Intestinal surgery in small animals: historical foundations, current thinking, and future horizons

Area of Science:

• Veterinary Surgery
• Small Animal Medicine
• Surgical Techniques

Background:

• Intestinal wound closure in small animals is critical to prevent dehiscence, morbidity, and mortality.
• Factors like sepsis, hypoalbuminemia, and surgical technique influence dehiscence risk.
• Mucosal eversion poses significant risks, particularly in septic abdominal environments.

Purpose of the Study:

• To review and compare various intestinal wound closure techniques in small animals.
• To evaluate the efficacy and safety of different suturing patterns, stapling devices, and laparoscopic approaches.
• To provide guidance for optimizing clinical outcomes in small animal intestinal surgery.

Main Methods:

• Review of established and novel intestinal closure methods, including approximating and inverting suture patterns.
• Comparison of manual suturing techniques, disposable skin staples, and knotless quilled sutures.
• Evaluation of hand-sewn versus automated stapling devices, considering factors like abdominal sepsis.
• Discussion of laparoscopic-assisted techniques and their role in minimally invasive surgery.

Main Results:

• Approximating suture patterns demonstrate optimal healing and equal bursting strength to inverting patterns.
• Knotless quilled sutures exhibit bursting strength comparable to monofilament sutures in canine cadavers.
• Automated stapling devices show similar dehiscence rates to hand-sewn methods in uncomplicated cases.
• Automated stapling may be preferred in cases of abdominal sepsis, depending on patient size.

Conclusions:

• Surgeons have diverse options for small animal intestinal closure, each with specific advantages.
• Approximating patterns and stapling devices are effective alternatives for wound closure.
• Laparoscopic techniques represent a promising advancement for minimally invasive intestinal surgery.
• Adherence to standard care, including leak testing and early feeding, is essential regardless of technique.