Monofilament intermediate to prolonged absorbable suture
1/2 circle, taper needle
2‐0 to 3‐0
Skin stapler (wide); GIA (3.5 mm)
Larger suture size is recommended due to tension on the gastropexy suture line. Skin staplers have been used successfully for gastropexy. A limited number of dogs have undergone gastropexy using a GIA linear stapler.
Pancreas, Marsupialization
Monofilament, intermediate to prolonged absorbable suture
Hilar resection TA 30; partial resection TA (3.5 mm)
Some surgeons prefer multifilament suture for guillotine biopsy. Monofilaments are recommended for laceration repair since smooth surface does not cut friable tissue. Blue linear staple lines may not control all hemorrhage during partial lobectomy; electrocoagulate or skeletonize and ligate remaining bleeders.
Common Bile Duct, Gall Bladder/Cholecystotomy, Choledocotomy, Anastomosis
Monofilament intermediate to prolonged absorbable sutures
Fine 3/8 to 1/2 circle taper
4‐0 to 5‐0
NA
Multifilament sutures can be used successfully. Nonabsorbable sutures may act as a nidus of infection or calculus formation.
Small Intestine/Anastomosis, Enterotomy, Serosal Patch, Enteroplication
Monofilament, intermediate to prolonged absorbable suture
1/2 circle taper needle
3‐0 to 4‐0
GIA (3.5 mm), TA (3.5 mm), skin stapler (regular)
Multifilament sutures can be successfully used for intestinal surgery but they cause more tissue drag and may potentiate infection in the presence of contamination. Monofilament nonabsorbable sutures are an acceptable alternative. Avoid nonabsorbable sutures in continuous lines because suture migration – linear foreign body formation is possible.
Large Intestine/Colotomy, Colostomy, Typhlectomy
Monofilament, intermediate to prolonged absorbable suture
1/2 circle taper needle
3‐0 to 4‐0
Circular stapling 21, 25 mm; GIA (3.5 mm), TA (3.5 mm)
Multifilament sutures can be successfully used for intestinal surgery but they cause more tissue drag and may potentiate infection in the presence of contamination. Monofilament nonabsorbable sutures are an acceptable alternative. Circular stapler size is a limitation for small dogs and cats. Tissue thickness must be more than 1 mm and less than 2.5 mm for proper staple engagement and formation.
Colopexy
Monofilament prolonged absorbable suture
1/2 circle taper needle
2‐0 to 3‐0
NA
Larger suture size is recommended due to tension on the colopexy suture line.
Rectum/Partial Resection, Anastomosis
Monofilament, intermediate to prolonged absorbable suture
1/2 circle taper needle
3‐0 to 4‐0
Circular stapling 21, 25 mm (3.5 to 4.8 mm)
Multifilament sutures can be successfully used for intestinal surgery but they cause more tissue drag and may potentiate infection in the presence of contamination. Monofilament nonabsorbable sutures are an acceptable alternative. Circular stapler size is a limitation for small dogs and cats. Tissue thickness must be more than 1 mm and less than 2.5 mm for proper staple engagement and formation.
Anus/Anal Mass Resection, Mucosal Repair
Rapid to intermediate absorbable sutures
3/8 to 1/2 circle taper or taper‐cut
4‐0
NA
Healing of anal mucosa is rapid, so intermediate absorbable sutures are preferred. Multifilament sutures may not irritate sensitive anal mucosa compared to more rigid multifilament knot ears.
NA = Not Applicable.
2.1.8 Biofragmentable Anastomosis Ring
The Bowel Anastomosis Ring (BAR) (Valtrac, Medtronic, Minneapolis, MN) is a biofragmentable medical device made of two interconnecting half‐shells made of polyglycolic acid and barium sulfate (Figure 2.1). The device is designed to facilitate anastomosis of the inverted ends of bowel without suturing. The device is placed without an incision in the cecum or retrograde placement through the rectum. It has been reported for use in human and veterinary colonic anastomoses, but also in small bowel and esophagogastric anastomoses (Corman et al. 1989; Thiede et al. 1998; Ryan et al. 2006). Its size range (21–34 mm) generally limits its use in small animal surgery for colonic and rectal anastomosis in larger breed dogs. Purse‐string sutures are placed with a Furniss clamp at the ends of bowel to be connected and the affected bowel is resected. The purse‐string sutures are tightened individually over the middle of the two interconnecting half‐shells of the BAR. The half‐shells are compressed together and intestinal continuity is restored. The rings gradually dissolve and are shed into the bowel for evacuation. The rate of leakage and stricture formation associated with the BAR is comparable to that reported in the literature for stapled and hand‐sewn colon repairs in humans (Corman et al. 1989). The BAR has been used with success in cats with megacolon (Ryan et al. 2006). The presence of the megacolon allows placement of a 25 mm BAR with 1.5 mm gap between the two‐half after compression. Relaxation of the wall of the colon to facilitate placement of the BAR can be induced with warm saline irrigation, application of topical 1% lidocaine or with IV glucagon (Hardy et al. 1987).
Surgical staples have been used in virtually all aspects of gastrointestinal surgeries.
Staple height is the length of the legs of the staple after trigger closure. Choosing the proper staple leg length is critical because staple legs that are too short do not engage the opposing tissue plane properly or may occlude the intramural blood supply, and choosing legs that are too long may produce ineffective closure, with subsequent leakage of bowel contents or hemorrhage. Surgeons should inspect the thickness of the tissues before choosing the appropriate stapler cartridge (staple height), since edema, and thickened and inflamed intestinal wall,
