Double Suture Research Articles

The effect of the number of anchors used in the medial row on clinical outcomes in arthroscopic double row repair of rotator cuff tears: retrospective evaluation of patients with 3 to 7 years of follow-up

Aim: Arthroscopic double row (DR) suture anchor repair is one of the most frequently applied methods in the surgical treatment of rotator cuff tear (RCT). Various modifications have been tried to eliminate some of the disadvantages of this technique such as operation time, high cost, and the high risk of retearing. In this study, we aimed to investigate whether placing a single or double suture anchor in the medial row affects clinical and functional outcomes and retear rates in patients with RCT who were operated with the DR suture anchor technique.
 Material and Method: A retrospective study including 58 patients aged 18-65 years who underwent DR suture anchor repair due to medium-sized RCT and had a minimum follow-up period of 3 years was conducted. One knotless anchor was placed in the lateral row in all patients. In the medial row, we placed 1 all suture anchor (ASA) in group 1 and 2 ASAs in group 2. Visual pain scale (VAS), University of California Los Angeles Score (UCLA), American shoulder and elbow score (ASES) scales were used for preoperative and postoperative clinical and functional evaluation, and complications and retears were recorded.
 Results: When the preoperative and postoperative VAS, UCLA and ASES scores were compared within groups, there were significant difference from pre- to post-operative findings in both groups (p 0.05). Operation time in Group 1 was significantly shorter than in Group 2 (p

Spade-Shaped Anastomosis after Laparoscopic Proximal Gastrectomy Using Double Suture Anchoring between the Posterior Wall of the Esophagus and the Anterior Wall of the Stomach (SPADE Operation): A Case Series

Simple SummarySPADE is a novel reconstruction technique that is performed after laparoscopic proximal gastrectomy to reduce reflux. The aim of this study was to demonstrate the clinical outcomes of SPADE operations. Only one patient (2.9%) had reflux symptoms, which required anti-reflux drugs and reflux esophagitis on postoperative endoscopy. No anastomotic leakage was observed after the SPADE method. The rate of strictures at the site of anastomosis was 14.7%, and these patients were well managed with endoscopic ballooning. Therefore, the SPADE operation is a promising reconstruction method after proximal gastrectomy.We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June 2017 and March 2020 were retrospectively reviewed. Reflux was evaluated based on the patients’ symptoms and follow-up endoscopy using Los Angeles (LA) classification and RGB Classification (Residue, Gastritis, Bile). Other complications were classified using the Clavien–Dindo method. The incidence of reflux esophagitis was 2.9% (1/34). Bile reflux was observed in six patients (17.6%), and residual food was observed in 16 patients (47.1%) in the endoscopy. Twenty-eight patients had no reflux symptoms (82.4%), while five patients (14.7%) and one patient (2.9%) had mild and moderate reflux symptoms, respectively. The rates of anastomotic stricture and ileus were 14.7% (5/34) and 11.8% (4/34), respectively. No anastomotic leakage was observed. The incidence of major complications (Clavien-Dindo grade III or higher) was 14.7%. The SPADE operation following laparoscopic PG is effective in reducing gastroesophageal reflux. Its clinical usefulness should be validated using prospective clinical trials.

A clinical case of the uterine complete rupture along with the previous scar during pregnancy with atypical clinical features

This article presents an unusual case of rupture of the scarred uterus at 36-37 weeks of gestation. The patient presented with pain in the pubic and hip joint area, growing stronger while her walking, seated and changing position. No clinical manifestations of hemorrhagic shock were observed. External obstetric examination revealed a normotonic uterus and satisfactory fetus condition. Provocation tests were conducted to exclude subluxation of the pubic joint. Pubic symphysis diastasis palpation, long dorsal sacroiliac ligament palpation, P4 test, Patricks test, and the modified Trendelenburg test were negative. Pelvic examination revealed sharp pain in lower uterus segment. Ultrasound scan revealed deformation and thinning of the scar up to 1 mm, and no abnormalities in pubic symphysis. A threatening uterine rupture was diagnosed, and emergency cesarean section was performed. Intraoperative examination showed that the scar located in the lower segment consisted of connective tissue. In addition, there was a 4 5 cm scar defect with the overlying amniotic sac, no hemorrhage being noted. After removing the fetus, scar excision was performed. The uterine defect was repaired with a double layer running-locking suture. The patient was discharged from hospital on day 5 of postpartum period. The infant was exposed in the neonatal intensive care unit to provide an early developmental care.

