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Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model
Author(s) -
Duffy Daniel J.,
Cocca Christina J.,
Chang YiJen,
Moore George E.
Publication year - 2021
Publication title -
veterinary surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.652
H-Index - 79
eISSN - 1532-950X
pISSN - 0161-3499
DOI - 10.1111/vsu.13550
Subject(s) - medicine , fibrous joint , surgery , gastrectomy , cadaver , leakage (economics) , anatomy , cancer , economics , macroeconomics
Objective To determine the influence of stapling on leakage pressures after canine partial gastrectomy. Study design Ex vivo study. Sample population Gastric specimens from 24 adult canine cadavers. Methods Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90‐mm thoracoabdominal stapling device and a 4.8‐mm staple cartridge; group 2, hand‐sewn double‐layer inverting suture closure with 3‐0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern. Leakage and pressure testing were performed. Initial leakage pressure (ILP), maximal leakage pressure (MLP), and leakage location were recorded. Significance was set at P < .05. Results Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2‐fold and 2.8‐fold, respectively, compared with stapled closures alone ( P < .001). Constructs closed with double‐layer suture closure reached ILP and MLP 4.5‐fold and threefold greater, respectively, compared with those with stapled closures alone ( P < .001). Maximal leakage pressure did not differ between groups 2 and 3 ( P = .14). Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs. Conclusion Double‐layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques. Reinforcing staple closures with an inverting suture line improved resistance to leakage. Clinical significance Reinforcing single‐layer closure of partial gastrectomies with an inverting Cushing pattern is recommended to improve resistance to leakage. In vivo investigation is warranted to evaluate influence of closure technique on gastric healing, postoperative stasis, ischemic injury, and postoperative dehiscence.