J. Vet. Med. A 39,193-203 (1992) 8 1992 Paul Parey Scientific Publishers, Berlin and Hamburg ISSN 0931-184X
'Department of Veterinary Surgery, University of Ziirich (Head: Prof. J . A. Auer), zllepartment of Veterinary Pathology, University of Ziirirh (Head: Prof. A . Pospischil),
'Department of Veterinary Parasitology, University of Berne (Head: Pro& B. Homing), and
+Departmentof Veterinary Andrology and Gynecology, University of Zurich
Comparison of Staple and Gambee Techniques for Enterotomy Closure in the Normal Bovine Jejunum* A. STEINER',A. WALDVOGEL~, P.WICKI', B. SCHWALBACH' and M.LANG' Address of authors: Dr. A. STEINER,Department of Veterinary Medicine & Surgery, Texas A & M University, College Station, TX 77843, USA With 7figures and 5 tables (Received for publication September 23, 1991)
Summary Two suturing techniques for closure of jejunal enterotomies - the stapling and the Gambee technique - were compared in 7 bulls. Stapling was less time consuming (P < 0.0001)and reduced the overall duration of surgery by 15 %. Furthermore, the lumen diameter was significantly less decreased in the stapled intestine at 8 weeks after surgev (P50
Total
P
Stapling suture (A) Hand suture (B)
5 13
10 3
4 2
2 3
21 21
< 0.005
Postoperative clinical findings One bull suffered from diarrhoea immediately after the first surgery and 5 bulls suffered from bronchopneumonia a fortnight after the first surgery. However no signs of colic were noticed in any of the animals. There was no disturbance in the progress of abdominal wound healing. Gross findings Twenty stapled enterotomy sites (95 %) adhered to the neighbouring small intestinal loops and mesentery (Tables 1 and 2). One third of the adhesions took a maximum expansion of more than 25 cm. The stapling sutures were involved partially or completely into the adhesions 16 times (76 Yo).
Table 3. Thickness of intestinal wall at the enterotomy site Technique
+
Stapling suture (A) Hand suture (B)
4 21
Additional thickening of intestinal wall
++
+++
++++
Total
P
6 0
9
2
0
0
21 21
< 0.0001
+ = Less than 3 mm; ++ = < 50 % of suture as thick as 3 mm; 3 mm. ++++ = more than 3 mm.
+++ = 50 % - 100 Yo of suture as thick as
Table 4. Diameter of intestinal lumen at the enterotomy site % reduction of lumen diameter at positin (%f sd)
Technique
1
2
Stapling suture (A) Hand suture (B)
8.2 k 6.7
5.9 ? 8.3 4.6 6.1
7.1 t 5.1
Total
3
*
*
2.6 3.2 11.2 t 2 . 1 "
~~
" = Statistically different from A3 (P < 0.05) and from B2 (P < 0.05).
5.2 t 6.0 6.8 k 5.3
Comparison of Staple and Gambee Techniques for Enterotomy Closure
199
Only 11 enterotomy sites sutured according to Gambee (53 %) adhered near the suture line and only at 8 sites (38 YO)the suture line itself was either partially or completely involved. In one case (5 %), the adhesions exceeded an area of 25 cm diameter. The difference between the two techniques in the extent of adhesions (P < 0.01) and in the involvement of the suture h e itself (P
'Department of Veterinary Surgery, University of Ziirich (Head: Prof. J . A. Auer), zllepartment of Veterinary Pathology, University of Ziirirh (Head: Prof. A . Pospischil),
'Department of Veterinary Parasitology, University of Berne (Head: Pro& B. Homing), and
+Departmentof Veterinary Andrology and Gynecology, University of Zurich
Comparison of Staple and Gambee Techniques for Enterotomy Closure in the Normal Bovine Jejunum* A. STEINER',A. WALDVOGEL~, P.WICKI', B. SCHWALBACH' and M.LANG' Address of authors: Dr. A. STEINER,Department of Veterinary Medicine & Surgery, Texas A & M University, College Station, TX 77843, USA With 7figures and 5 tables (Received for publication September 23, 1991)
Summary Two suturing techniques for closure of jejunal enterotomies - the stapling and the Gambee technique - were compared in 7 bulls. Stapling was less time consuming (P < 0.0001)and reduced the overall duration of surgery by 15 %. Furthermore, the lumen diameter was significantly less decreased in the stapled intestine at 8 weeks after surgev (P50
Total
P
Stapling suture (A) Hand suture (B)
5 13
10 3
4 2
2 3
21 21
< 0.005
Postoperative clinical findings One bull suffered from diarrhoea immediately after the first surgery and 5 bulls suffered from bronchopneumonia a fortnight after the first surgery. However no signs of colic were noticed in any of the animals. There was no disturbance in the progress of abdominal wound healing. Gross findings Twenty stapled enterotomy sites (95 %) adhered to the neighbouring small intestinal loops and mesentery (Tables 1 and 2). One third of the adhesions took a maximum expansion of more than 25 cm. The stapling sutures were involved partially or completely into the adhesions 16 times (76 Yo).
Table 3. Thickness of intestinal wall at the enterotomy site Technique
+
Stapling suture (A) Hand suture (B)
4 21
Additional thickening of intestinal wall
++
+++
++++
Total
P
6 0
9
2
0
0
21 21
< 0.0001
+ = Less than 3 mm; ++ = < 50 % of suture as thick as 3 mm; 3 mm. ++++ = more than 3 mm.
+++ = 50 % - 100 Yo of suture as thick as
Table 4. Diameter of intestinal lumen at the enterotomy site % reduction of lumen diameter at positin (%f sd)
Technique
1
2
Stapling suture (A) Hand suture (B)
8.2 k 6.7
5.9 ? 8.3 4.6 6.1
7.1 t 5.1
Total
3
*
*
2.6 3.2 11.2 t 2 . 1 "
~~
" = Statistically different from A3 (P < 0.05) and from B2 (P < 0.05).
5.2 t 6.0 6.8 k 5.3
Comparison of Staple and Gambee Techniques for Enterotomy Closure
199
Only 11 enterotomy sites sutured according to Gambee (53 %) adhered near the suture line and only at 8 sites (38 YO)the suture line itself was either partially or completely involved. In one case (5 %), the adhesions exceeded an area of 25 cm diameter. The difference between the two techniques in the extent of adhesions (P < 0.01) and in the involvement of the suture h e itself (P