Интрасклеральное ущемление узлов без вскрытия конъюнктивы и обнажения склеры при склеральной усиленной шовной фиксации интраокулярной линзы: собственная модификация

Purpose. Development of new technique for scleral reinforced suture fixation of intraocular lens (IOL) in the absence of capsule support with intrascleral capture of knots without conjunctival opening. Material and methods. Three patients with «IOL-capsular bag» complex dislocation into the vitreous cavity underwent scleral fixation of the IOL in the new modification. The IOL was placed into ciliary sulcus on two 9-00 double polypropylene sutures brought out transsclerally without conjunctival opening. Both sutures were passed intrasclerally for 3.0 mm, sticking each of needles into the sclera at the points of sutures exit from conjunctiva, and brought out through conjunctiva. Threads were cut, leaving 2.0 mm free ends, and knots (2-1-1) were tied with the tension necessary to capture them in the scleral canals. At the points of exit of threads' ends from the conjunctiva, additional needles with looped double threads were sticked again, passed intrasclerally for 3.0 mm and were brought out through conjunctiva; ends of the threads fixing the IOL were captured in loops and dipped in the scleral canals. Results. During the follow-up, position of the IOL was correct, sites of neddles' sticks into the conjunctiva were epithelized, and no tendency to erosion of intrascleral threads was observed. Conclusions. New modification of scleral fixation of IOLs is technically simple, does not require conjunctival opening. It involves the use of double suture, which increases the durability of fixation. Technique can be used for fixation of any IOL model, as well as artificial irido-lens diaphragm, intracapsular ring or intracapsular segment. Key words: scleral fixation of intraocular lens.

Biomechanical study of a newly developed continuous double knots technique compared with the 4-strand double-modified Kessler technique for flexor tendon repair

PurposeIn this study we compare the biomechanical properties of a novel suture technique that we developed called the continuous double knots technique for repairing flexor tendon injuries with the standard 4-strand double-modified Kessler technique.MethodsThis was an experimental study. Eighty porcine flexor digitorum profundus tendons were harvested and divided randomly into two groups of 40. The first group (N = 40) was repaired using the 4-strand double modified Kessler technique and the second group (N = 40) was repaired using our new continuous double knots technique. The two groups were randomly divided and the ultimate failure load (n = 20) and cyclic testing to failure (n = 20) were compared.ResultsThe mean ultimate failure load was 25.90 ± 7.11 (N) and cyclic testing to failure 88 ± 47.87 (cycles) for the 4-strand double modified Kessler technique and 34.56 ± 6.60 (N) and 189 ± 66.36 (cycles) for our new continuous double knots technique. The T-test revealed a significant difference between the 2 techniques (p < 0.05). In terms of biomechanical properties in tendon repair, the continuous double knots technique group had a higher tensile strength than the 4-strand double-modified Kessler technique group. There were also significant differences between the ultimate failure load and cyclic testing to failure for the flexor tendon sutures.ConclusionsThe continuous double knots technique suture technique had significantly higher maximum tensile strength and cyclic testing than the 4-strand double modified Kessler technique in an in vitro study, and in thus an optional technique for flexor tendon repair.

Elbow Ulnar Collateral Ligament Shoelace Repair with Internal Bracing for Treating Throwing Athletes Who Have Ulnar Collateral Ligament Instability

This Technical Note aimed to present a surgical technique of ulnar collateral ligament (UCL) shoelace repair using suture anchors and double suture tapes in combination with internal bracing to correct UCL instability along with epiphyseal avulsion of the medial epicondyle in throwing athletes Skeletally immature throwing athletes playing baseball and softball are at a risk of sustaining medial epicondyle epiphyseal separation that can result in UCL instability, predisposing to elbow UCL disruption later. There are several surgical techniques that can restore elbow UCL function and stability. In cases where large fragments of the medial epicondyle are present in skeletally immature athletes, the residual bony fragment and the shortened, chronically injured UCL make surgical treatment quite challenging. Recent studies have shown that UCL repair with internal bracing can effectively treat acute UCL injury. However, this procedure is not ideal for restoring large disruption of the UCL such as fragmentation. Here, we present a surgical technique of UCL shoelace repair using suture anchors with double suture tapes in combination with internal bracing for correcting UCL instability concurrent with epiphyseal fragmentation of medial epicondyle in throwing athletes.

Double Cross-Looped Coracoclavicular Suture Fixation For Acute Acromioclavicular Joint Separations: Long Term Follow-Up in 72 Patients

Double Cross-Looped Coracoclavicular Suture Fixation For Acute Acromioclavicular Joint Separations: Long Term Follow-Up in 72 Patients

Double versus single suture stenting to manage hypertensive spikes after glaucoma drainage device implantation.

