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 8. As you tighten the Cushing suture pattern, invert the mucosa with the needle holder.
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.

COMPLICATIONS


Figure 9. Tie off the Cushing suture pattern to the original knot end.
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 10. For added security, oversew the site with a Lembert suture pattern.
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

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

REFERENCES

1. Fossum TW. Surgery of the digestive system. In: Small animal surgery. 2nd ed. St. Louis, Mo: Mosby, 2002;337-340.

2. Hall JA. Diseases of the stomach. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 5th ed. Philadelphia, Pa: WB Saunders Co, 2000;1159-1177.

3. Rasmusen LM. Stomach. In: Slatter D, ed. Textbook of small animal surgery, 3rd ed. Philadelphia, Pa: WB Saunders Co, 2003;592-618.

4. Hunt GB, Bellenger CR, Allan GS, et al. Suspected cranial migration of two sewing needles from the stomach of a dog. Vet Rec 1991;128:329-330.

5. Felts JF, Fox PR, Burk RL. Thread and sewing needles as gastrointestinal foreign bodies in the cat: a review of 64 cases. J Am Vet Med Assoc 1984;184:56-59.

6. Haragopal V, Suresh Kumar RV. Surgical removal of a fish bone from the canine esophagus through gastrotomy. Can Vet J 1996;37:156.

7. Kerpsack SJ, Birchard SJ. Removal of leiomyomas and other noninvasive masses from the cardiac region of the canine stomach. J Am Anim Hosp Assoc 1994;30:500-504.

8. Sheard AL, Harrington MG. Gastric dilatation in a bulldog. Vet Rec 1990;127:291.

9. Thomas RE. Gastric dilatation and torsion in small or miniature breeds of dogs—three case reports. J Small Anim Pract 1982;23:271-277.


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