Monthly Journal Round-Up - May/June 2018

Thanks as always to Lara Brunori DVM CertAVP MRCVS

Clinical practice reviews:

  • MacFarlane, P. (2018) ’Managing perioperative pain in dogs and cats’. In Practice, 40(4), pp.130-140.
  • Bradbrook, C.A. & Clark, L. (2018) ‘State of the art analgesia - recent developments in pharmacological approaches to acute pain management in dogs and cats. Part 1’. The Veterinary Journal (Early view).
  • Bradbrook, C.A. & Clark, L. (2018) ‘State of the art analgesia - recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2’.The Veterinary Journal, 236, pp. 62-67.
  • Hagman, R. (2018) ‘Pyometra in small animals’. Veterinary Clinics of North America: Small Animal Practice, 48(4), pp. 639-661.
  • Clarke, D.L. (2018) ‘Feline ureteral obstructions Part 1: medical management’. Journal of Small Animal Practice, 59(6), pp. 324-333.
  • Clarke, D.L. (2018) ‘Feline ureteral obstructions Part 2: surgical management’. Journal of Small Animal Practice (Early view). 

Clinical studies:

Prospective:

  • Seitz, M.A. et al. (2018) ‘Evaluation for association between indwelling urethral catheter placement and risk of recurrent urethral obstruction in cats’. Journal of the American Veterinary Medical Association, 252 (12), pp. 1059-1520.
  • Ortiz, V. et al. (2018) ‘Evaluating the effect of metronidazole plus amoxicillin-clavulanate versus amoxicillin-clavulanate alone in canine haemorrhagic diarrhoea: a randomised controlled trial in primary care practice’. Journal of Small Animal Practice (Early view).
  • Walters, A.M. ‘Evaluation of the agreement between focused assessment with sonography for trauma (AFAST/TFAST) and computed tomography in dogs and cats with recent trauma’. Journal of Veterinary Emergency and Critical Care (Early view).
  • Ash, K. Et al. (2018) ‘Performance evaluation and validation of the animal trauma triage score and modified Glasgow Coma Scale with suggested category adjustment in dogs: A VetCOT registry study’. Journal of Veterinary Emergency and Critical Care, 28(3), pp.192-200.

Retrospective:

  • Schwartz, Z & Coolman, B.R (2018) ’Closure of gastrointestinal incisions using skin staples alone and in combination with suture in 29 cats’. Journal of Small Animal Practice, 59(9), pp.281-285.
  • Canonne, A.M. et al. (2018) ‘Angiostrongylosis in dogs with negative fecal and in‐clinic rapid serological tests: 7 Cases (2013‐2017)’. Journal of Veterinary Internal Medicine, 32(3), pp. 951-955.

Case reports: 

  • Matiasovic, M. Et al. (2018) ‘Barium peritonitis with abdominal abscessation’. Journal of Small Animal Practice (Early view).
  • Kjaergaard, A.B. et al. (2018) ‘Treatment of carprofen overdose with therapeutic plasma exchange in a dog’. Journal of Veterinary Emergency and Critical Care (Early view). 
  • Leary, M.L. & Sinnott-Stutzman, V. (2018) ‘Spontaneous gastric dilatation-volvulus in two cats’. Journal of Veterinary Emergency and Critical Care (Early view).

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

Pick of the Month

‘Closure of gastrointestinal incisions using skin staples alone and in combination with suture in 29 cats’
Schwarz, Z. & Coolman, B.R., Journal of Small Animal Practice, 2018, 59(9), pp. 281-285.

Various stapling techniques to close gastrointestinal incisions have been reported in humans and multiple animal species. 

The use of specific devices like linear and circular staplers has been successfully implemented in human medicine. However, their application in veterinary practice is restricted by their high cost, limited availability and size which is often too large for our smaller patients.

The use of standard skin staples instead has been trialled in pigs and successfully used in dogs both in experimental and clinical settings.

According to the authors, this retrospective study is the first publication describing the use of skin staples for closing gastrointestinal incisions in feline patients. 

The study involved 29 cats undergoing gastrointestinal surgeries in a US-based referral centre. Each gastrointestinal incision and closure has been considered separately, for a total of 42 procedures: 

  • 15 gastrostomies 
  • 1 partial gastrectomy 
  • 12 jejunotomies 
  • 2 jejunal anastomosis 
  • 12 colonic anastomosis 

The procedures were performed by four different surgeons with different skill levels: one Board-certified surgeon, one residency-trained surgeon, one surgical resident and one emergency veterinarian. All surgeons underwent a short training session by one of the senior surgeons who was comfortable using the stapling method.

Gastrostomies and gastrectomy were closed with a hybrid technique combining sutures with monofilament material including the mucosa and submucosa and skin staples for the seromuscular layer. 

Jejunotomies and jejunal anastomosis were closed with only one layer of staples while colonic anastomosis was either closed with the hybrid method (when the surgeon could distinguish the mucosa/submucosa from the seromuscular layer) or with only one layer of skin staples. 

Overall 26 out of 29 cats survived at a 12-day follow up. No dehiscence of any of the gastrointestinal closures was reported and the three deaths were deemed not directly related to surgical procedure failure: two cats were euthanised as a consequence of a neoplastic process diagnosis and the third cat suffered a cardiovascular arrest in the immediate post-operative period.

This study, however interesting and bearing encouraging results, presents several intrinsic limitations:

  • A small sample size
  • No control group
  • The decision of using a hybrid or single technique was not randomised and left to the surgeon’s subjective judgment
  • The stapling technique described requires a scrubbed-in assistant which is not always possible in primary/Out-of-Hours practice
  • Stapling was not considered for linear incisions of the small intestine unless already dilated (i.e. from the previous presence of a foreign body)
  • No post-mortems were performed on the deceased cats
  • The follow-up period reported is fairly short and mainly focuses on evaluating the risk of dehiscence for the stapling technique. No long-term consequences have been assessed. There was a brief mention of a few cats (unspecified number) undergoing radiography and followed up to a 6-week period in which the authors found the staples migrating into the gastrointestinal lumen to then be passed with the faecal material.

Conclusion:

In conclusion, this study shows that standard disposable skin staples can be safely used alone or in combination with regular sutures for feline gastrointestinal closures. These techniques can be performed by surgeons of various levels of experience without any significant short-term complications. Nevertheless, further studies with larger samples and longer follow-up periods are needed to confirm the encouraging results reported by the authors.

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

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