To evaluate the safety and efficacy of double compared to single intraluminal suture stenting in reducing early postoperative hypertensive spikes (HS) and hypotony after Baerveldt glaucoma implant surgery. For this retrospective study, we reviewed the medical charts of 60 patients (60 eyes) who underwent Baerveldt drainage device surgery between 2017 and 2019. Two groups were formed according to whether a single suture stent was placed within the tube (5-0 polypropylene, 30 eyes, group 1) or a double suture (5-0 and 6-0 polypropylene, 30 eyes, group 2). Intraocular pressure (IOP) was measured at baseline, at 6 h, and on postoperative days 1, 2, 5, 7, 14, 21, 30, 60, 90, 180. The occurrence of HS (IOP ⩾ 30 mmHg), anterior chamber reformation, decompressive paracentesis, anti-glaucoma medication, and adverse events were recorded. There was a greater decrease in IOP from baseline at days 1, 2, and 21 (p < 0.05) and number of HS at 6 h (p = 0.006) and postoperative day 1 (p < 0.001) in group 2. The mean number of decompressive paracentesis, anterior chamber reformation procedures, and topical anti-glaucoma medications was the same in both groups; the need for oral acetazolamide was significantly lower in group 2 at days 1, 21, and 30 (p < 0.05). While both stenting methods provide a gradual, controlled decrease in IOP, the double stenting technique was associated with a sooner and greater postoperative reduction in IOP and a good safety profile thanks to fewer HS in the early postoperative period and less need for oral acetazolamide.

Clinical Application of a Modified Double Purse-String Continuous Suture Technique for Pancreaticojejunostomy: Reliable for Laparoscopic Surgery and Small Size Main Pancreatic Duct.

Background The technical challenge of pancreatojejunostomy (PJ) is the greatest barrier for surgeons to complete pancreatoduodenectomy (PD). The authors present an easy-to-master PJ anastomosis technique with limited technical requirements. This technique uses two layers of sutures and double purse-string sutures to complete the entire anastomosis. This anastomosis technique has achieved good results in laparoscopic surgery (LS) and small size main pancreatic duct (MPD). Methods From February 2015 to August 2020, 63 patients who met the surgical indications underwent a modified double purse-string continuous suture pancreaticojejunostomy technique in our center. We collected patient demographic characteristics and perioperative outcomes and analyzed these data. Results A total of 63 patients underwent PD using our new anastomosis technique. Thirty-eight patients underwent LS, and 26 patients had a small MPD (<3 mm). The median operative time (OT) was 270 min, and the median estimated blood loss (EBL) was 200 ml. Ten patients had grade B postoperative pancreatic fistula (POPF), while no patients had grade C POPF. No 90-day mortality was observed. There were significant differences in the OT and postoperative hospital stay (PHS) among groups with different surgical procedures, while there were no significant differences among groups with different MPD sizes. Neither the surgical procedure nor the MPD size affected early postoperative complications. Conclusion This new technique can not only reduce the incidence of POPF but also is reliable for LS and surgeries with small size MPD. Therefore, this technique is worthy of clinical promotion and application in the future.

The efficacy of single suture for exit site wound closure and stabilization of hemodialysis central tunneled catheter.

Introduction:The majority of the end-stage renal disease patients begin hemodialysis with the central tunneled catheter as a permanent or bridge vascular access. The procedure of central tunneled catheter insertion can be complicated by exit site bleeding, prolonged tunnel healing, and infection. The study aimed at evaluating whether the catheter exit site wound closing with a single-suture method is equally effective as the double suture method, which is most frequently applied. The assumption was that the single-suture method, which is less traumatizing for the skin, could offer an advantage for the patients with “paper” skin, that is, elderly, after long-term immunosuppressive treatment.Methods:Insertion of central tunneled catheter with antegrade tunnel formation was performed in 140 patients divided randomly into two groups of 70 patients using either single-suture method or double suture method.Results:Follow-up observations revealed a comparable number of early complications, that is, bleeding or exit site infection, in about 26% of the patients from both groups. No difference appeared in the catheter displacement, either. The percentage of patients with a prolonged central tunneled catheter exit site wound healing was not significantly lower in the single-suture method group: 5.8% versus 11.3%, p = 0.367. There was no impact of single-suture method versus double suture method on the central tunneled catheter long-term function and survival.Conclusion:The single-suture method of the central tunneled catheter exit closure is equal in efficacy to the double suture method. Its potential benefit for the patients with an increased risk of poor wound healing should be tested in further study.

