VSR 421: Regional Veterinary Surgery (2+1)

 GASTROTOMY

• Gastrotomy is an incision through the stomach wall into the lumen.

Indication

• In dogs and cats, most common indication is removal of foreign body.
• Gastric mucosal biopsy.
• Exploration for ulceration, ncoplascia or hypertrophy.

Surgical technique

• A ventral midline abdominal incision from the xiphoid to pubis has to be made. Para costal approach is another alternative.
• Adequate exposure of the gastrointestinal tract can be achieved by the use of retractors.
• Before incising the stomach, inspect the entire abdominal contents.
• Isolate the stomach from remaining abdominal contents with moistened laparotomy sponges, for reducing the chance of contamination.
• Stay sutures can be placed to assist in manipulation of the stomach and to prevent spillage of gastric contents.
• Select a hypovascular area on the ventral aspect of the stomach for making the incision. It should be between the greater and lesser curvatures.
• The incision should be away from the pylorus, or closure of the incision may cause excessive tissue to be enfolded into the gastric lumen, resulting in outflow obstruction.
• First make a stab incision into the gastric lumen with a scalpel, and then extend the incision with metzenbaum scissors.
• Suction can be used to aspirate gastric contents to avoid spillage. 2 – 0 or 3 – 0 absorbable suture material is used to close the stomach in a two layer inserting sero-muscular pattern.
• In the first layer, serosa, muscularis and submucosa is included by a simple continuous or cushing suture. Then with a Lembert or cushing pattern that incorporates serosal and muscularis layers.
• To reduce the post operative bleeding, as an alternative we can close the mucosa in a simple continuous suture pattern as a separate layers.
• Substitute sterile instruments and gloves for those contaminated by gastric contents.
• If gastrotomy is performed for removal of foreign body, be sure to check the entire intestinal tract for additional material that could cause an intestinal obstruction.