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1. Comparative Evaluation Of Conventional Method And Staple Suture Technique For Intestinal Aanastomosis In Dogs

by Hafiz Kashif Shahzad | Prof. Dr. Muhammad Arif Khan | Dr. Aneela | Dr. Shehla Gul Bokhari.

Material type: book Book; Format: print Publisher: 2013Dissertation note: Intestinal resection and anastomosis is frequently essential during abdominal surgeries. Indications for intestinal resection are malignancy, inflammation, stricture formation, injuries and ischemia. Several surgical situations necessitate the resection of intestinal segments and the formation of consistent anastomoses. Conventionally, a large diversity of suture materials has been used to make hand-sewn anastomoses. Surgical stapler was made for the first time at the beginning of 20th century but its use remained limited in gastrointestinal surgery. Currently, stapled anastomoses is an essential part of the majority of the gastrointestinal surgeries. The simple-interrupted, single-layer, approximating technique, in which absorbable monofilament suture material is used, is presently believed to be the technique of choice for end-to-end bowel anastomosis. This procedure is mostly used in gastrointestinal surgeries with comparatively lesser complications. Intestinal anastomosis with skin staples was started by military surgeons for the soldiers suffering from bowel trauma caused by gunfire. In this technique, stainless steel skin staples were used to create a seromuscular intestinal anastomoses. There are several types of staplers available in markets, e.g. circular ligators, clip appliers, endoscopic staplers etc. The circular stapler is a disposable anastomotic instrument that places a round, double staggered row of titanium staples connecting intervening tissues. It can generate an end-to-end, end-to-side, or side-to-side anastomosis. This round stapler is available with a variety of staple line diameters to be used according to need. In current years, there has been a large shift from hand-sewn method towards the use of intestinal stapler in gastrointestinal surgery. They present a possible reduction in operational timing and are easy to learn and use than for hand-sewn method. So, staplers are very popular in the trainee. This research project was tested on 12 mongrel dogs divided randomly into two different groups (A and B). Each group comprised of 6 dogs. Conventional hand-sewn method of end-to-end anastomosis was applied on group A and stapled anastomosis was made in the dogs of group B. Two surgical techniques were applied for end to end anastomosis of jejunum. In group-A conventional hand-sewn anastomosis technique was applied. In this method a piece of jejunum was removed and then anatomosed with simple interrupted, single-layer, approximating technique. The absorbable, monofilament suture material was applied manually. This is currently considered the method of choice for end-to-end intestinal anastomosis in small animal surgery. This technique is well described and has been used throughout the canine gastrointestinal tract with a relatively low complication rate. In group-B a circular mechanical stapler was used to construct anastomosis. In this method a piece of jejunum was removed and end-to-end anatomosis was made using a mechanical stapler. Comparison of both techniques was made on the basis of clinical parameters (temperature, pulse, respiration, vomiting, diarrhea and blood in feces), radiographic evaluation, exploratory laparotomy, change in lumen diameter and duration of surgical procedure. There is a significant difference in change in diameter within each group before and after surgery but there is no significant difference in change in diameter or stenosis formation between these two groups. There is a significant difference in the duration of operation; stapled group significantly requires an average of 10 minutes less than conventional hand-sewn method. Conclusively it was inferred that there is no significant difference in change in diameter between stapled group and hand sewn group but the anastomosis construction time is shorter in stapled group. Stapled anastomosis is safe and faster technique than hand-sewn method. The prevalence of low complication rate makes it all the more ideal for application in routine practices. Availability: Items available for loan: UVAS Library [Call number: 1533,T] (1).

2. Comparative Efficacy Of Prolene And A Novel Prolene-Vicryl Composite Mesh For Ventral Hernia Repair In Dogs

by Hira Anjum | Dr. Shehla Gul Bokhari | Muhammad | Muhammad Arif Khan.

Material type: book Book; Format: print ; Literary form: drama Publisher: 2013Dissertation note: Prolene (Polypropylene) is a gold standard for repairing ventral or incisional hernias but exhibits increased inflammatory responses as a non-absorbable foreign material and causing post-operative complications. Prolene composite mesh has a reduced polypropylene concentration in addition to an equal proportion of absorbable material. Hence they provide more tissue in-growth and less inflammatory response and minimal adhesion formation. The present project was designed to compare the two mesh implants viz., the simple non-absorbable poly-propylene (prolene) mesh and the prolene-vicryl composite mesh which is comprised of an outer latticework of the non-absorbable polypropylene, in addition to absorbable polyglactin 910 (vicryl) on the inner side. Both mesh implants are readily available in Pakistan; the non-absorbable polypropylene mesh is available in Pakistan with the Trade name of Prolene® (Ethicon, Johnson & Johnson, USA), while the prolene-vicryl composite mesh is available with the Trade name of Vypro® (Ethicon, Johnson & Johnson, USA). Both meshes were compared on the basis of post-surgical complications (Pain evaluation, wound healing, hematoma, seroma and abscess formation), inflammatory responses mesh shrinkage and adhesion formation after application of hernioplasty implant. The experimental study was conducted on 12 (twelve) healthy mongrel dogs to compare prolene and prolene-vicryl composite mesh for ventral or incisional hernia repair in dogs. The dogs were randomly selected as either male or female, aged between one to two years (mean age 1.5 years). The body weight of the experimental animals was in the range between 16-20 kg (mean weight 18 kg). The dogs were housed in kennels at Pet Centre of University of Veterinary and Animal Sciences, Lahore for a period of 3 months (including adaptation and post-operative period). The dogs were divided into three groups (A, B & C) comprising of 4 dogs in each group; and they were numbered from # 1-4 in Group A, #5-8 dogs in Group B, and #9-12 dogs in Group C, for proper identification and for ease of research. The respective meshes were used for ventral or incisional hernia repair in group A and group B dogs, while group C dogs served as control group. The groups were surgically treated as follows: Group A (Prolene mesh) Group B (Prolene-vicryl composite mesh) Group C (Control group) During experimental trials, it was seen that polypropylene mesh resulted in a persistent inflammatory response, prominent foreign body reaction, rare vascularization, more fibroblast more granulating tissue, increased thickness of connective tissue, and extensive collagen fiber. In comparison, the polypropylene-vicryl composite mesh resulted in better vascularization, rare inflammatory response, moderate collagen fiber formation, smooth incorporation of collagen fibers into the mesh, low foreign body reaction, less fibroblast proliferation and lesser granulating tissue. Based upon all the findings it was concluded that the Prolene-Vicryl composite mesh is safer and more effective in terms of post-operative complications and outcomes. Availability: Items available for loan: UVAS Library [Call number: 1727,T] (1).

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