Clinical and Radiological Outcomes Following Arthroscopic Dual Tibial Tunnel Double Sutures Knot-bump Fixation Technique for Acute Displaced Posterior Cruciate Ligament Avulsion Fractures.

Many fixation options (Open and arthroscopic) are described for Posterior Cruciate Ligament avulsion (PCL) fractures. In this retrospective series, we evaluated functional and radiographic outcomes following arthroscopic dual tunnel double sutures knot bump technique for acute PCL tibial end avulsion fractures. 23 patients with acute PCL avulsion fractures who were operated between 2009 and 2016 by Arthroscopic dual tunnel double sutures technique at a minimum of two years of follow-up were included in the study. Clinical outcomes were measured by Lysholm and International Knee Documentation Committee (IKDC) scores. The radiographic assessment included union status of fracture, the grade of osteoarthritis, and knee laxity. The mean age of patients was 34.43 years (range, 18-54 years) with a mean follow up of 52.8 months (36-94 months). At the final follow-up, mean subjective IKDC and Lysholm scores were 82.71 (range, 65.5-100) and 95.82 (range, 81-100), respectively. On the IKDC objective scale, ten patients (43.47%) were graded as A, 11 patients [47.82%] as grade B, and two patients as grade C [8.7%]. On kneeling stress view, knee laxity in 21 patients (91.3%) was graded 0, and the remaining two as grade I and II. The fracture had united in all cases by the end of 12 weeks except one which had non-union. 21 patients had no evidence of osteoarthritis at the final follow up. Arthroscopic dual tibial tunnel double suture knot bump technique for acute PCL avulsion fractures is a safe and reliable technique that restores the stability and function of the knee.

English

English

Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct

Proximal hamstring tendon injuries occur frequently in the athletic population resulting in varying degrees of functional disability depending on severity of injury. The purpose of our case vignette is to describe a surgical technique and clinical outcome for open proximal hamstring tendon repair with a confirmed biomechanically sound construct. We also describe and summarize the current literature recommendations for proximal hamstring injuries. We present a case and surgical technique report on a 27-year-old male who suffered a proximal hamstring tendon rupture. Utilizing a double row all-knotless suture bridge construct with a total of four anchors and six suture limbs allowed for anatomic footprint coverage and strength. Two years of clinical follow-up was obtained evaluating hip and knee range of motion, strength, and functional ability. Our patient underwent uncomplicated open surgical repair and returned to all activity at four months following surgery. Range of motion and strength returned to preoperative levels at the four-month postoperative mark. The use of a reproducible double row all-knotless suture bridge technique provided adequate strength and stability in the setting of a proximal hamstring tendon rupture. Open and endoscopic surgical techniques performed acutely both show positive postoperative subjective outcomes as well as a high likelihood of returning to sport. Controversy remains present in regard to the repair technique as well as postoperative bracing and physical therapy recommendations.

Effects of type II SLAP lesion repair techniques on the vascular supply of the long head of the biceps tendon: a cadaveric injection study

One option for the treatment of type 2 superior labral anterior to posterior (SLAP) lesions is arthroscopic repair. However, the fact that the vascular supply of the proximal long head of the biceps tendon (LHBT) arises from the soft tissue near the SLAP repair site must also be considered. The aims of this study were to evaluate the vascular channel of the proximal long head biceps tendon and to compare potential damage to the vascular supply with alternative SLAP techniques. Forty-five fresh cadaveric shoulders were divided into 3 groups: 9 shoulders each for the normal group and the created SLAP group, and 27 shoulders for the repaired SLAP group. SLAP group shoulders were repaired using one of 3 techniques: 2 anchors with simple sutures, 1 anchor with double sutures, or 1 anchor with a horizontal mattress suture. India ink was then injected into the acromial branch of the thoracoacromial artery. The proximal LHBT was resected for a histologiccross-sectional study. The intratendinous vascular distance was measured and compared among the groups. The vascular supply of the proximal LHBT arises from soft tissue lying anterior and dorsal to the tendon origin. In the normal shoulders, the average intratendinous vascular distance was 16.9 ± 1.5 mm(95% confidence interval: 15.8-18.1). A comparison of nonrepaired SLAPs with each of the repair techniques found that using 2 anchors with simple sutures showed no significant difference in vascular distance (P = .716), whereas the other techniques showed a significant disruption of the blood supply. The differences in vascular distance among the 3 repair techniques were statistically significant (P = .0001). The main vascular supply of the proximal LHBT comes from the anterior-dorsal direction. Some SLAP repair techniques can disrupt vascularization; however, the technique using 2 anchors with simple sutures, 1 anchor 3 mm anterior to the anterior border and 1 at the posterior border of the tendon, can preserve the vascularization of the LHBT.

