Duffy et al: Influence of crotch suture augmentation on leakage pressure and leakage location during functional end-to-end stapled anastomoses in dogs
Veterinary Surgery 4, 2022

🔍 Key Findings

Augmenting FEESA with two simple interrupted crotch sutures (TCS) or simple continuous crotch suture (SCCS) significantly increased initial leakage pressure (ILP) compared to no suture or a single suture (NCS, SICS).
SCCS had the highest ILP (47.6 mm Hg), followed by TCS (37.8 mm Hg), SICS (33.0 mm Hg), and NCS (27.1 mm Hg).
All crotch suture types increased maximal leakage pressure (MLP) compared to no crotch suture.
Leakage from the crotch occurred most commonly in NCS (67%) and SICS (50%), but only 8% with TCS and 0% with SCCS.
SCCS was the only technique where leakage never occurred at the crotch site.
SCCS had the highest MLP (100.6 mm Hg), supporting its use in clinical settings with high-risk patients.
Intraluminal pressures during leakage in NCS constructs were sometimes below normal physiologic pressures, emphasizing risk of leakage without crotch suture.
The transverse staple line never leaked in any group, indicating the crotch is the primary weak point.

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Duffy et al: Influence of crotch suture augmentation on leakage pressure and leakage location during functional end-to-end stapled anastomoses in dogs
Veterinary Surgery 4, 2022

🔍 Key Findings

Augmenting FEESA with two simple interrupted crotch sutures (TCS) or simple continuous crotch suture (SCCS) significantly increased initial leakage pressure (ILP) compared to no suture or a single suture (NCS, SICS).
SCCS had the highest ILP (47.6 mm Hg), followed by TCS (37.8 mm Hg), SICS (33.0 mm Hg), and NCS (27.1 mm Hg).
All crotch suture types increased maximal leakage pressure (MLP) compared to no crotch suture.
Leakage from the crotch occurred most commonly in NCS (67%) and SICS (50%), but only 8% with TCS and 0% with SCCS.
SCCS was the only technique where leakage never occurred at the crotch site.
SCCS had the highest MLP (100.6 mm Hg), supporting its use in clinical settings with high-risk patients.
Intraluminal pressures during leakage in NCS constructs were sometimes below normal physiologic pressures, emphasizing risk of leakage without crotch suture.
The transverse staple line never leaked in any group, indicating the crotch is the primary weak point.

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Multiple Choice Questions on this study

In Duffy 2022 et al., on crotch suture techniques, why are two simple interrupted sutures (TCS) or SCCS considered superior to a single suture (SICS)?

A. They decrease staple line offset

B. They reduce peritoneal contamination

C. They allow faster healing time

D. They improve tension distribution at the crotch

E. They are easier to place intraoperatively

Answer: They improve tension distribution at the crotch

Explanation: TCS and SCCS better distribute tension at the crotch, reducing leakage risk.

In Duffy 2022 et al., on crotch suture techniques, which statement best describes leakage location outcomes with SCCS?

A. Leakage occurred in 50% at the crotch

B. Leakage occurred in 100% at the crotch

C. Leakage occurred only at the transverse staple line

D. Leakage occurred only at the longitudinal staple line

E. Leakage was equally distributed between crotch and staple line

Answer: Leakage occurred only at the longitudinal staple line

Explanation: No leakage was observed at the crotch with SCCS; all leakage occurred at the longitudinal staple line.

In Duffy 2022 et al., on crotch suture techniques, which technique resulted in the highest **initial leakage pressure** during FEESA in dogs?

A. Simple interrupted crotch suture (SICS)

B. Two simple interrupted crotch sutures (TCS)

C. Simple continuous crotch suture (SCCS)

D. No crotch suture (NCS)

E. Interrupted cruciate pattern

Answer: Simple continuous crotch suture (SCCS)

Explanation: SCCS produced the highest ILP at 47.6 mm Hg, significantly higher than all other techniques.

In Duffy 2022 et al., on crotch suture techniques, which statement is true regarding maximal leakage pressure (MLP)?

A. Only SCCS increased MLP compared to NCS

B. Only TCS increased MLP compared to NCS

C. All crotch suture techniques increased MLP compared to NCS

D. MLP was highest with SICS

E. MLP was lowest with SCCS

Answer: All crotch suture techniques increased MLP compared to NCS

Explanation: MLP increased significantly in all augmented groups (SICS, TCS, SCCS) relative to NCS.

In Duffy 2022 et al., on crotch suture techniques, which group had the **lowest resistance to leakage**, sometimes leaking below physiologic pressures?

A. No crotch suture (NCS)

B. Simple interrupted crotch suture (SICS)

C. Two simple interrupted crotch sutures (TCS)

D. Simple continuous crotch suture (SCCS)

E. Oversewn transverse staple line only

Answer: No crotch suture (NCS)

Explanation: NCS constructs sometimes leaked at <25 mm Hg, which is below normal canine peristaltic pressures.

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