Abstract
Objective: The objective of this study was to compare the bursting strength and characterize the mode of failure of cranial and caudal midline celiotomies closed with 2 suture patterns and an absorbable monofilament suture material.Design: Randomized, cadaveric, ex- vivo mechanical testing.Sample: Feline cadavers (n = 32).Methods: Specimens were randomized into two groups based on the closure technique (small 2 × 2 mm or large 5 × 5 mm suture-bite-stitch-interval [SBSI] groups). Cranial or caudal midline celiotomies, 7.5 cm long, were created. A custom-made polyurethane bladder was inserted into the abdomen, and the celiotomies were closed in a simple continuous pattern using 3-0 polydioxanone. The repair was loaded to failure by inflating the bladder with compressed air. Bursting strength and mode of failure were recorded. Effects of body weight, gender, thickness and width of linea alba, suture-bite-stitch-interval, and location of celiotomy were analyzed using a mixed model analysis and an independent t- test, with P < 0.05 considered statistically significant.Results: There was no difference in bursting strength between cranial and caudal celiotomies. Bursting strength was lower for celiotomies closed with a large SBSI (P = 0.003). Bursting strength was greater in males compared to females (P = 0.003). Twenty five specimens failed distant from celiotomy closure, while 4 failed by fascial tearing at the site of needle penetration. Failure by loosening of the suture line with intact knots only occurred in 3 caudal celiotomies closed with a large SBSI. Gender, body weight and SBSI accounted for 61.5% of variability in bursting strength (P = 0.005).Conclusions: Small SBSI technique was mechanically superior to large SBSI when tested under these loading conditions.Clinical relevance: Supraphysiological pressures were required to cause failure in all specimens. Both small and large SBSI may be clinically applicable for midline celiotomy closure in domestic cats.
Highlights
Ventral midline celiotomy is one of the most common surgical approaches for abdominal surgery in small animals
body weight (BW), and SBSI accounted for 61.5% of variability in bursting strength in the regression analysis (P = 0.005)
This study showed that the use of smaller bites and larger bite widths provided a stronger celiotomy closure when compared to other combinations (36)
Summary
Ventral midline celiotomy is one of the most common surgical approaches for abdominal surgery in small animals. The complication rate for ventral midline celiotomy, including incisional hernia, appears to be very low in small animals (5); the consequences may be severe (4), when accompanied by eventration (1, 4). Despite the reported low incidence, some authors have suggested that the true incidence of this postsurgical complication may be higher, as it is likely underreported (1, 6) This suggestion is supported by the results of a retrospective study of major abdominal evisceration in dogs and cats, where half of the dogs and all cats included in the study developed incisional hernias within 4 days after ovariohysterectomy (4). The data available in the literature about the true incidence of incisional hernia in small animals is not up to date, and likely does not accurately reflect the current situation due to improvements in surgical techniques and suture materials available
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