Die Anwendung von Staplern in der abdominalen und thorakalen Chirurgie beim Hund

Zusammenfassung

Gegenstand und Ziel: Die Arbeit zeigt klassische Indikationen für den Staplereinsatz im Abdomen und Thorax beim Hund auf und gibt Entscheidungshilfen zur Geräteauswahl. Vor- und Nachteile beim Einsatz in der Praxis und postoperative Komplikationen werden beschrieben und die Ergebnisse eines Kosten-Nutzen-Vergleichs dargestellt. Ferner erfolgt ein Vergleich der eigenen Staplertechnik sowie der resultierenden Operationszeiten mit Angaben in der gängigen Literatur. Material und Methode: Der Stapler wurde bei 15 Lobektomien der Lunge, fünf Lobektomien der Leber, bei sechs Seit-zu-Seit-Anastomosen des Darms, bei einer Gastrektomie und bei einer Pankreasteilresektion verwendet. Zum Einsatz kamen der thorakoabdominale Stapler (TA-Stapler) und der gastrointestinale Stapler (GIA-Stapler). Ergebnisse: Als großer Vorteil dieser Methode ergab sich die Zeiteinsparung. Der Kosten-NutzenVergleich zeigte, dass die Kosten für den Staplereinsatz höher anzusetzen sind als die Kosten einer konventionellen Operation mit Nahttechniken. Im Sinne des Tieres, vor allem bei Patienten mit schlechtem Allgemeinbefinden, erscheint uns die schnellere Staplertechnik der konventionellen Handnaht überlegen. Schlussfolgerung und klinische Relevanz: An der Lunge lassen sich Stapler standardmäßig gut und einfach einsetzen. An der Leber und am Magen-Darm-Trakt können Stapler ebenfalls eine große Hilfe darstellen. Wir empfehlen für den Praxisgebrauch den TA-Stapler mit 60 mm langer Klammerreihe und 4,8 mm Klammerhöhe sowie den GIA-Stapler mit 60 mm langer Klammerreihe und 3,8 mm Klammerhöhe als die am flexibelsten einzusetzenden Stapler und Klammergrößen.

Summary

Objective: Classic indications for the usage of staplers in the abdomen and thorax of dogs are presented and advice for choosing the right instrument is given. Daily usage with its advantages and disadvantages and postoperative complications is described as well as the results of a cost-benefit comparison. The usage of staplers and the operative time of the own study are compared with the literature. Material and method: A thoraco-abdominal stapler (TA-stapler) and a gastrointestinal stapler (GIA-stapler) were used for 15 lung lobectomies, five liver lobectomies, six side-to-side anastomoses at the small intestine, one gastrectomy and one pancreatectomy. Results: A major advantage of this technique is the time-saving aspect. The cost-benefit comparison showed that costs for the use of the stapling instrument are higher than the costs for conventional surgery. For the benefit of the animal, especially in patients with a bad general condition, applying the faster stapling device seems to be better than the conventional method of hand suturing. Conclusion and clinical relevance: Staplers are a method of choice for pulmonary resections in small animals. They can also be helpful for surgery of the liver and digestive system. We prefer the TA 60-4.8-stapler and the GIA 60-3.8-stapler for daily use. These are the stapling instruments and staples which provide the most flexible use.

Schlüsselwörter

Hund - Lobektomie - Lunge - Leber - Darmanastomose - Stapler - Zeiteinsparung - Kosten-Nutzen-Vergleich

Key words

Dog - lobectomy - lung - liver - anastomoses of the small intestine - stapler - time-saving aspect - cost-benefit comparison

