Author

Stephen J. Birchard DVM, MS, Diplomate ACVS

Friday, August 23, 2013

Fine tuning surgical removal of gastric foreign bodies


Today's blog may seem a little basic but it's a good start to what will be several more blogs describing gastric surgical techniques such as debridement and closure of full thickness ulcers, incisional gastropexy to prevent gastric dilatation volvulus, and pyloroplasty for pyloric hypertrophy.
Gastric surgery requires adequate surgical exposure.  The ventral midline abdominal approach should begin at the xyphoid cartilage and extend beyond the umbilicus.  Self-retaining retractors (e.g. Balfour) are very helpful in the exposure. 
Contamination of the abdomen with stomach contents can be minimized by isolating the stomach from the remainder of the abdomen with laparotomy sponges, using stay sutures to elevate the gastrotomy incision, and using suction to remove stomach debris and fluid.  If an upper GI radiographic contrast study was performed preoperatively, prevent spillage of barium into the peritoneal cavity.
Always do a thorough examination of all abdominal organs. Besides the stomach, pay particular attention to the intestines, liver, and pancreas.  In cases of gastric neoplasia, close examination of regional lymph nodes and liver must be done to check for metastatic disease.
Indications for gastrotomy include gastric foreign body, distal esophageal foreign body, or gastric biopsy.  Figures 1-4 are from a dog whose owners discarded turkey drippings onto the gravel driveway on Thanksgiving Day. That was the tastiest driveway the dog had ever eaten. (Yes, the gravel was removed from the stomach using a sterile teaspoon.)
Make the gastrotomy incision in a relatively avascular area, halfway between the lesser and greater curvature.  Traditional gastrotomy closure is a two-layer inverting pattern such as a Cushing (Fig 5) followed with a Lembert pattern (Fig 6).  Absorbable sutures such as Monocryl or PDS on taper needles are acceptable for closure. Be sure to penetrate the submucosal layer of the stomach with the suture. After taking a bite of the tissue, if you can see the suture through the tissue the submucosa has probably not been included in the suture bite. Some surgeons prefer to close the gastrotomy incision with a simple continuous of the full thickness gastric wall followed by a Cushing pattern of the seromuscular layer. Dr Becky Ball, also a surgeon at Circle City Veterinary Specialty Hospital, prefers that technique.


Figures 1 and 2

Figures 3 and 4
Figure 5
Figure 6