Abstract
BackgroundIn literature only one article describes and compares methods of achieving hemostasis in equine mesenteric arteries during jejunal resection and anastomosis, and most textbooks favor ligating-dividing mechanical devices. The latter method cannot always be used, not least because the devices are expensive and in some cases even contra-indicated. Various types of knots, including sliding knots, are widely used to provide hemostasis in laparoscopy.The objective of this study was to compare a triple ligature for mesenteric vessels composed of three sliding knots with a triple ligature composed of a modified transfixing and two surgeon’s knots.MethodsPortions of jejunum with associated mesenteric vessels were collected from 12 horses at a local abattoir. These were divided into 24 specimens containing five mesenteric arteries each. Each artery was closed with a triple ligature. In group A, a surgeon’s knot was used to tie the ligatures (two circumferential and one modified transfixing) while in group B all ligatures (three circumferential) were tied with a parallel alternating sliding knot. Both groups were divided ino two subgroups depending on suture material used (multifilament or monofilament suture material). Time to perform ligatures for every specimen were recorded and compared between groups.After closure, arteries were cannulated and intraluminal pressures were increased until ligature failure. Leaking pressures were recorded and compared between groups.ResultsLigation of mesenteric arteries was significantly faster to perform with sliding knots than with surgeon’s knots, both with monofilament and multifilament suture material. With multifilament suture material, the leaking pressure of sliding knot ligatures was significantly higher than that of surgeon’s knot ligatures. With monofilament suture, there were no statistically significant differences in leaking pressure between ligature methods. Both ligating methods were stronger with monofilament suture material than with multifilament suture material.ConclusionsRegardless of the ligature used, monofilament suture material performed better than multifilament suture material to achieve hemostatic knots. Independently of the suture material, the sliding knot is comparable or better than the surgeon’s knot in providing hemostasis, and is faster to perform.
Highlights
In literature only one article describes and compares methods of achieving hemostasis in equine mesenteric arteries during jejunal resection and anastomosis, and most textbooks favor ligating-dividing mechanical devices
In the article by Rumbaugh et al[2], the ligating-dividing stapler was compared with an energy-based vessel sealing device and with a double ligature including a circumferential and a modified transfixing ligature. Both ligatures used a surgeon’s knot to tie the suture, this knot is considered unreliable for hemostatic ligatures [8].Sliding knots are widely used in equine laparoscopy and recently have been described as hemostatic knots in other species [8,9,10]
Knots applied when the animal is under anaesthesia may initially provide hemostasis, but may not resist higher pressures experienced during the recovery phases [18]
Summary
In literature only one article describes and compares methods of achieving hemostasis in equine mesenteric arteries during jejunal resection and anastomosis, and most textbooks favor ligating-dividing mechanical devices. In the article by Rumbaugh et al[2], the ligating-dividing stapler was compared with an energy-based vessel sealing device and with a double ligature including a circumferential and a modified transfixing ligature Both ligatures used a surgeon’s knot to tie the suture, this knot is considered unreliable for hemostatic ligatures [8].Sliding knots are widely used in equine laparoscopy and recently have been described as hemostatic knots in other species [8,9,10]. They are quick and easy to perform and behave as or better than the surgeon’s knot when used to provide hemostasis of arteries [8]
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