• Literatur

• 1 Ahmadu-Skuda F, Withrow SJ, Wendell Nelson A, Husted PW, Gillette EL, Whiteman CE. Billroth II gatrojejunostomy in dogs. Stapling technique and postoperative complications. Vet Surg 1988; 17: 211-219.
• 2 Ballantyne GH, Burke B, Rogers G, Lampert G, Boccia J. Accelerated wound healing with stapled enteric suture lines. An experimental study comparing traditional sewing techniques and a stapling device. Ann Surg 1985; 210: 360-364.
• 3 Beard WL, Bertone AL. Surgery of the equine small intestine. Comp Cont Educ Pract Vet 1992; 14: 1508-1512.
• 4 Boudrieau RJ, Fossum TW, Birchard SH. Surgical correction of primary pneumothorax in a dog. J Am Vet Med Assoc 1985; 186: 75-78.
• 5 Brown D, Conzemius MG, Shofer FS, Swann H. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997; 210: 1302-1306.
• 6 Chassin JL, Rifkind KM, Turner JW. Errors and pitfalls in stapling gastro -intestinal tract anastomoses. Surg Clin North Am 1984; 64: 441-459.
• 7 Chassin JL, Rifkind KM, Sussman B, Kassel B, Fingaret A, Drager S, Chassin PS. The stapled gastrointestinal tract anastomosis: Incidence of postopera -tive complications compared with the sutured anastomosis. Ann Surg 1978; 188: 689-696.
• 8 Clark GN. Gastric surgery with surgical stapling instruments. Vet Clin North Am Small Anim Pract 1994; 24: 279-303.
• 9 Coolman BR, Ehrhart N, Pijanowski GJ, Ehrhart EJ, Coolman SL. Comparison of skin staples with sutures for anastomosis of the small intestine in dogs. Vet Surg 2000; 29: 293-302.
• 10 Fossum TW, Hedlund CS, Hulse DA, Johnson AL, Seim HB, Willard MD, Carroll GL. Small Animal Surgery, 3rd ed. St. Louis, Missouri: Mosby; 2007: 453-457. 485, 573, 626
• 11 Green CE. Surgical and traumatic wound infections. In: Infectious Diseases of the Dog and Cat 2nd ed.. Green CE. ed Philadelphia: Saunders; 1998: 343
• 12 Howard RJ. Surgical infections. In: Principles of Surgery 7th ed.. Schwartz SI. ed New York: Mc Graw-Hill; 1999: 123
• 13 Hültl H. II Kongress der Ungarischen Gesellschaft für Chirurgie, Budapest, Mai 1908. Pester Med Chir Presse 1909; 45: 108-122.
• 14 Kudisch M. Surgical stapling of large intestines. Vet Clin North Am Small Anim Pract 1994; 24: 323-334.
• 15 LaRue SM, Withrow SJ, Peterson PR. Lung resection using surgical staples in dogs and cats. Vet Surg 1987; 16: 238-240.
• 16 Lawrence GH, Ristroph R, Wood JA, Starr A. Methods for avoiding a dire surgical complication: Bronchopleural fistula after pulmonary resection. Am J Surg 1982; 144: 136-140.
• 17 Lewis DD, Bellenger CR, Lewis DT, Latter MR. Hepatic lobectomy in the dog. A comparison of stapling and ligation techniques. Vet Surg 1990; 19: 221-225.
• 18 Lipscomb VJ, Hardie RJ, Dubielzig RR. Spontaneous pneumothorax caused by pulmonary blebs and bullae in 12 dogs. J Am Anim Hosp Assoc 2003; 39: 435-445.
• 19 McGinty CP, Kasten MC, Kinder JL, Hunt RS. Update on stapled bowel anastomosis. Mo Med 1979; 76: 145-150. 159
• 20 Miles WFA, Greig JD, Wilson RG, Nixon SJ. Technique of laparoscopic splen -ectomy with a powered vascular linear stapler. Brit J Surg 1996; 83: 1212
• 21 Morgenstern L. The intestinal anastomosis with the end-to-end stapling instrument. Progress and problems, 1980. Arch Surg 1981; 116: 141-142.
• 22 Nagorney DM, Edis AJ. A use for the stapler in pancreatic surgery. Am J Surg 1981; 142: 384-358.
• 23 Nance FC. New techniques of gastrointestinal anastomosis with the EEA stapler. Ann Surg 1979; 189: 587-600.
• 24 Pachter HL, Pennington R, Chassin J, Spencer FC. Simplified distal pancreat -ectomy with the Auto Suture stapler: preliminary clinical observations. Surgery 1979; 85: 166-170.
• 25 Pemberton LB. Secure closure of duodenal stump with staples. Am J Surg 1980; 139: 293-294.
• 26 Polglase AL, Cunningham IG, Hughes ES, Masterton JP. Initial clinical experience with the EEA stapler. Aust N Z J Surg 1982; 52: 71-75.
• 27 Povoski SP. Linear staplers in pancreatic surgery. Am J Surg 2004; 187: 796
• 28 Ravitch MM. Sewing with staples. Clin Med 1974; 81: 17-23.
• 29 Ravitch MM. The use of stapling instruments in surgery of the gastrointes -tinal tract, with a note on a new instrument for end-to-end low rectal and oesophagojejunal anastomoses. Aust N Z J Surg 1978; 48: 444-447.
• 30 Ravitch MM, Steichen FM. Experience with a second generation of stapling instruments in general and thoracic surgery. Bull Soc Int Chir 1972; 31: 502-509.
• 31 Ravitch MM, Steichen FM. Techniques of staple suturing in the gastrointestinal tract. Ann Surg 1972; 175: 815-837.
• 32 Schwartz A. Historical and veterinary perspectives of surgical stapling. Vet Clin North Am Small Anim Pract 1994; 24: 225-246.
• 33 Shigemura N, Akashi A, Nakagiri T, Ohta M, Matsuda H. Complete versus assisted thoracoscopic approach: a prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques. Surg Endos-cop 2004; 18: 1492-1497.
• 34 Shope TR, Cooney RN, McLeod J, Miller CA, Haluck RS. Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anstomosis. Obes Surg 2003; 13: 355-359.
• 35 Slatter G. Textbook of Small Animal Surgery, 3rd ed. Oxford: Elsevier; 2003: 242-243. 597-598, 1059-1060
• 36 Steichen FM, Ravitch MM. Stapling in Surgery. Chicago: Year Book Medical Publishers; 1984
• 37 Templeton JL, McKelvey ST. Low colorectal anastomoses: an experimental assessment of two sutured and two stapled techniques. Dis Colon Rec 1985; 28: 38-41.
• 38 Ullman SL. Surgical stapling of the small intestine. Vet Clin North Am 1994; 24: 305-322.
• 39 Van der Velden MA, van der Gaag I. The use of staplers in equine intestinal surgery. Vet Rec 1987; 28: 201-204.
• 40 Weissberg D, Kaufman M. Suture closure versus stapling of bronchial stump in 304 lung cancer operations. Scand J Thorac Cardiovasc Surg 1992; 26: 125-127.