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Management of Gastrointestinal Obstruction
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Gastrotomy
Gastrotomy is a common procedure most often performed for removal of gastric foreign bodies. The procedure is facilitated with the placement of stay sutures at each end of the proposed incision. The body of the stomach is opened with a stab incision into the lumen in a relatively avascular area between the greater and lesser curvatures. The incision is continued with Metzenbaum scissors to create an opening large enough to remove the foreign material. Synthetic absorbable monofilament suture with a swaged-on taper needle is the material of choice for most gastrointestinal surgery.
Regardless of the suture pattern, the common theme for all gastrointestinal surgery is inclusion of the submucosal layer in the closure. Full-thickness purchase of the tissue ensures that this holding layer is incorporated in the suture line. Specific options for gastrotomy closure include: two-layer continuous inverting pattern (Cushing follwed by Lembert), single-layer simple interrupted pattern, or single-layer simple continuous pattern. For simple gastrotomy, the author prefers a single-layer simple continuous pattern with 3-0 monofilament absorbable suture. A two-layer pattern may be more appropriate if performing a partial gastrectomy or if there is a concern regarding tissue viability.
Enterotomy / Enterectomy
Although there are several significant differences in the healing properties of the small and large intestine, the same suturing principles apply regardless of the location of the foreign body within the gastrointestinal tract. Gentle tissue handling, adequate tissue purchase, use of appropriate suture material, and proper suture placement will ensure a secure closure. Luminal compromise is not usually an issue with simple enterotomies, however some surgeons prefer to routinely close longitudinal incisions transversely to avoid this problem altogether. Inverting patterns have been proposed to minimize mucosal eversion and the formation of adhesions. However, since adhesions are an infrequent problem in small animals and since luminal diameter would be decreased by inverting the tissue, this technique is not recommended. Options for simple enterotomy closure include: single-layer simple interrupted approximating pattern or single-layer simple continuous approximating pattern.
End-to-end intestinal anastomosis is most commonly performed following removal of nonviable tissue (enterectomy). Intestinal viability is based on assessment of subjective parameters such as color, thickness, arterial pulsation, capillary bleeding, and peristalsis. As with enterotomy closure, single-layer approximating patterns are preferred. Simple continuous patterns are faster and use less suture material, which is not only economical, but also decreases the amount of foreign material in the abdominal cavity. Tissue apposition is also thought to be better. The concern about creating a purse-string effect with a continuous pattern can be avoided if a modified simple continuous pattern is performed. In this technique, two suture lines are used, one originating at the mesenteric border and the other originating at the antimesenteric border. Good visualization of the mesenteric knot is imperative as this is the most common site for leakage. A single-layer full thickness continuous suture line is placed from the mesenteric knot to the stay suture at the antimesenteric knot with tissue purchases 2mm from the wound edge and 2 to 3 mm apart. This is repeated on the other side from the antimesenteric knot to the mesenteric knot. There is no difference in reported rates of dehiscence between animals with simple continuous anastomotic closures and animals with simple interrupted closures. [...]
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