Stephen J. Birchard DVM, MS, Diplomate ACVS

Sunday, October 6, 2013

Final thoughts on suture patterns for linea alba closure including what size suture to use. Also results of GI surgery procedures poll.

GI Surgery Poll

Here is the final tally on which gastrointestinal surgeries the participants feel comfortable doing:

Which of these surgeries do you feel comfortable doing? (multiple answers are accepted)

The results were about what I was expecting. 
I know that the complicated part of this is that you frequently do not know until you are in the abdomen which procedure will be necessary. Also, sometimes it is difficult to determine if a segment of intestine is viable or not and should be removed. Remember the basic criteria for viability: color, blood supply, peristalsis, and temperature. Also, it can be helpful to first remove a foreign body and then give the bowel a few minutes to see if its color improves. In the end it comes down to a judgement call that you have to make.
Also remember, when in doubt . . . cut it out!
Septic peritonitis requires intensive care, is expensive, and has a high mortality rate. So, not surprising that most people find it a difficult disorder to treat.

Closure of the Linea Alba

There's one day left on the suture pattern poll but barring a huge change in the final day it appears that simple continuous pattern is the winner! Of the comments posted on my Facebook page, 12 of 13 people said they prefer simple continuous. I routinely use a simple continuous pattern with PDS and use the following sizes:
  • - cats and small dogs: 3-0 
  • - medium size dogs: 2-0
  • - large dogs: 0
Obviously these are general guidelines and can be modified for dogs that are extremely active or athletic. In dogs with significant healing issues such as Cushing's disease, on chemotherapy, or hypoproteinemia I substitute polypropylene for the PDS but still use the same sizes.
See Ethicon's website for more information about their sutures:

What's in Store For Next Week?

We'll continue with intestinal topics such as more on intussusception, subtotal colectomy in cats, and risk factors for intestinal incision dehiscence. I'm also working on a video of simple continuous closure of intestinal anastomosis using a surgical model. Any other GI topics you are interested in?

Stay tuned!

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