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.
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.
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| Figures 1 and 2 |
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| Figures 3 and 4 |
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| Figure 5 |
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| Figure 6 |
Did you fish out the gravel in the intestines, or leave it figuring it would pass on its own?
ReplyDeleteThanks for your question Gina! We left the intestinal gravel alone since the pieces were small and not causing any obstruction. He passed them without any problem.
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