Gastrotomy

• Surgery to gain access to the stomach lumen.

• Gastric foreign bodies Stomach: gastric foreign body removal is the most common indication - though this is a relatively rare occurrence in cats, which are normally discriminate eaters.
  Note that linear foreign bodies Intestine: linear foreign body removal are however relatively common in cats and may be anchored underneath the tongue.
• To obtain gastric biopsies when an endoscope is not available or endoscopic biopsies would not be appropriate.
• Exploration/treatment of gastric ulceration /neoplasia.
• Removal of esophageal foreign body Esophagus: foreign body.

Advantages

• Gastrotomy allows easy evaluation and palpation of the entire gastric mucosa.

Disadvantages

• Gastrotomy is a major surgical procedure Enteroscopy.

• Endoscopy may not always be feasible in cats if suitable-sized equipment is not available, but when possible it offers an attractive alternative to major surgery and can be used to effect definitive treatment or as part of preoperative investigations.

Preparation

• 10 min.

Procedure

• Approximately 60 min.

Criteria for choosing test

• A thorough clinical and radiographic examination Radiography: abdomen of the entire abdomen should be made in all cases. Occasionally, there may be more than one lesion and one of these may be spurious/incidental, eg incidental gastric foreign body but an obstructing lesion distally in the intestine.

Risk assessment

• Patients with vomiting should be stabilized with respect to hydration, acid-base and electrolyte status preoperatively.

Minimum equipment

• Standard surgical pack.
• Balfour retractors (Pediatric)  .

Ideal equipment

• Suction.
• Babcock forceps  .

Minimum consumables

• Synthetic absorbable suture material eg polydioxanone 3/0.
• Gauze sponges.
• Scalpel blade, number 15.

Ideal consumables

• Laparotomy sponges.
• Sample container with formalin for preservation of biopsy specimens.
• Readily accessible lavage fluids in case of gastric content leakage.

• Standard premedication if employed.

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

• Routine surgical preparation for a ventral midline laparotomy/celiotomy Laparotomy: midline.

• General anesthesia.
• 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 the abdominal walls and viscera in the cranial abdomen.
• Isolate the stomach using moistened laparotomy sponges.
• Elevate the surgical site on the stomach using stay sutures or Babcock forceps  .

Step 1 - Gastrotomy

• Select a relatively hypovascular area between the gastric curvatures on the ventral aspect of the stomach.
• Make a stab incision into the gastric lumen using a number 15 scalpel blade.
• Extend the incision to 2-3 cm using Metzenbaum scissors  .
• Use suction to remove gastric content if necessary.
  Take great care to avoid spillage of gastric contents into the abdomen. The use of stay sutures/Babcocks to elevate the operative zone and thorough walling-off using large moistened laparotomy sponges helps here.

If inadvertant spillage does occur, copious lavage with warmed sterile saline is indicated.

Step 2 -

• Inspect the gastric mucosa and retrieve foreign bodies, take biopsies etc as appropriate for procedure being undertaken.

Step 1 - Closure

• Two-layered techniques incorporating inversion are employed.
• Use swaged-on synthetic absorbable suture material of an appropriate gauge, eg 3/0 polydioxanone.
• Two possible methods are as follows.

Method 1

• 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.

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.

Step 2 -

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

Fluid requirements

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

General Care

• Monitoring for vomiting and signs of peritonitis.

Analgesia

• Postoperative analgesia Analgesia: overview is required for laparotomy/celiotomy patients.

Antimicrobial therapy

• Not indicated for straight forward foreign body removal in most cases.

Potential complications

• Peritonitis Peritonitis due to intra- or postoperative gastric leakage. This is a grave sign.
• Affected cats are severely depressed, may be vomiting, and may show signs of abdominal pain and fluid leakage from the laparotomy/celiotomy 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 a likely sequel.
• ?Wound dehiscence.

• Usually excellent in straight forward foreign body removal.
• The stomach heals rapidly.

• Failure to diagnose and treat the clinical lesion in animals with more than one abnormality, eg incidental gastric foreign body but clinical obstruction of the intestine distally. This is avoided by thorough and systematic exploration of the entire intestinal tract at surgery.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Felts J F, Fox P R & Burk R L (1984) Thread and sewing needles as gastrointestinal foreign bodies in the cat: a review of 64 cases. JAVMA 184 (1), 56-9 PubMed.