Fluid pressure was measured until leakage from the distal stump through the ligature or emasculation site occurred. Fluid leakage marked the end of the experiment and the value thus obtained was identified as the leaking pressure [7,14,15]. Fluid pressure was measured by the manometer in mH 2 O then converted into mmHg to relate the results to physiological values in vivo.…”

Evaluation of three ligatures in simulated equine open castration

“…In each group, the ligature was completed with a Glicomer 631 USP n°0 (Biosin; Covidien Italia, Milan, Italy) and apposed proximally to the transecting line at a standard length of 10 mm . The transfixing knot was created with a surgeon's knot with four overthrows, for a total of six throws . The giant knot had only one reverse half‐hitch on the alternate post .…”

Clinical evaluation of a jejunojejunal end‐to‐end anastomosis with skin staples with or without coverage by a mesenteric flap

“…The mesenteric arteries of the intestinal tract to be removed were ligated with a suture of 2‐0 polydioxanone sulfate (Ethicon) with two sliding knots proximal to the resection site and distally with one knot (Gandini et al . ). Anastomosis was performed by an experienced surgeon (M.G.)…”