In vitro comparison of leakage pressure and leakage location for various staple line offset configurations in functional end-to-end stapled small intestinal anastomoses of canine tissues

2015 ◽  
Vol 76 (7) ◽  
pp. 644-648 ◽  
Author(s):  
Lane A. Hansen ◽  
Daniel D. Smeak
Author(s):  
Heba Al-Kharraz ◽  
Rahaf Nader ◽  
Maha Al-Asmakh ◽  
Jessica P Johnson

Background: The equine small intestine can be affected by a variety of disorders, which may require some form of bypass or anastomosis procedure. Several small intestinal anastomosis techniques have been reported in scientific literature with the intention to minimize post-operative complications, however to our knowledge there are no published descriptions of the hand-sewn end-to-end single layer simple continuous Appositional technique for equine jejunojejunostomy. Objective: To compare and evaluate differences in the single layer continuous Appositional and the single layer continuous Lembert with respect to construction time, leakage pressure and bursting pressure; for the purpose of small intestinal anastomosis in the horse. Hypothesis: We hypothesized that the time spent in the execution, leakage pressure and bursting pressure will be similar between the single layer continuous Lembert and the single layer simple continuous Appositional techniques. Since this is a pilot study, it is the first step to prove the efficacy of the Appositional technique by showing its similarity with the Lembert technique, considering the latter to be the ‘gold standard’. Methodology: Thirty-Seven intestinal segments from two horses were used to compare the single layer continuous Appositional and single layer continuous Lembert techniques. The time taken to execute the anastomoses, and the number of bites taken for each pattern, were recorded. Biomechanical testing was performed to determine leakage pressure and bursting pressure. Statistical analysis was performed using GraphPad Prism 8. Result: The comparison in construction time between the Lembert group (mean, 24.23 mins, n=19) and the Appositional group (mean, 21.74 mins, n=18) were found to be statistically insignificant (P=0.3088). There was also no changes in Leakage pressure (P=0.3862) and bursting pressure (P=0.3135) between the two groups. Conclusion: This study has demonstrated that the Appositional technique is a viable alternative to the Lembert technique, with respect to construction time, leakage and bursting pressures, for the purpose of end-to-end jejunojejunal anastomosis in the horse


Author(s):  
Heba Alkharraz ◽  
Rahaf Nader ◽  
Maha Al‐ Asmakh ◽  
Jessica Johnson

Background: The equine small intestine can be affected by a variety of disorders, which may require some form of bypass or anastomosis procedure. Several small intestinal anastomosis techniques have been reported in scientific literature with the intention to minimize post-operative complications, however to our knowledge there are no published descriptions of the hand-sewn end-to-end single layer simple continuous Appositional technique for equine jejunojejunostomy. Objective: To compare and evaluate differences in the single layer continuous Appositional and the single layer continuous Lembert with respect to construction time, leakage pressure and bursting pressure; for the purpose of small intestinal anastomosis in the horse. Hypothesis: We hypothesized that the time spent in the execution, leakage pressure and bursting pressure will be similar between the single layer continuous Lembert and the single layer simple continuous Appositional techniques. Since this is a pilot study, it is the first step to prove the efficacy of the Appositional technique by showing its similarity with the Lembert technique, considering the latter to be the ‘gold standard’. Methodology: Thirty-Seven intestinal segments from two horses were used to compare the single layer continuous Appositional and single layer continuous Lembert techniques. The time taken to execute the anastomoses, and the number of bites taken for each pattern, were recorded. Biomechanical testing was performed to determine leakage pressure and bursting pressure. Statistical analysis was performed using GraphPad Prism 8. Results: The comparison in construction time between the Lembert group (mean, 24.23 mins, n=19) and the Appositional group (mean, 21.74 mins, n=18) were found to be statistically insignificant (P=0.3088). There was also no changes in Leakage pressure (P=0.3862) and bursting pressure (P=0.3135) between the two groups. Conclusion: This study has demonstrated that the Appositional technique is a viable alternative to the Lembert technique, with respect to construction time, leakage and bursting pressures, for the purpose of end-to-end jejunojejunal anastomosis in the horse.


2014 ◽  
Vol 38 (5) ◽  
pp. 967-971 ◽  
Author(s):  
Ulf J. Schlegel ◽  
Klaus Püschel ◽  
Michael M. Morlock ◽  
Katrin Nagel

2021 ◽  
Vol 140 ◽  
pp. 110054
Author(s):  
Pablo Gallego-Lobillo ◽  
Alvaro Ferreira-Lazarte ◽  
Oswaldo Hernández-Hernández ◽  
Mar Villamiel

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A737-A737
Author(s):  
Loise Francisco-Anderson ◽  
Loise Francisco-Anderson ◽  
Mary Abdou ◽  
Michael Goldberg ◽  
Erin Troy ◽  
...  

BackgroundThe small intestinal axis (SINTAX) is a network of anatomic and functional connections between the small intestine and the rest of the body. It acts as an immunosurveillance system, integrating signals from the environment that affect physiological processes throughout the body. The impact of events in the gut in the control of tumor immunity is beginning to be appreciated. We have previously shown that an orally delivered single strain of commensal bacteria induces anti-tumor immunity preclinically via pattern recognition receptor-mediated activation of innate and adaptive immunity. Some bacteria produce extracellular vesicles (EVs) that share molecular content with the parent bacterium in a particle that is roughly 1/1000th the volume in a non-replicating form. We report here an orally-delivered and gut-restricted bacterial EV which potently attenuates tumor growth to a greater extent than whole bacteria or checkpoint inhibition.MethodsEDP1908 is a preparation of extracellular vesicles produced by a gram-stain negative strain of bacterium of the Oscillospiraceae family isolated from a human donor. EDP1908 was selected for its immunostimulatory profile in a screen of EVs from a range of distinct microbial strains. Its mechanism of action was determined by ex vivo analysis of the tumor microenvironment (TME) and by in vitro functional studies with murine and human cells.ResultsOral treatment of tumor-bearing mice with EDP1908 shows superior control of tumor growth compared to checkpoint inhibition (anti-PD-1) or an intact microbe. EDP1908 significantly increased the percentage of IFNγ and TNF producing CD8+ CTLs, NK cells, NKT cells and CD4+ cells in the tumor microenvironment (TME). EDP1908 also increased tumor-infiltrating dendritic cells (DC1 and DC2). Analysis of cytokines in the TME showed significant increases in IP-10 and IFNg production in mice treated with EDP1908, creating an environment conducive to the recruitment and activation of anti-tumor lymphocytes.ConclusionsThis is the first report of striking anti-tumor effects of an orally delivered microbial extracellular vesicle. These data point to oral EVs as a new class of immunotherapeutic drugs. They are particularly effective at harnessing the biology of the small intestinal axis, acting locally on host cells in the gut to control distal immune responses within the TME. EDP1908 is in preclinical development for the treatment of cancer.Ethics ApprovalPreclinical murine studies were conducted under the approval of the Avastus Preclinical Services’ Ethics Board. Human in vitro samples were attained by approval of the IntegReview Ethics Board; informed consent was obtained from all subjects.


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