title: In vitro evaluation of bursting pressure and intestinal luminal area of three jejunostomy tube placement techniques in dogs.
abstract: OBJECTIVE
  To compare pursestring, Witzel (seromuscular inversion), and seromuscular incision jejunostomy tube placement techniques in vitro.
  
  
  METHODS
  Jejunal specimens from 10 dogs.
  
  
  METHODS
  Jejunal segments (50 cm) were harvested immediately prior to euthanasia from 10 mixed-breed dogs Specimens were harvested with the orad and aborad ends clamped and stored in saline (0.9% NaCl) solution-soaked towels during instrumentation. Three jejunostomy tubes were placed via 3 techniques (pursestring, Witzel, and seromuscular incision), and 2 double lumen central venous catheters were placed at each intestinal end for luminal filling and leak testing. Intestinal luminal area was measured ultrasonographically with specimens suspended in a warm undyed saline solution bath with the intestinal lumen filled with dyed saline solution (intraluminal pressure, 6 mm Hg). Leak testing was performed by means of infusion of dyed saline solution (4 mL/min) until each jejunostomy site failed. Intestinal luminal area and leakage pressure were compared between the 3 tube placement techniques.
  
  
  RESULTS
  The Witzel and seromuscular incision techniques decreased the intestinal luminal area measured at the tube insertion site, albeit nonsignificantly. For the seromuscular incision technique, a significant decrease in intestinal luminal area at the intraluminal site of measurement was found. For 2/30 specimens (1/10 pursestring and 1/10 seromuscular incision), failure occurred at pressures within the range of previously reported peak peristaltic pressure for dogs. Failure occurred at supraphysiologic peristaltic pressures for the remaining 28 specimens, including all 10 specimens for the Witzel technique.
  
  
  CONCLUSIONS
  In this in vitro study, all specimens for the Witzel technique withstood physiologic peristaltic pressures during leak testing. Both tunneling techniques (Witzel and seromuscular incision) created a decrease in intestinal luminal area. Further investigation, including in vivo testing, is indicated to evaluate the clinical relevance of these findings.
authors.affiliation: Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610., Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695.
authors.forename: Marije
authors.initials: M
authors.lastname: Risselada
authors.forename: Gary W
authors.initials: GW
authors.lastname: Ellison
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Winter
authors.forename: Robson F
authors.initials: RF
authors.lastname: Giglio
authors.forename: Andre
authors.initials: A
authors.lastname: Shih
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Hernandez
authors.forename: Emily
authors.initials: E
authors.lastname: Griffith
mesh_terms: D000818:Animals; D002404:Catheterization; D004285:Dogs / Q000601:surgery*; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000601:surgery*; D007582:Jejunostomy / Q000662:veterinary*; D011312:Pressure; D012965:Sodium Chloride / Q000737:chemistry
chemical_list: D012965:Sodium Chloride