Tips for Successful Intestinal Anastomosis

General Principles

When considering gastrointestinal surgery, conta-mination is of prime concern. Every effort should be made to minimize exposure of intestinal contents to the abdominal cavity.

• All clean procedures (hepatic biopsy, lymph node removal, etc…) should be performed prior to techniques that enter the GI tract.
• Proper isolation of the segment of tract to be opened is crucial. Stay sutures and atraumatic forceps should be used for manipulation.
• Abrasion and dessication can increase adhesion formation and reduce GI motility. Gentle handling and keeping tissue moist is important.
• Moistened laparotomy pads should be used as a barrier to cordon off the intestinal segment in question from the rest of the abdomen. This will also prevent dessication of the tissues
• A set of clean instruments should be set aside prior to entry of the GI tract, and used for abdominal closure.
• Gloves should be changed prior to closure of the abdomen.
• Powder should be rinsed from the outside of gloves to reduce granuloma and adhesion formation.
• Frequent and copious lavage is essential if there is gross contamination of the peritoneal cavity. Perferably, lavage a contaminated segment outside the abdomen.
• Use warm fluid. Fluid that is too hot may increase adhesion formation and cause vasodilation with subsequent hypotension. Cold fluids exacerbate hypothermia.
• Evacuate all fluid prior to closure. Residual fluid inhibits the normal defense mechanisms within the peritoneal cavity
• Should a breach in technique occur, it is beneficial to have chosen appropriate antibiotics for the segment of GI tract entered. Antibiotics should be given at the time of anesthetic induction, and dosing may be repeated during lengthy procedures.
• Small intestine - Gram positive and gram negative coverage, such as ampicillin/baytril, second generation cephalosporins, or a penicillin and aminoglycoside (if well-hydrated without renal compromise).
• Large intestine - As above, but with particular attention to anaerobes.
• Intestinal healing is optimized if the patient is kept stable during anesthesia, contamination of the environment is minimized.

Preoperative Considerations

Attempt to stabilize the patient before anesthesia.

• Correct fluid imbalances
• Crystalloids - 75-85% move into the interstitial space within one hour of administration.
• Colloids remain in the intravascular space and attract fluid from the interstitium. Duration of volume expansion for hetastarch is 12-48 hours
• Correct electrolyte abnormalities
• Hypokalemia common in the vomiting animal
• Consider the area of the GI tract to be addressed
• Treat pain [...]