Contributors: Andrew Gardiner, Jill Sammarco
Species: Canine | Classification: Techniques
- Incision into the stomach to gain access to the lumen.
- Most commonly for the removal of gastric foreign bodies Stomach: foreign body when endoscopic retrieval is not possible.
- To obtain gastric biopsies when an endoscope is not available or endoscopic biopsy is not appropriate, eg submucosal lesion.
- Exploration/treatment of gastric ulceration Gastric ulceration or neoplasia Stomach: neoplasia.
- Exploration/treatment of gastric mucosal hypertrophy Stomach: chronic hypertrophic gastritis.
- Removal of esophageal foreign body Esophagus: foreign body.
- Open surgical gastrotomy allows thorough evaluation of the mucosal surface by direct inspection and palpation.
- Gastrotomy is a major surgical procedure cf endoscopy.
- 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.
- 15 min.
- Approximately 60 min.
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.
- Stabilization of the vomiting patient should be commenced before surgery, consider hydration, acid-base and electrolyte status.
- Synthetic absorbable suture material, eg polydioxanone 2/0 or 3/0.
- Scalpel blade.
- Sample container with formalin for preservation of biopsy specimens.
- Readily accessible warmed lavage fluids in case of gastric content leakage.
- Laparotomy sponges.
- Fast animal for 12 hours prior to anesthetic for elective procedures to prevent reflux esophagitis.
- Standard surgical preparation for a ventral midline laparotomy Laparotomy: midline
- General anesthesia General anesthesia: overview.
- Dorsal recumbency.
Step 1 - Inspection of the abdomen; elevation of the stomach
- Systematically explore the entire abdomen, including the full length of the intestinal tract .
- Place Balfour retractors to retract abdominal wall from the cranial abdomen area .
- Isolate the stomach using moistened laparotomy sponges.
- Place stay sutures or Babcock forceps to elevate and stabilize the portion of the stomach to be incised .
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 .
- Use suction to remove gastric content if applicable .
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 -
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.
- Most frequently employed.
- 1st layer: Cushing or simple continuous suture of submucosa, muscularis and serosa .
- 2nd layer: Cushing or Lembert suture of muscularis and serosa .
- 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 .
Step 2 -
- Close the laparotomy incision in standard three-layered fashion.
- Continue intravenous fluids Fluid therapy until oral intake is established.
- 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.
- Not indicated for straightforward foreign body removal in most cases.
- 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.
- 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
- How to perform a canine gastrotomy. dvm360: www.youtube.com/watch?v=rtNwyBxZk0o