Comparison of Stapler , Single Layer and Double Layer Techniques for Colon Closure in Dogs

The present study was performed on 18 healthy dogs (aged 16.80±1.22 months) and body weight (17.07± 2.21 kg) to determine the best suturing technique among single layer, double layer and stapler technique for the closure of colon in dogs. All dog were divided into three groups, placing 6 animals in each group, i.e. group A was closed with single layer suture technique, group B was closed with double layer suture technique and group C was closed with stapler technique. The number of stitches required for colon closure were 8.83, 16.33 and 9.16 in groups –A, B and C respectively. The mean number of stitches and time taken for the completion of double layer technique was significantly higher (P<0.01) than single layer and stapler techniques. The mean of total duration of abdominal closure was 47.00, 45.16 and 34.83 minutes in group A, B and C respectively. The mean of total duration for surgery was 57.16, 64.50 and 46.33 minutes in group A, B and C respectively..The study reveals that all the techniques were not completely free from complications and advantages. Although stapler technique had some advantages like minimal adhesion between anastomotic line and other structures, higher bursting wall tension at operated site and less duration required for closure of anastomosis. It is concluded that stapler technique used in this study proved better than single layer and double layer suture techniques in dogs.


INTRODUCTION
Wound is a break in the continuity of the cellular and molecular structure of the body while its repairing is more complex process which takes proper period of time [1,2].The majority of the surgical wounds are created by the surgeons therefore their obligation is to provide a hygienic environment which ultimately promotes the wound healing process [3].The existing treatment strategies are designed multi directional as including surgery, radiation and chemicals however it is surprising that wound healing process becomes a globally important matter of discussion.Whether the wound is surgically created or due to some other reason and the patients undergo some form of surgical procedure during the course of their disease for treatment or diagnostic purpose [4].Intestinal disorders due to various causes are more common in canine, which needed surgical facilitation at an early stage [5].Adoption of foreign bodies in bowel blockage related to fluid imbalance as a result of increase secretion impaired by oral intake fluid and vomiting [6], foreign bodies of intestine are frequently originate upon *Address correspondence to this author at the Department of Veterinary Surgery & Obstetrics, Sindh Agriculture University Tandojam, Pakistan; E-mail: drkhan00789@yahoo.comdomesticated animal which shows multiplicity of clinical signs related to the obstruction location which need surgical facility.Intestinal alignments with modern suturing instruments show good results in clinical use [7], and best surgical technique is the fundamental requirement for colon surgery which causes low tissue damage and less complication rate [8].

MATERIAL METHODS
This study was performed on 18 healthy dogs at Department of Surgery and Obstetrics, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam.The dogs were arranged from surrounding area of Tandojam.Healthy animals were used in this research study in order to achieve the required results.Dogs of varying ages between 10 to 20 months old with an average body weight of 17.07± 2.21 kgwere brought 12 days before start of the surgery for adaptation the surrounding environment.

Groups
Eighteen dogs were randomly divided into 3 groups, A, B and group C by placing 6 animals in each group.
One suturing technique was employed on the colon of dogs in each group (Table 1).

Techniques of Suturing
Three suturing techniques such as stapler, single layer and double layer were applied on colon of dogs each technique for each group.Single layer and double layer for group A and B respectively were carried out with using Dexon 3/0 (suture material) while Stapler (Intestinal linear stapler, Haier Private Limited) was used in group C.

Pre-Operative Preparations
Each dog was off fed for 12 hours and water was with held for 6 hours before the start of the experiments.Dogs were operated randomly one dog for each day.

Anaesthesia and Surgical Procedure
Xylazine hydrochloride 0.5 mg/kg IM was used as pre-medication, anaesthesia was inducted and maintained with 10 mg/kg IV thiopental sodium (Pentothal Sodium, Abbott).Xylazine which is a good sedative analgesic was injected i/m 10 minutes before surgery for the purpose of keeping the animal calm and easily handled.The experiment were conducted under aseptically and hygienic condition in the operation theater in the Department of Surgery & Obstetrics SAU, Tandojam.After induction the anaesthetized animal was placed on the operated table in order to perform the surgical procedure.The incision site was prepared by clipping the hairs of the surrounded area.

