Evaluation of intraluminal pressure in cystorrhaphies with and without intestinal serosal patch supplementation from canine cadavers

PURPOSE:To evaluate the maximal intraluminal pressure (MIP) supported by canine cadaveric urinary bladders that underwent cystotomy followed by cystorraphy, with and without serosal patching-supplementation.METHODS:Two groups (n=8 each) were formed, and in one (conventional) the cystotomy was closed with cushing pattern. In the other group (serosal), the same procedure was performed, and a piece of jejunum was used for the construction of the serosal patching over the cystorraphy. MIP was measured by means of an invasive blood pressure transducer with closed stopcock attached to a multiparameter monitor. At the end of each measurement, the bladder body circumference was assessed.RESULTS:Mean±SD MIP sustained for the conventional and serosal groups were 28.88±5.08 and 65.38±10.99 mmHg, respectively (p<0.0001). Bladder circumference did not change significantly between groups (p=0.35) and did not correlate with MIP assessed in conventional (p=0.27; r=0.4379) and serosal groups (p=0.37; r=-0.3637).CONCLUSION:Serosal patch-supplemented cystorraphies were able to sustain intraluminal pressures 55.8% higher, than nonsupplemented cystorraphies in specimens from canine cadavers.

Comparative study of hand sewn single layer anastomosis of dog's bowel / Estudo comparativo das anastomoses manuais em plano único do intestino delgado de cães

BACKGROUND: Two-layer intestinal anastomosis increases the inflammatory response while single-layer anastomosis results in a better wound healing. However the four main kinds of stitches which may be chosen in performing single layer intestinal sutures never before had been comparatively studied. AIM: To compare the four more commonly used types of single layer surgical anastomosis sutures of the digestive tract. METHODS: Six mongrel dogs were operated, each one receiving two anastomosis: one at 30 cm from de Treitz angle - sero-submucosal technique, and the other at 60 cm - total technique. This placement was alternatively inverted. The four more commonly used types of single layer surgical anastomosis sutures of the digestive tract, namely: sero-submucosal stitches tied in the lumen, over the submucosa; sero-submucosal stitches tied in the exterior of the organ, over the serosa; total stitches tied in the lumen, over the mucosa; and total sutures tied in the exterior, over the serosa (Gambee's stitches) were tested. After euthanasia (7th post-operative day) macro and microscopic features were evaluated. Friedman's test was applied for morphometry and for evaluation of the peritoneal adhesions. RESULTS: Statistical significance was demonstrated through major residual acute inflammation and proliferation in total sutures and more profuse adhesions with the sero-submucosal stitches tied in the lumen. The sero-submucosal stitches tied in the exterior over the serosa, had excellent realignment and regeneration of the layers. CONCLUSION: The sero-submucosal stitches tied in the exterior, over the serosa, were the best ones.

RACIONAL: As anastomoses intestinais em dois planos aumentam a resposta inflamatória tecidual, enquanto que a anastomose em plano único resulta em um lúmen maior com menos danos às bordas teciduais. Entretanto, os quatro tipos de suturas mais comumente utilizados em suturas intestinais nunca foram antes estudados comparativamente. OBJETIVO: Comparar os quatro tipos de sutura do tubo digestivo em plano único mais freqüentemente utilizados para anastomoses manuais do tubo digestivo. MÉTODOS: Seis cães de raça indefinida foram operados, cada um recebendo duas anastomoses: uma a 30 cm do ângulo de Treitz - técnica sero-submucosa, e a outra a 60 cm - técnica total. Esta localização foi aleatoriamente invertida. Os quatro tipos de sutura em plano único mais freqüentemente utilizados para anastomoses manuais do tubo digestivo, denominados: pontos extramucoso atados no lúmen da víscera, sobre a submucosa, pontos extramucosos atados no exterior, sobre a serosa, pontos totais atados no lúmen, sobre a mucosa, e pontos totais especiais de Gambee atados no exterior sobre a serosa, foram testados. Eutanásia e necropsia parcial no 7º dia pós-operatório permitiu avaliação de aspectos macro e microscópicos. O teste de Friedman's foi aplicado para a morfometria e avaliação das aderências peritoniais. RESULTADOS: Foi demonstrada diferença estatisticamente significante para a inflamação residual aguda e maior proliferação nas suturas totais, bem como na maior ocorrência de aderências com pontos extramucosos atados no lúmen da víscera, sobre a submucosa. A sutura extramucosa com nós atados na serosa teve regeneração das bordas e alinhamento excelentes. CONCLUSÃO: A sutura extramucosa com nós atados na serosa mostrou-se a melhor.

Serosal patch of the gastroesophageal junction an experimental study in dogs

Thirty two dogs were operated on in order to evaluate the mucosal regeneration of the serosal patch at the gastroesophageal junction. The operation began with a cardiotomy involving one centimeter of the esophagus and two centimeters of the stomach, originating an elliptical serosal surface three centimeters long and one centimeter large, turned to the digestive lumen. The animals were divided into four groups of eight dogs each and named: 1,2,3 and 4; they were sacrified after one, two, four and eight weeks respectively. The results were evaluated by post-operative clinical aspects, macro and microscopic analysis. Post-operative morbidity was low, without signs of digestive tract obstruction. Macroscopically, the patch area at the first week became an ulcerated lesion, with a necrotic bottom; at the second and fourth weeks there was a progressive reduction of the ulcer, from its boundaries to the center, until the complete healing at the eighth week. Microscopically, the serous membrane disappeared early and it was replaced by inflamatory cells and severe neovascular formation, which fitted as a bed to the epithelial proliferation. The neo-epithelization occurred from the periphery to the center lesion. At the esophagus this process was completed within two weeks, with multiple layers of cells, at the stomach, within four weeks, with an unicellular epithelium. The corium, showing an inflamatory reaction at the first week, with fibrinoid necrosis and polimorphonuclear cells, changed to a fibroblastic proliferation with mononuclear cells at the second and fourth weeks and, finally, to fibrosis at the eighth week. In the animals sacrified lately there was regeneration of the snooth muscle layer of the esophagus. At electronic microscopy, the neo-epithelium of the esophagus had all the layer which constitute the normal esophageal epithelium.

Anterior seromyotomy with posterior truncal vagotomy in chronic duodenal ulcer.

Anterior seromyotomy with posterior truncal vagotomy was carried out on 25 patients with chronic duodenal ulcer to evaluate its effectiveness as an acid reducing procedure. There was a 76.7% and 76.8% reduction in basal and maximal acid output respectively (augmented histamine test). Twenty-three patients were asymptomatic at 4-6 years' follow-up, while two patients had delayed gastric emptying not necessitating reoperation. There was no mortality. This procedure is a reasonable alternative to highly selective vagotomy.

Seromiotomia gástrica Anterior e vagotmia troncular posterior: análise experimental / Anterior gastric seromiotomy and posterior troncular vagotomy: experimental analysis

Os autores analisam 12 cäes operados com a técnica de seromiotomia gástrica anterior, vagotomia posterior e desvascularizaçäo do fundo gástrico. Seis meses após a cirurgia foram realizados estudos da produçäo ácida gástrica com teste de Hollander, pH gástrico (pHO'=SD 0,17), vermelho-congo (83% totalmente negativos, 17% parcialmente positivos). Näo houve estase gástrica nos exames radiológicos. O volume gástrico de jejum foi normal. Os dados obtidos forma analisados pelo teste t de Student para 95% de confiabilidade