Vet360 Vol 3 Issue 04 August 2016 - Page 31

SURGERY An avascular area midway between the greater and lesser curvature is the most common site for surgical procedures of the stomach. A stab incision is made in the stomach and a large incision is extended from the stab incision. Note that mucousal eversion is normal and occurs readily. Once surgery has been completed the stomach should be closed in a double layer closure. An inverting suture pattern such as a Cushing, Connell or Lembert should be used. These patterns should not however be used in surgery of the pylorus as they can decrease the outflow diameter of the pylorus. A simple continuous pattern is generally recommended for surgery in this area. If you’re using stay sutures, make sure the incision does not have tension on it when you are closing the stomach because when you let go of the stay sutures your closure will be loose. Only a monofilament absorbable suture material should be used in the stomach. Multi-filament materials have increased tissue drag and are not ideal for use in the delicate gastric tissues. The most commonly used monofilament materials are Polydiaxanone, Polyglyconate and Poliglecaprone 25. Polydiaxone is not ideal as it shows an increased degradation rate approximately 10 times normal in an acidic environment. Polyglyconate and Poliglecaprone show an initial increase in degradation rate but this stabilises and they are the materials of choice. Chromic catgut shows rapid degradation in gastric juices and should not be used. Once the incision into the stomach has been closed all instruments and gloves should be changed. A new surgical set is opened and the abdomen closed. Nothing that was used to open the stomach should be used to close the abdomen. The abdomen should be lavaged with warmed ringers lactate. The ringer’s lactate should be warmed by placing it in a hot water bath or incubator. Heating bags up in the microwave can lead to uneven heating of the fluid and burns to the patient this, a small gastrotomy is performed and a full thickness section of stomach is removed and sent for histopathological examination. The gastrotomy site is closed according to general principles. Gastrotomy A gastrotomy is performed to remove foreign bodies from the stomach and linear foreign bodies. It is performed via a midline celiotomy, and through the ventral surface of the stomach. An avascular area is selected between the greater and lesser curvature. Stay sutures should be used used and handled by an assistant to prevent contamination of the abdomen. Closely inspect the deep area of the fundus for foreign bodies as well as the pylorus and cardia. The site is closed as previously described. Always obtain postoperative radiographs to ensure that nothing has been left behind. Partial Gastrectomy or Gastric Wall Invagination These procedures are commonly performed to remove non-viable gastric tissue after gastric dilatation/volvulus. It incorporates many of the basic surgical principles such as stay sutures and packing off the abdomen to isolate the stomach and prevent contamination with gastric content. The big difficulty is deciding on which tissue is viable and non-viable. This is a very subjective assessment and multiple factors should be taken into account. The colour of the stomach, palpation of wall thickness, capillary refill time and peristalsis should all be taken into accou