Abstract
To compare the bursting strength and failure mode of ventral midline celiotomy closed with a simple continuous suture pattern with 1 of 2 knot combinations, a novel self-locking knot combination of a forwarder start with an Aberdeen end knot (F-A) and a traditional combination of a surgeon's start with a surgeon's end knot (S-S). Ex vivo experimental. Equine cadavers (n = 14). A 20-cm ventral midline celiotomy was created in 14 equine cadavers. Horses were assigned to celiotomy closure with an F-A or S-S knot combination. Prior to closure, a 200-L inflatable bladder was placed in the abdomen and then insufflated until failure of the celiotomy closure. The horses' signalment, weight, breed, and age, as well as knot combination type, mode of failure, closure time, and bursting strength (mm Hg) were recorded. The median bursting strength was significantly greater when incisions were closed with the F-A knot combination (388 mm Hg) compared with the S-S knot combination (290 mm Hg) (P = .035). Most incisions failed along the fascia when closed with F-A combinations and at the knot when closed with S-S combinations. The bursting strength of ventral midline incisions in equine cadavers was increased by an average of 25% when closed with the self-locking F-A knot combination. Closing ventral midline celiotomies with an F-A knot combination may provide a more secure closure than the traditional S-S knot combination. Additional in vivo investigation is required prior to recommending this closure in clinical cases.
Highlights
We hypothesized that 1)_ventral midline celiotomy bursting strength would be significantly higher following closure with the selflocking F-A knot combination compared to closure with the traditional surgeon’s end knot (S-S) knot combination, 2) failure of the closure would occur most commonly along the suture line and most commonly at the knot regardless of knot combination used for closure and 3) that the F-A closure time would be significantly longer than that of the S-S knot combination
Ex vivo evaluation of a simple continuous suture pattern with a combination of the forwarder start and an Aberdeen end knot (F-A) compared to a traditional surgeon’s start and surgeon’s end knot (S-S) for ventral midline closure found that a F-A knot combination offers a more secure closure than that of a traditional S-S knot combination
The use of the self-locking knot combination increased incisional bursting strength by an average of 25%
Summary
Complications involving the incision following ventral midline celiotomy in horses include incisional infection, herniation, acute incisional dehiscence, suture sinus formation, swelling, incisional drainage and abscess formation.[1,2,3,4,5] Incisional herniation occurs frequently, affecting 16% of horses undergoing celiotomy, resulting in significant patient morbidity.[2,5,6,7] Incisional herniation is suggested to occur due to complications of the celiotomy closure such as protrusion of the omentum between sutures, partial tearing of the suture material through the tissue, suture breakage, knot slippage, and incisional infection.[2,5,8,9,10,11] These complications of the closure can contribute to acute incisional dehiscence post-celiotomy, which occurs with less frequency (0.3-2.9%), but causes significant patient morbidity and mortality.[5,6] Given the significant morbidity and/or mortality following ventral midline celiotomy due to incisional complications, further investigation into improvement in ventral midline celiotomy closure is warranted. Its use has been reported in human laparoscopic and bariatric surgery, its use in veterinary medicine has only recently been investigated in vitro using large gauge suture.[19,23] Both of these self-locking knots have superior mechanical properties compared to a surgeon’s knot, exhibiting a greater knot holding capacity (KHC) and a greater relative knot strength (RKS), while requiring less suture material.[17,18,19,21,27] A knot combination with a higher breaking strength and a smaller volume may help reduce suture related incisional complications post ventral midline celiotomy. We hypothesized that 1)_ventral midline celiotomy bursting strength would be significantly higher following closure with the selflocking F-A knot combination compared to closure with the traditional S-S knot combination, 2) failure of the closure would occur most commonly along the suture line and most commonly at the knot regardless of knot combination used for closure and 3) that the F-A closure time would be significantly longer than that of the S-S knot combination
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