Perforations of tri‐layer nitrile‐latex and natural rubber latex gloves during ex‐vivo equine intestinal anastomoses

Abstract

Objective: To compare perforation rates between tri-layer nitrile-latex and natural rubber latex surgical gloves after single-layer end-to-end jejunojejunal anastomoses in equine cadavers.Study Design: Prospective randomized ex-vivo study. Sample Population: Pairs of surgical gloves (n = 46) worn during jejunojejunal anastomoses.Methods: Tri-layer nitrile-latex and rubber latex pairs of gloves were equally but randomly allocated to a right-handed surgeon performing 46 single-layer end-to-end jejunojejunal anastomoses on cadaveric material. Number and location of perforations were determined with the water leak test after each procedure. Ten unused pairs of both glove types were tested as controls.Results: At least one perforation occurred in 41% (19/46) of the pairs of gloves.Glove perforations were present in 22% (5/23; 95% CI: 9-42) of tri-layer glove pairs and 61% (14/23; 95% CI: 41-78) of the rubber glove pairs. The odds of glove perforation were 5.6 times (p = .009, 95% CI: 1.5-20.5) lower when trilayer rather than rubber gloves were used. The duration of procedure did not affect the risk of glove perforation (p = .679). No perforations were observed in the unused gloves. Conclusion:Perforations were less common when the surgeon wore tri-layer nitrile-latex gloves rather than to the natural rubber latex gloves tested in this study. Clinical Relevance: Tri-layer nitrile-latex gloves were more resistant to perforations in experimental settings; further studies may confirm that they are also superior in a clinical setting. | INTRODUCTIONSurgical site infections (SSIs) are significant complications in both human and veterinary medicine, resulting in delayed wound healing, 1 prolonged hospitalization, increased use of antimicrobials, increased cost of The results of this report have been presented in poster format at the 2019 Bain Fallon Memorial Lectures from 21st -25th

Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses

“…Rupture at the mesenteric attachment in the control segments (Figure 3) has been described in other equine BP studies ex vivo 2,3,30 and with healed anastomoses, 21,31 but is rare in clinical cases 30 . Our subjective impression was that elongation of the control segment during distention tore the mesentery off its intestinal attachment.…”

“…Possibly, post-mortem collapse of large vessels that penetrate intestinal muscle layers at the mesenteric attachment creates muscle wall defects that weaken it. 30 The predominant sites of anastomotic leakage in the current study were at mesenteric and antimesenteric sutures, possibly because these sites were weakened by stay sutures. Attention to these sites would seem warranted in the clinical case.…”

“…In this study, the length of the control intestinal segments (40 cm) might have put more stress on the normally curved mesenteric attachment as it straightened under pressure. Possibly, post‐mortem collapse of large vessels that penetrate intestinal muscle layers at the mesenteric attachment creates muscle wall defects that weaken it 30 . The predominant sites of anastomotic leakage in the current study were at mesenteric and antimesenteric sutures, possibly because these sites were weakened by stay sutures.…”

“…5 Rupture at the mesenteric attachment in the control segments (Figure 3) has been described in other equine BP studies ex vivo 2,3,30 and with healed anastomoses, 21,31 but is rare in clinical cases. 30 Our subjective impression was that elongation of the control segment during distention tore the mesentery off its intestinal attachment. In this study, the length of the control intestinal segments (40 cm) might have put more stress on the normally curved mesenteric attachment as it straightened under pressure.…”