Influence of crotch suture augmentation on leakage pressure and leakage location during functional end‐to‐end stapled anastomoses in dogs

• Published in: Veterinary surgery Vol. 51; no. 4; pp. 697 - 705
• Main Authors: Duffy, Daniel J., Chang, Yi‐Jen, Moore, George E.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2022; Blackwell Publishing Ltd
• Subjects: Anastomosis; Anastomosis, Surgical - methods; Anastomosis, Surgical - veterinary; Animals; Augmentation; Cadavers; Dogs; Jejunum - surgery; Leakage; Neurosurgical Procedures - veterinary; Placement; Pressure; Segments; Suture Techniques - veterinary; Sutures; Sutures - veterinary
• ISSN: 0161-3499; 1532-950X
• DOI: 10.1111/vsu.13764

Objective To determine the influence of anastomotic crotch suture augmentation on leakage pressures and leakage location following intestinal functional end‐to‐end stapled anastomosis (FEESA) in dogs. Study design Ex vivo, randomized, experimental. Sample population Chilled jejunal segments from 3 adult dogs. Methods Jejunal specimens were tested within 24 hours of collection. A FEESA was performed and randomly assigned to 1 of 4 treatment groups (n = 12/group): (1) no crotch suture (NCS); (2) simple interrupted crotch suture (SICS); (3) two simple interrupted crotch sutures (TCS) placed laterally on opposing jejunal limbs; (4) simple continuous crotch suture (SCCS) augmentation. Crotch sutures were performed using 3‐0 USP polydioxanone. Initial (ILP) and maximal (MLP) leakage pressures (Mean ± SD mm Hg) and leakage location were recorded and compared between groups. Results Initial leakage pressure was greater after placement of TCS (37.8 ± 6.4, P < .039) and SCCS (47.6 ± 11.0, P < .002) than NCS (27.1 ± 2.5) and SICS (33.0 ± 6.0). Maximal leakage pressure was greater in specimens including SICS, TCS, and SCCS than those without crotch suture augmentation (P < .043). Leakage occurred at the anastomotic crotch in 8/12 NCS, 6/12 SICS, 11/12 TCS, and 12/12 SCCS constructs (P < .001). Conclusion Augmentation of FEESA with TCS and SCCS increased ILP and decreased the occurrence of leakage from the anastomotic crotch, while all methods of anastomotic crotch augmentation increased MLP. Clinical significance Augmenting the FEESA with crotch suture(s) improved the resistance of the jejunal anastomosis to leakage in normal cadaveric segments. Placing 2 crotch sutures or use of a simple continuous pattern for anastomotic augmentation appeared to be superior to the placement of a single suture.