DOI
https://doi.org/10.18849/ve.v10i3.714Abstract
PICO Question
In dogs undergoing enterotomy, does using a Gambee suture pattern instead of a single interrupted suture pattern to close the intestinal incision reduce the risk of postoperative complications?
Clinical bottom line
Category of research
Treatment.
Number and type of study designs reviewed
Three papers addressed the PICO question and matched the search terms. All were experimental clinical trials. One study was a controlled but non-randomised trial, another was a non-controlled, non-randomised clinical trial, and the third was a randomised but non-controlled clinical trial.
Strength of evidence
Weak.
Outcomes reported
The first study suggested that the simple interrupted technique was easier, faster, and safer, with a significantly lower stenotic index at the anastomotic site and with relatively lower adhesion formation and rapid gain in tensile strength than the Gambee method. The second study found the risk of postoperative complications after enterotomy in dogs was no different whether Gambee or simple-interrupted sutures were used. The third study showed that the time for closure was significantly less for the simple interrupted suture group compared to the Gambee suture group. Despite this, the mean initial and maximum leak pressure values in the Gambee group were higher.
Conclusion
The study design of those papers is considered poor and the strength of evidence weak in support of the PICO question. For now, the decision between Gambee and single interrupted suture for intestinal closure depends on the vet surgeon’s choice. Future studies should be designed more efficiently before recommending a specific technique in clinical practice.
References
Allen, D. A., Smeak, D.D. & Schertel, E.R. (1992). Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. Journal of the American Animal Hospital Association. 28(1), 70–76.
Athar, M., Chaudhry, N., Shakoor, A. & Khan, M. (1996). Studies on end-to-end colonic anastomosis in the dog: a comparison of techniques. Acta Veterinaria Hungarica. 44(3), 349–356.
Azevedo, J.L.M.C, Hypólito, O., Azevedo, O.C., Becker Jr, O.M. & Freire, D.F. (2008). Comparative study of hand sewn single layer anastomosis of dog's bowel. Arquivos de Gastroenterologia. 45(4), 319–322. DOI: https://doi.org/10.1590/S0004-28032008000400011
Brown, D. (2012). Small Intestine. In: K. Tobias & S. Johnston, ed., Veterinary Surgery: Small Animal. Louis: Elsevier, 1513–1541.
DePompeo, C.M., Bond, L., George, Y.E., Mezzles, M.J., Brourman, J.D, Chandler, J.C, Murphy, S.M, Pike, F. & Mason D.R. (2018). Intra-abdominal complications following intestinal anastomoses by suture and staple techniques in dogs. Journal of the American Veterinary Medical Association. 253(4), 437–443. DOI: https://doi.org/10.2460/javma.253.4.437
Duell, J.R., Thieman Mankin, K.M., Rochat, M.C., Regier, P.J., Singh, A., Luther, J.K, Mison, M.B. Leeman, J.J. & Burke, C.M (2016). Frequency of Dehiscence in Hand Sutured and Stapled Intestinal Anastomoses in Dogs. Veterinary Surgery. 45(1), 100–103. DOI: https://doi.org/10.1111/vsu.12428
Hedlund, C.S. & Fossum, T.W. (2007). Surgery of the Digestive System. In: Fossum, T.W., ed., Small Animal Surgery. 3rd ed. St.Louis: Elsevier, 458–459.
Kieves, N.R, Krebs, A.I. & Zellner, E.M. (2018). A comparison of ex vivo leak pressures for four enterotomy closures in a canine model. Journal of the American Animal Hospital Association. 54(2),71–76. DOI: https://doi.org/10.5326/JAAHA-MS-6459
Milovancev, M.,Weisman, D.L. & Palmisano, M.P. (2004). Foreign body attachment to polypropylene suture material extruded into the small intestine lumen after enteric closure in three dogs. Journal of the American Veterinary Medical Association. 225(11), 1713–1715. DOI: https://doi.org/10.2460/javma.2004.225.1713
Mullen, K.M., Reiger, P.J., Ellison, G.W. & Londoño, L. (2020). The Pathophysiology of Small Intestinal Foreign Body Obstruction and Intraoperative Assessment of Tissue Viability in Dogs: A Review. Topics in Companion Animal Medicine. 40, 100438. DOI: https://doi.org/10.1016/j.tcam.2020.100438
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