Modelo experimental de sutura manual em colon de cão por vídeo-laparoscopia

Abstract

Develop an experimental model of laparoscopic hand-sewn suture in colon of dogs to be specially used for surgeons' training. Forty male dogs were operated on, weight between 15 and 20 kg, from the laboratory of the Veterinary School of the State University of Ceara. They were distributed within two groups with 20 animals each: GI--The colonic wall incision was done with an electrical scalpel followed by haemosthasia and GII--The colonic wall incision was performed with a scissors. Each group was shared in two other groups with 10 animals each, according to the abdominal approach used. A-Laparotomic approach and B-Laparoscopic approach. Under intra-venous general anesthesia, a transverse incision was performed envolving 50% of the sigmoid wall, 15 cm far from the pelvic peritoneal pouch, followed by an extra-mucosa, one layer and interrupted suture with 000 polydioxanona (PDSâ). The animals were evaluated concerning to the clinical recovery, macroscopic appearance, suture-tension test and histologic study. The animals were sacrificed on the 7th postoperative day. Fisher and Qui-square tests were used for statistical analysis. All the animals submitted to colotomy performed by scissor (GIIA, GIIB) and nine animals operated on with an electrical scalpel (GI), five (50.0%) by laparotomic approach (GIA) and four (40.0%) laparoscopically (GIB) had a satisfactory clinical recovery, walking and accepting oral diet on the first post-operative day. The first bowel movement occurred between 48 and 72 hours. It didn't occur diarrhea or vomits. Eleven animals from group I, five (50%) from group IA and six (60.0%) from group IB didn't accept oral diet and complained of diarrhea (3 to 5 evacuations each day), 1 to 3 episodes of vomits each day and they die between the fourth and seventh postoperative day. Comparing groups GI with GII, a statistical significant difference was observed (p<0.005). There was no difference between GIA and GIB. Colonic sutures were intact in all the animals from group II and in five from group I with statistical significant difference (p<0.005). Three (30.0%) were from group IA and two (20.0%) from group IB. The colonic suture was envolved by epiploon in four animals, two (20%) from GIA and 2 (20%) from GIB. Suture dehiscence with peritonitis occurred in eleven (55%) animals from GI (p<0.005), five (50%) from GIA and six (60%) from GIB (p>0.005). All the animals died between the fourth and seventh postoperative day. The tension suture test was performed with an average pressure of 222,1 mmHg and there was no colonic suture disruption in any animal from the group II and in five (40.0%) from the group I (p<0.005). Three (30%) animals were from GIA and two (20.0%) from GIB (P>0.005). Colonic suture rupture occurred in four (20%) dogs from group I, two from GIA and two (20%) from GIB with an average pressure of 94.0 mmHg. The histological analysis of the surgical specimens removed on the 7th postoperative day demonstrated the same level of the inflammatory process in both approach used. The handsewn laparoscopic colonic suture in dogs can be safely performed, showing the same results of the laparotomic approach. The surgical results depend specially on the adequate surgeon's training in laparoscopic surgical technique.