Ex vivo comparison of single-layer and double-layer laparoscopic closure of equine bladders with 2 types of barbed sutures.
Authors: Major Dustin S, Duff Amy H, Cohen Noah D, Hardy Joanne
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Laparoscopic Bladder Closure Techniques in Horses Laparoscopic repair of bladder trauma in horses presents technical challenges, particularly regarding optimal closure strategy and suture selection. Major and colleagues conducted an ex vivo comparison using 30 cadaver bladders to evaluate whether single-layer versus double-layer closure with unidirectional or bidirectional barbed sutures differed in their ability to withstand physiological pressures following a standardised 5-cm apical incision. Bursting pressure testing revealed no significant differences between any treatment group, though all sutured bladders failed at pressures below those of intact controls; reassuringly, the 95% confidence intervals for all closure techniques exceeded the physiologically relevant threshold of 30 mm Hg, suggesting adequate safety margins during normal micturition. Single-layer closures demonstrated greater efficiency gains with operator experience compared to double-layer techniques, with surgical time decreasing as competency improved. These findings suggest that equine surgeons may select either single- or double-layer laparoscopic closure using either barbed suture type based on personal preference and clinical circumstances, without compromising bladder integrity, though this ex vivo model cannot account for the inflammatory and healing variables present in live tissue repair.
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Practical Takeaways
- •Either single-layer or double-layer laparoscopic closure techniques are acceptable for equine bladder repair; choice can be based on surgeon preference and time considerations
- •Barbed suture type (unidirectional vs bidirectional) does not significantly impact closure integrity, so selection can depend on availability and cost
- •Single-layer closure may be preferred in clinical practice due to faster operative time without compromising functional strength
Key Findings
- •No significant difference in bursting pressure between single-layer and double-layer laparoscopic bladder closures using barbed sutures
- •Both unidirectional and bidirectional barbed sutures performed equally well, with all repaired bladders withstanding pressures exceeding the 30 mm Hg physiological threshold
- •Single-layer closures showed faster learning curve and reduced surgical time compared to double-layer technique
- •All repaired bladders failed at pressures lower than intact controls, indicating some strength loss despite adequate functional integrity