Key gastrointestinal surgeries: Gastrotomy - Veterinary Medicine
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Key gastrointestinal surgeries: Gastrotomy
When performed correctly, this procedure can help in the diagnosis and treatmentof many conditions—with minimal risk to patients. Follow this guide to the proper surgical technique.


VETERINARY MEDICINE



Figure 4. A full-thickness incision made in the gastric body midway between the lesser and greater curvatures.
Make a stab incision into the gastric wall with a No. 10 blade. Often the mucosa will retract from the blade and will need to be incised separately to enter the gastric lumen. Extend the incision with Metzenbaum or Mayo scissors (Figure 4).1,3 Remove liquid gastric contents with suction by using a Poole suction tip to decrease the risk of contamination from spillage. Food and other large-particulate matter may clog the aspirator, necessitating manual removal or the passage of a large-diameter orogastric tube. In patients with generalized disease (e.g. inflammatory bowel disease), biopsy samples can be removed from the margin of the gastrotomy site with dissecting scissors. Do not handle the samples with thumb forceps, which can damage the tissues.


Figure 5. To start the closure, take a bite at one end of the incision and tie it. Leave the tag long and secure it with a hemostat.
If necessary, the gastric incision can be enlarged to extract foreign bodies and to allow thorough examination of the gastric mucosa and lumen. An index finger can be inserted through the pylorus to check patency and diameter. If a distal esophageal foreign body is present, gently insert blunt-ended forceps (e.g. Carmalt or sponge forceps) through the lower esophageal sphincter to grasp the foreign body. If the foreign body cannot be easily retracted into the stomach, incise the diaphragm, and with one hand in the thorax, manipulate the foreign body within the esophagus while attempting to grasp the object with the transgastric forceps. Thorough endoscopic examination of the esophagus can be performed after a difficult foreign body extraction to determine the extent of the trauma. Insufflation during endoscopy may result in tension pneumothorax in animals with esophageal perforation, so be prepared to perform thoracocentesis or place a chest tube.


Figure 6. Close the mucosa with a simple continuous suture pattern, and tie the suture at the opposite end.
The gastric incision is usually closed in two layers with synthetic, monofilament, absorbable suture to reduce intraluminal bleeding and form a secure seal.3 The first suture layer should appose mucosa with a continuous suture pattern to prevent postoperative hemorrhage. This suture will be rapidly covered during the healing process and, therefore, become isolated from digestive degradation.3 Closure can be full-thickness or only incorporate mucosa. The second suture layer should include serosa, muscularis, and submucosa in an inverting Lembert or Cushing suture pattern with 2-0 or 3-0 monofilament absorbable suture.1,10,13 Tapered needles are recommended for use in the stomach since they pass through the wall easily and are less traumatic.3


Figure 7. Invert the seromuscular layer with a Cushing suture pattern, taking bites parallel to the incision line that do not penetrate the lumen.
For rapid closure, take an initial bite of stomach wall perpendicular and just beyond the end of the mucosal incision. Tie a knot in the suture, leaving the tag long (Figure 5), and secure the tag with a hemostat. Then close the mucosa with a simple continuous or running mattress suture pattern, ending just beyond the incision (Figure 6). Once the first layer is closed, continue back with the same suture in a Cushing or Lembert suture pattern, and tie to the initial suture tag (Figures 7-10).3 Omentum can be tacked over the incision site with a few simple interrupted sutures for added security against leakage.


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Source: VETERINARY MEDICINE,
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