Preventing Leakage after Intestinal Surgery

Dehiscence and intraluminal leakage of small intestinal contents is a critical postoperative complication in canine intestinal surgery. Mortality rates associated with septic peritonitis have ranged from 30% to 70% in several studies. The leak test, which is regularly performed in human medicine, is recommended to assess intraoperative enteric suture line security. Studies have demonstrated that intraoperative leak testing significantly reduces the incidence of postoperative clinical and radiologic leaks. Previously, the optimum volume of saline required to exert the appropriate pressure levels for leak tests had not been established in veterinary studies. This study used 38 dogs to identify the saline volume required to achieve targeted intraluminal pressures (normal peristaltic pressures of 20 and 34 cm water) in a 10-cm canine jejunal segment containing a closed biopsy site.The digital and Doyen methods of luminal occlusion were used: With digital occlusion, the mean volume of saline injected to achieve an intraluminal pressure of 20 cm water was 12.2 ± 4.2 mL (95% confidence interval [CI]: 10.9–13.6 mL; range, 6–22 mL; median, 11 mL), and for 34 cm water was 17.6 ± 6.1 mL (95% CI: 16.3–19 mL; range, 6–31 mL; median, 16 mL). With Doyen occlusion, the mean volume of saline injected to achieve an intraluminal pressure of 20 cm water was 9.8 ± 3.2 mL (95% CI: 8.5–11.1 mL; range, 5–17 mL; median, 10 mL) and for 34 cm water was 13.4 ± 4.3 mL (95% CI: 12.1–14.8 mL; range, 5–25 mL; median, 12.5 mL). The correlation between saline volume and pressure was higher with Doyen (0.86) than digital (0.76) occlusion; this is likely due to the less secure nature of digital occlusion.

Commentary: It is still unclear whether intraoperative leak testing is clinically relevant in dogs. However, this study supported a role for leak testing in the prevention of complications from improper suturing. A study limitation is the lack of evaluation in diseased intestines (neoplastic or inflammatory lesions). In addition, small intestinal distensibility may vary in different situations and affect leak-test results.—Heather Troyer, DVM, Diplomate ABVP (Canine & Feline Practice)

Saline volume necessary to achieve predetermined intraluminal pressures during leak testing of small intestinal biopsy sites in the dog. Saile K, Boothe HW, Boothe DM. VET SURG 39:900-903, 2010.