Science Digest: Stapled enterectomy reduces surgical time when compared with sutured enterectomy

11 November 2024

Feline enterectomy is a common procedure performed in both general and referral veterinary practice, to remove diseased intestine. There is a lack of research on the outcomes and risk factors for gastrointestinal surgical techniques in cats, and a new study published in Journal of Feline Medicine and Surgery is the first to report on outcomes and compare closure techniques in cats undergoing enterectomy¹.

The study compared the use of surgical staplers for functional end-to-end anastomosis (SFEEA) with hand-sewn end-to-end anastomosis (EEA) in cats, by retrospectively reviewing records of 54 cats that had undergone enterectomy at four referral hospitals.

EEA was performed using a conventional technique with a 3/0 or 4/0 polydioxanone (PDS) synthetic monofilament, with suture patterns either simple interrupted, simple continuous, modified Gambee or a combination of these. SFEEA was performed using a GIA DST series (with staples deployed in two rows), Ethicon linear cutter or Ethicon EndoGIA stapler (with staples in three rows). Staple height selection was based on the surgeon’s preference, with most cases (91.7%) using cartridges with a 1.5 mm closed staple height. Preoperative, intraoperative and postoperative data were compared between cats undergoing SFEEA (24 cats) and EEA (30 cats).

Of the cats in the study, 93% (50 out of 54) survived to discharge, and median duration of hospitalisation was 4 days. Cats that didn’t survive to discharge were complex cases with multifaceted clinical issues. There was a significant difference in surgery times between the two groups, and SFEEA was significantly faster by a mean of 34.3 ± 9.274 minutes compared with EEA. Veterinary surgeons were >3 times more likely to use a surgical stapler in the presence of pre-existing septic peritonitis. There was no association between American Society of Anesthesiologists (ASA) score in the cats and surgical time.

The overall complication rate after enterectomy was 19.2%, generally agreeing with existing evidence of low complication rates in cats undergoing gastrointestinal surgery. SFEEA had higher complications rates (29.2%) than EEA (14.3%). Minor short-term complications included surgical site infection (in 1 case after SFEEA and 2 cases after EEA) and seroma (in 1 case after SFEEA and none after EEA). Major short-term complications were reported only after SFEEA; haemoabdomen (1 case), dehiscence (1 case) and stricture (2 cases). Stricture and dehiscence at the SFEEA site were reported with the use of the Ethicon Linear Cutter, 1.5 mm closed staple height and transverse line closure with a TA stapling device with a 1.5 mm closed staple height without oversewing. Major long-term complications were delayed surgical site infection (in 2 cases after EEA) and stricture (in 2 cases after SFEEA). Whilst complication rates were higher for stapled enterectomy, this may be due to selection bias, as these cases were more likely to have concurrent pathology.

The study was limited by the retrospective nature of the study, resulting in incomplete patient records and owner memory bias, and there were not enough negative outcomes to identify any risk factors for dehiscence or mortality.

Take home message

This study demonstrates that using a surgical stapler is significantly faster than hand-sewing the enterectomy site, has low rates of dehiscence and shorter anaesthetic time, and so minimises the opportunity for complications in high risk patients, although it does have a higher complication rate than hand-sewing. Mortality is more likely related to health status at the time of surgery or concurrent pathologies. Using a surgical stapler could be considered for feline enterectomy to reduce surgical time, especially where shorter anaesthetic time is desired, whilst being mindful of potential complications, particularly the small long-term risk of stricture at the anastomotic site.

Reference

¹Costello S, McRae B, Olive M, et al. (2024) Stapled enterectomy reduces surgical time when compared with sutured enterectomy: a retrospective review of 54 cats. Journal of Feline Medicine and Surgery. 26(9). doi:10.1177/1098612X241264723