Post-Operative Care
Antiseptics (pyodine) were applied on the incision site after suturing.Antibiotics (Amoxicillin 10mg/kg) 3cc was given to dogs dally up to 10 days to avoid secondary infections.Anti-inflammatory analgesics (Diclofenac Sodium, Meloxicam) were given to reduce inflammation and pain.Soft food were offered to the operated dogs up to completion of healing.Dogs were monitored daily two times i.e. (morning and evening) for physiological and clinical parameter postoperatively (Feeding, drinking, urination, defecation and behavior, pulse rate, respiration rate and body temperature etc.).The clinical appearance of wound were scored two time points 18 to 24 hrs and 10 to 14 days post-surgically.Skin wound healing were observed through naked eye in each day.Wounds were scored based on swelling, erythemia, dehiscence and discharge.

Necropsy Findings
The dogs were euthanized with magnesium sulphat intravenously.After euthanization the operated side of each euthanized dog was reopened.The anastomotic site was evaluated by collecting tissue sample during dissection on 3 rd , 10 th and 20 th day after surgery for histopathological study, by scarifying nine animals per occasion three from each group.

RESULTS AND DISSCUSSION
This study was performed to compare three unlike colon suturing techniques in relation to postoperative complications which was based on the clinical observations.The study was conduct through a proper channel without arising any issue.The mean number of stitches in colon of group A was 8.83 + 0.60 and time taken for colon closure was 9.50 + 0.42 minutes, the mean no of stitches for peritoneum were 9.16 + 0.47 and duration for its closuring was 14.16 + 0.54 minutes.No of stitches in linea alba were 9.83 + 0.47 and complete in 7.66 + 0.66.The no of stitches for skin closuring were 10.16 + 0.47 and time taken for its completion was 9.16 + 0.47 minutes.The total duration of abdominal closure and for surgery was 47 + 1.71 and 57.16 + 1.81 minutes respectivelym.The mean number of total stitches in colon of group B was 16.33 + 0.42 and total time taken for colon closure was 18.33 + 0.55 minutes, the mean no of stitches for peritoneum was 8.16 + 0.30 and duration for its closuring was 6.50 + 0.34 minutes.No of stitches in linea alba 7.66 + 0.21, closure with 6.33 + 0.80 minutes.The no of stitches for skin closuring were 9.00 + 0.36 and time taken for its The mean of the number of stitches in colon of group A (Single layer technique) and C (Stapler technique) were not significantly different from each other while the mean of the number of stitches and time taken for its closure of group B (Double layer technique) was significantly higher form both of the groups i.e.(groupA and C).Time of colon closure with stapler technique was significantly lower than Single layer and double layer technique.However the mean of all other parameters were not significantly different from each other.There were no significant difference in the adhesion % among the all groups.Similarly observations were recorded by [9], [7], while comparing oppositional single layer, inverted two layer and

CONCLUSSION
The study reveals that all the techniques were not completely free from complications.Although stapler technique had some advantages like minimal adhesion between anastomotic line and other structures, higher bursting wall tension and less duration required for closure of anastomosis.Stapler technique is superior than single layer and double layer suture technique in the sense that it provide rapid closure, lesser leakage, less narrowing of anastomotic lumen diameter, histologically better apposition of the anastomotic layers with minimum adhesions, excellent wound healing and lesser complications.It is concluded that stapler technique used in this study proved better than single layer and double layer suture technique in dogs.

Table 3 : Mean Values of Parameters i.e. Total no. of Stitches and Duration in Colon, Peritoneum, Linea Alba and Skin for Laparotomy and Anastomosis of Colon in Group-A, B and C Group A (Single layer technique) Group B (Double layer technique) Group C (Stapler technique) PARAMETER
During this research work two patients one from each group A and B were died due to intestinal leakage after day 3 post surgically.The Table5represented the leakage % in group-A, B and C.

Table 5 : Average Bursting Pressure (mm of Hg) of Colon at Operated Sites in Group A, B and C Animals Mean + S.E Groups Dogs no Control Operated Days after surgery Control Operated
were compared to normal colon diameter.After euthanization the lumen diameter was 45.50 + 2.92 and 35.00 + 2.33 mm respectively for normal and operated colon for group-A.For group-Bwas 42.66 +1.87 and 36.33 +2.40 mm for normal and operated while for group-C was 20 43.66 + 2.99 and 36.00 + 2.91 mm respectively for normal and operated colon. th