Patients that have had a diaphragmatic incision will require diaphragmatic closure and removal of intrathoracic air by transdiaphragmatic
thoracocentesis or the placement of a chest tube. In some patients, the chest tube can be placed through the diaphragmatic
incision, which is then closed in a continuous suture pattern. Once the diaphragm is closed, aspirate the tube until the chest
is emptied of residual fluid and air. Then pull the tube before abdominal closure. Patients with diaphragmatic incisions will
require close monitoring for respiratory complications after surgery.
Figure 8. As you tighten the Cushing suture pattern, invert the mucosa with the needle holder.
Postoperative complications of gastrotomy are uncommon when tissue viability and quality are normal.3 Healing can be compromised, however, with marked gastric wall disease or neoplasia. Peritonitis secondary to intraoperative
contamination, incisional dehiscence, and tissue necrosis are the most severe complications but are rare if proper surgical
techniques are used. Because of the stomach's rich blood supply and collateral circulation, dehiscence is rarely a problem,
particularly if two-layer closures are used. Obstruction after two- or three-layer gastrotomy closure is rare but has been
reported secondary to reactions from polypropylene suture and to excessive inversion near the pylorus.14
Figure 9. Tie off the Cushing suture pattern to the original knot end.
If persistent postoperative vomiting occurs, rule out additional foreign bodies or tissue obstruction by using endoscopy or
gastric contrast radiography. Animals that have swallowed foreign objects containing metals such as zinc or lead may continue
to decline after surgery because of the toxic effects of these compounds.15-17 Postoperative chelation therapy is recommended in these patients.17
Figure 10. For added security, oversew the site with a Lembert suture pattern.
Elizabeth Shuler, BS
Karen M. Tobias, DVM, MS, DACVS
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996-4544
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