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