Contributors: Andrew Gardiner, Jill Sammarco

 Species: Canine   |   Classification: Techniques

Introduction Requirements Preparation Procedure Aftercare Outcomes Further Reading


  • Incision into the stomach to gain access to the lumen.



  • Open surgical gastrotomy allows thorough evaluation of the mucosal surface by direct inspection and palpation.


  • Gastrotomy is a major surgical procedure cf endoscopy.

Alternative Techniques

  • Endoscopic retrieval of gastric foreign bodies Gastroscopy or for mucosal examination/biopsy:
    • In skilled hands is less invasive, simpler and quicker than open gastrotomy.
    • Should be used whenever practicable, either as definitive treatment or as part of the pre-operative investigation of the patient.

Time Required


  • 15 min.


  • Approximately 60 min.

Decision Taking

Criteria for choosing test

  • Note that gastric foreign bodies may sometimes occur incidentally on survey radiographs; try to ensure that there are no other lesions which might cause the clinical signs.
  • Explore the entire gastrointestinal tract by clinical examination, diagnostic imaging and at surgery.

Risk assessment

  • Stabilization of the vomiting patient should be commenced before surgery, consider hydration, acid-base and electrolyte status.


Materials Required

Minimum equipment

  • Standard surgical pack.
  • Balfour retractors Surgical instruments self-retaining retractors - Balfour abdominal.

Ideal equipment

  • Suction.

Minimum consumables

  • Synthetic absorbable suture material, eg polydioxanone 2/0 or 3/0.
  • Sponges.
  • Scalpel blade.
  • Sample container with formalin for preservation of biopsy specimens.
  • Readily accessible warmed lavage fluids in case of gastric content leakage.

Ideal consumables

  • Laparotomy sponges.



Dietary Preparation

  • Fast animal for 12 hours prior to anesthetic for elective procedures to prevent reflux esophagitis.

Site Preparation




Step 1 - Inspection of the abdomen; elevation of the stomach

  • Systematically explore the entire abdomen, including the full length of the intestinal tract Stomach: gastrotomy 02 - diathermy Stomach: gastrotomy 03 - SC fat Stomach: gastrotomy 04 - linea alba.
  • Place Balfour retractors Surgical instruments self-retaining retractors - Balfour abdominal to retract abdominal wall from the cranial abdomen area Stomach: gastrotomy 05 - Gossett retractors.
  • Isolate the stomach using moistened laparotomy sponges.
  • Place stay sutures or Babcock forceps Surgical instruments intestinal tissue forceps - Babcock to elevate and stabilize the portion of the stomach to be incised Stomach: gastrotomy 06 - stay sutures.

Core Procedure

Step 1 - Gastrotomy

  • Select an area in the ventral aspect of the stomach between the gastric curvatures that is relatively hypovascular.
  • Make a stab entry into the gastric lumen using a scalpel blade.
  • Extend the incision to several cm length with Metzenbaum scissors Surgical instruments dissecting scissors - Metzenbaum.
  • Use suction to remove gastric content if applicable Stomach: gastrotomy 07 - incision Stomach: gastrotomy 08 - 4 stay sutures.
    Take great care to avoid spillage of gastric contents into the abdomen. Use stay sutures/Babcocks to elevate the operative zone and wall-off the operative zone using large moistened laparotomy sponges.If inadvertant spillage occurs, copious abdominal lavage and suction with warmed sterile saline is indicated.

Step 2 -

  • Inspect the gastric mucosa and retrieve foreign bodies, take biopsies etc as appropriate for the procedure being undertaken Stomach: gastrotomy 09 - gastric FB Stomach: gastrotomy 10 - FB retrieval.


Step 1 - Closure

  • Two-layered techniques incorporating inversion of one or both layers are commonly employed.
  • Use swaged-on synthetic absorbable suture material of an appropriate gauge, eg 2/0 or 3/0 polydioxanone.
  • Employ one of the methods below.
Method 1
  • Most frequently employed.
  • 1st layer: Cushing or simple continuous suture of submucosa, muscularis and serosa Stomach: gastrotomy 11 - closure (1st layer) Stomach: gastrotomy 12 - closure (1st layer).
  • 2nd layer: Cushing or Lembert suture of muscularis and serosa Stomach: gastrotomy 13 - closure (2nd layer) Stomach: gastrotomy 14 - closure (2nd layer).
Method 2
  • 1st layer: simple appositional suture through all 4 layers.
  • 2nd layer: Cushing or Lembert suture of muscularis and serosa.
    Some surgeons close the mucosa as a separate layer with a simple continuous suture, which reduces bleeding.
  • Lavage the operative site.
  • Lay a piece of omentum across the suture line Stomach: gastrotomy 15 - omentum Stomach: gastrotomy 16 - place omentum over incision.

Step 2 -

  • Close the laparotomy incision in standard three-layered fashion.



Fluid requirements

  • Continue intravenous fluids Fluid therapy until oral intake is established.

General Care

  • Monitor for vomiting and signs of peritonitis Peritonitis.


  • Post-operative analgesia Analgesia: overview as required by the individual patient.
  • All laparotomy patients should be assumed to require analgesia.

Antimicrobial therapy

  • Not indicated for straightforward foreign body removal in most cases.

Potential complications

  • Peritonitis Peritonitis due to intra- or post-operative gastric leakage: a grave sign.
  • Affected animals are severely depressed, may be vomiting, and may show signs of abdominal boarding and fluid leakage from the laparotomy wound.



  • Peritonitis Peritonitis before, during or after surgery.
  • Leakage of gastric contents constitutes a major surgical complication and emergency as fulminating peritonitis and shock is likely.


  • Usually excellent in uncomplicated foreign body retrieval.
  • The stomach normally heals rapidly.

Reasons for Treatment Failure

  • Failure to diagnose and/or treat a simultaneous lesion further distal in the intestinal tract, eg an incidental gastric foreign body but clinical obstruction of the intestine distally.
  • Hypoproteinemia → wound breakdown.

Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Haragopal V, Suresh Kumar R V (1996) Surgical removal of a fish bone from the canine esophagus through gastrotomy. Can Vet J 37 (3), 156 PubMed.
  • Fossum T W, Rohn D A, Willard M D et al (1995) Presumptive, iatrogenic gastric outflow obstruction associated with prior gastric surgery. JAAHA 31 (5), 391-395 PubMed.

Other sources of information