Retrospective study of complications associated with surgically-placed gastrostomy tubes in 43 dogs with septic peritonitis.

OBJECTIVES: To determine the safety of surgically-placed gastrostomy feeding tubes in dogs with septic peritonitis. MATERIALS AND METHODS: Retrospective analysis of 43 dogs with septic peritonitis that had undergone surgical exploration and gastrostomy tube (de Pezzer or Foley) placement as part of the surgical procedure. Postoperative recovery times, hospitalisation times, complication rates and overall survival times were documented. RESULTS: The most common cause of septic peritonitis was dehiscence of an enterotomy or enterectomy site. Fifteen dogs had a Foley gastrostomy tube placed and 28 had a de Pezzer gastrostomy tube placed. The median time from surgery to the start of enteral nutrition was 16 hours (range 3 to 28 hours). There were no major complications relating to the gastrostomy tube; minor complications occurred in 11 (26%) patients. The overall median time spent in hospital was 5 days (range 3 to 29 days) for patients surviving to discharge and 22 (51%) dogs survived overall. CLINICAL SIGNIFICANCE: Gastrostomy feeding tubes provide a safe way to provide enteral nutrition to dogs with septic peritonitis; they are associated with a low complication rate in these patients.

Intraperitoneal behaviour of a new composite mesh (Parietex™ Composite Ventral Patch) designed for umbilical or epigastric hernia repair.

INTRODUCTION: The most common treatment option for ventral and umbilical hernias is the implant of a prosthetic mesh. This study compares the behaviour of a new mesh, Parietex™ Composite Ventral Patch (Ptx), with two commercially available meshes, Ventralex™ ST Hernia Patch and Proceed™ Ventral Patch. MATERIALS AND METHODS: The following meshes were tested in a umbilical-hernia repair model using 54 rabbits: Ventralex™ ST Hernia Patch (Vent) (Bard Davol Inc., USA); Proceed™ Ventral Patch (PVP) (Ethicon, USA) and Ptx (Covidien, Sofradim, France) (n = 18 each). At 3, 7 and 14 days postimplantation, peritoneal behaviour and adhesion formation were assessed by sequential laparoscopy. Adhesions were scored for consistency and quantified by image analysis. The animals were euthanized at 2 (n = 27) and 6 weeks (n = 27) postsurgery. Mesothelial cover of meshes and tissue ingrowth were determined by scanning and light microscopy. RESULTS: Seroma was observed in 1/18 Vent, 7/18 PVP and 4/18 Ptx, mainly between the implant and subcutaneous tissue. Firm omental adhesions between the mesh and parietal peritoneum were noted in 2/9 Vent, 6/9 PVP and 3/9 Ptx at 2 weeks and in 3/9 Vent, 5/9 PVP and 1/9 Ptx at 6 weeks. Three (out of 9) encapsulated PVP implants showed "tissue-integrated" adhesions affecting the intestinal loops. No differences between implants were detected in the surface area occupied by adhesions at 2 weeks, though at 6 weeks, percentages were significantly higher (p < 0.01; Mann-Whitney U test) for PVP compared to Ptx or Vent. At this time point, Ptx and Vent showed good host tissue incorporation and optimal mesothelialization. CONCLUSIONS: The PVP implants showed greater adhesion formation than the other materials. Postimplantation behaviour was comparable for Ptx and Vent including scarce adhesion formation and optimal mesothelialization. Regarding tissue integration, Ptx showed greater long-term collagenization of the neoformed tissue.

Short- and long-term biomechanical and morphological study of new suture types in abdominal wall closure.

To perform an abdominal-wall closure, a continuous suture is the preferred method. The suture materials that are most commonly employed in abdominal surgery are polypropylene and polydioxanone. However, in recent times, new products have been marketed, such as non-absorbable polyurethane with elastic properties (Assuplus(®), Assut Europe, Italy) and absorbable barbed polydioxanone (Filbloc(®), Assut Europe, Italy). The purpose of this study was to compare the ability of those against the standard polypropylene (Surgipro(TM), Covidien, USA) and polydioxanone (Assufil(®), Assut Europe, Italy) to mimic the biomechanical behavior of the abdominal wall closure. Comparison of the sutures was made first with the materials alone and later in a laparotomy closure of a rabbit abdomen, used as an animal model. The biomechanical analysis consisted of uniaxial tensile tests of threads and sutured samples of the animal abdomen. In the latter case, results were analyzed at short- (21days) and long- (180days) term intervals after the surgery. The morphology studies and collagen expression of the samples were also investigated. The results determined that polydioxanone and polypropylene sutures showed a linear elastic behavior, with barbed polydioxanone as the most compliant suture and polyurethane as the stiffest. The sutured samples showed a statistically significant loss of resistance, measured as the load needed to perform a certain stretch, when compared with the corresponding control tissue. Analysis of the stress-stretch curves showed that elastic polyurethane was the only suture able to reproduce the mechanical behavior of healthy tissue in the short term, while the rest of the sutures remained less stiff. This coincides with the expression of type I collagen observed in this group at this point in the study. In the long term, there was no difference among the sutures, and none was able to mimic control behavior.

