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15Soft 9 Dental Tissue Equipment Surgery & Instrumentation www.vetinst.com Gastro-intestinal Surgery in General Practice Alasdair Hotston Moore MA VetMB CertSAC CertVR CertSAS CertMEd MRCVS - Bath Veterinary Referrals Intestinal forceps intended for the purpose should be the only instruments used to occlude the lumen (except of intestine being resected). Doyen’s forceps are atraumatic and are ideal. In general they are preferred to an assistant holding the intestine because the risk of slippage and contamination is minimised. During suturing, the intestine should be handled only as much as necessary since it is readily damaged by the surgeon. Standard rat tooth forceps should never be used for this purpose: dressing forceps are also unsuitable because the plain tips must be used with excessive force to hold the tissue. DeBakey forceps or fine toothed Adson forceps are suitable. Veterinary surgeons will often find themselves undertaking gastrointestinal surgery in the clinic, often as a non-elective procedure. With the exception of neutering, it is probably the commonest indication for abdominal surgery. However, since GI surgery is often part of an unplanned “ex-lap”, the surgeon must be prepared to manage whatever surgical situation arises. There are several areas in which preparation can be made to achieve the best outcome in such animals: • preoperative nursing care • provision of appropriate instrumentation • provision of appropriate consumables • knowledge of relevant surgical techniques • post operative patient care General nursing care before surgery is key to a good post operative recovery but will not be covered in depth here. However, the role of nursing staff is key to so many aspects of surgery. One small area worthy of specific mention is the role of the nurse in patient preparation for theatre. For the exploratory laparotomy, the patient must be clipped and prepped to allow a complete examination of the abdomen: the surgical field must be large enough to allow extension of the incision up to the xiphysternum (and occasionally cranial to this for hepatic, and gastric surgery) and down to the pubic symphysis. In the male dog, it is useful in addition to place a urethral catheter which is connected to a collection system and to secure the prepuce to one side to reduce the possibility of contamination of the surgical site. Selection of surgical consumables will play a significant part in improving the efficiency of surgery and reducing patient morbidity (by reducing contamination of the surgical field, for example). In the author’s clinic, commercially sterilised disposable drapes and gowns have entirely replaced linen alternatives. The apparent additional cost is balanced by the reduced costs of laundry, packaging and sterilising. Surgical swabs are a similar area worthy of consideration: pre sterilised surgical swabs are reliably sterile, packaged in standard counts and have radio-opaque markers: swab retention is less likely with these precautions and more readily resolved. In human surgery, using swabs that are not radio marked for surgery would be considered unacceptable. Laparotomy swabs (20cm square, radio marked and with tails) are highly recommended for similar reasons, and they are essential for packing and isolating organs during surgery. Modern suture materials should be used in preference to chromic catgut, for example, and high quality packaged suture with swaged on needles have real advantages. Swaged on needles from high end suppliers cause minimal tissue trauma and since they pass through tissues smoothly, the trauma of tissue handling is reduced. In certain situations, surgical staplers (endomechanical devices) offer real advantages to hand suturing. In dogs requiring gastric resection (most commonly associated with gastric dilation-volvulus), the linear cutter reduces surgical time and abdominal contamination, compared F6fVF&W6V7FBfW'6Wvrf"FR&R6ǒW&f&VBFW7F&W6V7FB7F626&FbFRƖV"7FW"BƖV"7WGFW"0FRVff6VBvbW&f&֖r&W6V7FBgV7FVBFV@7F62v6226V7W&R2B7WGW&rB6W6W2W72F77VPG&Vࠤf"v7G&2BWF27W&vW''F7V"&F֖&WG&7F'2&PV6W76'FFW7W&RFWVFrFR6RbFRFVB"7FF&B&fW"&WG&7F'2v76WB"&r&WG&7F"&P6VV7FVBࠥFR7W&vV6VBW6R&&FR7W&v67G'VVFFFPFW7FR'F7V"2&VFfVǒg&vRW7V6ǒFR&W6V6R`fF"'7G'V7FࠥFR7W&vVW7BfRFR&VWfBWW'F6R&FFv62@7W&v6FV6VW22f"276&RFRFv626VB&RFP&Vf&R7W&vW''WBF22Bv276&RGW&r&FגFP7W&vV6VB&R&RF&V6v6RFR66FF2tEbFW7Ff&Vv&GƖV"d"GW77W66WFW&f&FW&FF0WF2BfRFR62&WV&VBFFVvFFVखb7W&v67FW'2&RF&RW6VBFR7W&vVW7BfR&V6VfV@#C