VSR 421: Regional Veterinary Surgery (2+1)

PRINCIPLES OF INTESTINAL SURGERY

Fluid Therapy

• Correcting the fluid and electrolyte imbalance is of great priority before venturing for intestinal surgery Fluids like RL and MES are highly helpful and the dehydration score chart is used to correct the deficit. In case of severe blood loss blood transfusion and colloids administration is indicated

Antibiotic Prophylaxis

• The small intestine has both gram positive and gram negative organisms. The surgical procedure can be classified as clean, clean contaminated and contaminated depending upon the condition for which it is operated. In general a broad spectrum antibiotic is indicated as prophylaxis.
• Usually second or third generation cephalosporin is employed. In case of gangrene to counter anaerobic organisms metronidazole is indicated.

Assessment of Intestinal Viability

• This is important for prognosis of the patient. It can be done by visual comparison, Fluoroscein dye test and surface oximetry. Surface oximetry is more useful method

Choice of suture material for closure

• Monofilament synthetic absorbable (PDS) or synthetic non-absorbable (prolene) are excellent choices.
• Multi-filaments are also employed for closure but produces more tissue drag when compared to monofilaments

Choice of Suture Pattern

• Simple interrupted pattern is ideal.

Suture Reinforcement

• Application of Omental and serosal patch aids in faster healing clean instruments should be set aside for closure.
• Clean procedures such as liver biopsy should be performed before intestinal biopsy. Intestine samples can be obtained with a scalpel blade or skin biopsy punch suture can be placed in the intestine to be sampled.
• The stay suture allows manipulation of the sample without damage. The sample and attached stay suture can be placed directly in formalin; the suture will not interfere with processing.
• The intestinal wall should be incised near the stay suture to limit the size of the resulting surgical wound.