Revision guided suture-button bone block stabilization of the shoulder in the presence of significant retained glenoid metalwork

AimPositioning and fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, can be challenging. We present the results of a series of patients who underwent a revision bone block procedure secured with double suture buttons using a drill guide system, the position of which was calculated from a preoperative computed tomography (CT) scan.Materials and methodsWe undertook a revision bone block stabilization of the shoulder, using a guided double suture-button fixation, in 10 patients with significant retained glenoid metalwork from previous procedures. A preoperative CT scan was used to determine a position for the guide to allow a safe drill trajectory that would avoid any retained metalwork. A coracoid transfer was undertaken in 4 patients and an Eden-Hybinette in 6. Patients were assessed preoperatively and at final follow-up clinically and using the Oxford Shoulder Instability Score and the Subjective Shoulder Value score. Bone block position and healing was assessed by a CT scan at 6 months. The median follow-up was 36 months (range, 24-47 months).ResultsThere were 3 female and 7 male patients with a median age of 24.5 years (17-49 years). At final follow-up, the mean Oxford Shoulder Instability Score had decreased from 25.9 (range, 21-35) to 5.8 (range, 3-14) (P < .005). The mean Subjective Shoulder Value score had risen from 87.1 (range, 10-60) to 80 (range, 60-90) (P < .05). All of the patients considered their shoulder to be stable apart from 1 patient. There had been no redislocations. The bone block positioned in the glenoid lower quadrant had healed for all of the patients on CT at 6 months.ConclusionGuided suture-button fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, provides a satisfactory outcome in terms of shoulder stability, graft position, and healing.

Operative procedures of double circular suturing technique (DCST)

Operative procedures of double circular suturing technique (DCST)

Comparison between single and double suture passing techniques in the suture bridge rotator cuff repair with a 2-mm tape: A simulation study using a three-dimensional finite element method

BackgroundSuture bridge repair has been widely used as one of the standard procedures in the arthroscopic rotator cuff repair. We compared the intratendinous stress distribution between single and double suture passing techniques in the suture bridge repair using a 2-mm tape and clarified the roles of tensioning in this procedure. MethodsA board-like model of the supraspinatus tendon and humeral head was used in order to standardize conditions and exclude the influence of anatomical variations between individuals. Reattachment of the supraspinatus tendon to the bone was simulated using both single and double suture passing techniques for the suture bridge repair using a 2-mm tape. A tensile load was applied to the medial end of the tendon, and the stress distribution pattern was observed. Elastic analysis enabled comparison of the von Mises equivalent and maximum principal stresses between the single and double suture passing techniques. The tape configuration was subsequently translated 1 mm toward the insertion points of lateral anchors to simulate the tensioning maneuver. ResultsAlthough the distribution pattern of both the equivalent and the maximum principal stresses was similar for both models, areas with a high stress concentration were smaller in the single suture passing model than those in the double suture passing model. The equivalent stress concentrated within the tendon beneath the tapes as well as in the area between the crossing tapes and the lateral end of the tendon, whereas the maximum principal stress concentrated medial to the sites of suture penetration. ConclusionsSingle suture passing technique can reduce the extent of intratendinous stress concentration compared with double suture passing technique, which might be beneficial to reduce the incidence of type 2 retear after suture bridge repair of rotator cuff tendon using a 2-mm tape.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture

Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture. Methods From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded. Results Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion. Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results. Key words: Shoulder fractures; Arthroscopy; Suture anchors

Spontaneous Rectal Perforation with Transanal Evisceration

We present the case of an 83-year-old woman that visited the emergency room of our hospital for correcting the transanal small bowel evisceration after a defecatory effort, without any history of rectal trauma. Emergency laparotomy was indicated, with the intraoperative finding of perforation in the anterior superior rectum, with a defect of approximately 3 cm. Due to the absence of fecaloid peritonitis, it was decided to perform a primary closure with double sutures. The patient evolved favorably.

Comparative Efficacy of Single and Double Layer Suturing along with Stapling Technique for End-To-End Anastomosis of Esophagus in Dog

Comparative Efficacy of Single and Double Layer Suturing along with Stapling Technique for End-To-End Anastomosis of Esophagus in Dog