Long term behavior of biological prostheses used as abdominal wall substitutes.

BACKGROUND: Despite their degradation in the host organism, the benefits of collagen bioprostheses remain unclear. This study addresses the absorption and long-term host tissue incorporation of several collagen biomeshes. MATERIAL AND METHODS: Partial ventral hernial defects created in the abdominal wall of rabbits were repaired using the crosslinked meshes Permacol® or CollaMend®, or the non-crosslinked Surgisis®, Tutomesh® or Strattice®. After 90 and 180 days of implant, morphological studies and morphometric analysis of the thickness of the meshes were performed. Immunofluorescence confocal microscopy combined with differential interference contrast (DIC) imaging was used to distinguish newly formed collagen from that comprising the mesh. The macrophage response was examined by immunohistochemistry. RESULTS: At 90 days, the thinner non-crosslinked biomeshes Tutomesh and Surgisis were more fully degraded with much of their collagen replaced with loose connective tissue. By 180 days, both implants had been practically fully absorbed. In contrast, in Strattice only the outermost third was infiltrated by neoformed tissue. On both surfaces of the crosslinked meshes, a fibrous capsule with host cells lining its perimeter was observed at both time points, though at 180 days these cells had penetrated the mesh interior. At both implant times, Strattice showed the higher expression of collagen type I while collagen III expression was similar for all the meshes. The non-crosslinked materials elicited lower macrophage counts at both time points, significantly so for Strattice. The macrophage response decreased over time for all the meshes but Surgisis. CONCLUSIONS: Strattice, the thicker, more compacted non-crosslinked mesh showed the best balance between tissue incorporation and absorption while eliciting a minimal foreign-body reaction in the long-term.

[Minor surgery in primary care: consumer satisfaction]. / Cirugía menor en atención primaria: la satisfacción de los usuarios.

OBJECTIVE: To find the satisfaction of patients undergoing minor surgery at health centres and describe the processes. DESIGN: Retrospective study of population seeking the service. SETTING: Health district. PATIENTS: 160 people who had minor surgery during a year. MEASUREMENTS AND MAIN RESULTS: Descriptive variables of everyone who had minor surgery were analysed: age, sex, type of intervention, pre-surgical diagnosis, anatomical-pathological diagnosis and informed consent. Over three weeks the patients were interviewed by phone with use of a satisfaction questionnaire. 160 interventions took place, 80% of which were then studied histologically, with an 83.16% concordance index. 65% of patients were interviewed. 15% had no telephone, 20% were not found, 95.56% considered they were well attended and 3.17% badly attended. 92.06% would choose the health centre again for procedures of a similar nature. 89.9% thought that the explanations they had received were sufficient. 4.4% thought that the room's hygiene was poor. CONCLUSIONS: Minor surgery in primary care was favourably received by users. Activity at our centre had good anatomical-pathological concordance.

Cirugía menor en atención primaria: la satisfacción de los usuarios / Minor surgery in primary care: user satisfaction

Objetivo. Conocer la satisfacción de los pacientes sometidos a técnicas de cirugía menor en un centro de salud y describir los procesos atendidos. Diseño. Estudio retrospectivo sobre población demandante del servicio. Emplazamiento. Zona básica de salud. Pacientes. Las 160 personas sometidas a cirugía menor en el período de un año. Mediciones y resultados principales. Se analizan variables descriptivas de todos los intervenidos (edad, sexo, tipo de intervención, diagnóstico prequirúrgico, diagnóstico anatomopatológico y consentimiento informado). Se entrevista telefónicamente a los pacientes en un período de 3 semanas, utilizando una encuesta de satisfacción. Se practicaron 160 intervenciones, remitiéndose el 80 por ciento a estudio histológico, con un índice de concordancia del 83,16 por ciento. Se entrevista al 65 por ciento de los pacientes. Un 15 por ciento no disponía de teléfono, no localizándose al 20 por ciento. Un 95,56 por ciento considera que fueron bien atendidos y el 3,17 por ciento mal atendidos. En un 92,06 por ciento elegiría de nuevo el centro de salud para procesos de características similares. El 89,9 por ciento opina que las explicaciones recibidas fueron bastantes. La higiene de la sala es calificada como mala por un 4,4 por ciento. Conclusiones. La realización de cirugía menor en atención primaria tiene una aceptación favorable entre los usuarios. La actividad realizada en nuestro centro tiene alta concordancia anatomopatológica (AU)