Basic of Small Animals Stomach Surgery

Chapter 91
Veterinary Surgery: Small Animal Expert Consult, 2nd Edition
Stomach
DR.KambizYousefiPresented By :

A N A T O M Y
Grossly, The Stomach Is Divided Into The Cardia, Fundus, Body, And Pyloric Portions

A N A T O M Y
The Point Where The Intraabdominal Esophagus Blends Into The Stomach On The Left Side Is Termed
The Cardia.
The Cardiac Notch Is Formed Between The Cardia And The Blind Outpouching Of The Stomach, Termed The
Fundus.
The Incisura Angularis (Angular Notch) Produces An Intraluminal Protrusion Of Tissue At Approximately The
Midpoint Of The Lesser Curvature That Separates The Antrum And The Body. This Angular Notch Is The Area In
Which The Papillary Process Of The Liver Lies.
During Endoscopic Examination Of The Stomach, The Incisura Angularis Is An Important Landmark.
The Pyloric Portion Of The Stomach Is Divided Into The Thinner Walled Pyloric Antrum And The Area Known As
The Pyloric Sphincter, Which Is Defined By The Double Muscle Layer That Surrounds It.

A N A T O M Y
Omentum
The Greater And Lesser Omentum Are Attached To The Stomach At The Greater And Lesser Curvatures, Respectively.
The Greater Omentum Is Divided Into Three Portions Known As The Bursal, Splenic, And Veil Portions
The Bursal Portion Attaches Along The Greater Curvature Except On The Left, Where It Runs Obliquely Across The
Dorsal Surface Of The Stomach And Joins The Lesser Omentum To Close The Omental Bursa.
The Splenic Portion Of The Greater Omentum Forms The Gastrosplenic Ligament, Through Which The Gastroepiploic
Vessels Course To The Stomach.
A Portion Of The Lesser Omentum Forms The Hepatogastric Ligament That Passes From The Liver To The Stomach.

A N A T O M Y
Gastric Layers
The Stomach Wall Is Composed Of Four Distinct Layers; From The External To The Internal Surface,
They Are The Serosa, Muscle, Submucosa, And Mucosa. The Muscular Composition Of The Stomach Is
Divided Into Three Layers.
1- The Longitudinal Fibers On The Greater Curvature Of The Stomach Pass Longitudinally From The Esophagus
To The Duodenum
2- The Inner Circular Layer Begins At The Cardia
3- The Oblique Muscle Fibers

P R E S U R G I C A L P R E P A R A T I O N
Fa st ing
A nest het ic C o nsidera tions
A nt imicro bials
Withholding Food For A Minimum Of 8 To 12 Hours Before Surgery Has Been Recommended To Ensure An Empty Stomach And Minimize The Risk
For Gastric Spillage During The Operative Procedure
In Cases Of Functional Pyloric Outflow Obstructions, The Duration Of The Required Fast May Be Significantly Longer To Ensure An Empty Stomach.
Anesthetic Considerations For Patients Undergoing Gastric Surgery Are Closely Tied To The Underlying Disease Process. Clinical
Signs Frequently Associated With Gastric Disorders Include Vomiting And Regurgitation; As Such, Administration Of
Anticholinergics Such As Atropine Or Glycopyrrolate Should Be Considered In An Effort To Reduce Gastric Secretions
Bacterial Numbers In The Stomach Are Significantly Less Than In The Remainder Of The Gastrointestinal Tract Because Of The Acidic Nature Of
Stomach Secretions. In Specific Cases Such As Gastric Perforation, Obstructive Disease With Possible Bacterial Overgrowth, And Gastric Dilatation
Volvulus, Antibiotics Are Indicated Perioperatively. In Other Instances When The Lumen Of The Stomach Must Be Entered And The Surgeon Believes
There Is An Increased Risk For Contamination, Administration Of Prophylactic Antibiotics Should Be Considered.

G E N E R A L S U R G I C A L P R I N C I P L E S
Several Factors Make Gastric Surgery Challenging. First And Foremost, The Risk For Gastric Content Leakage Is
Considerable And, If Not Addressed, May Result In Significant Postoperative Morbidity And Mortality.
A p p ro a ch
Gastric Surgery Of The Small-animal Patient Is Most Commonly Performed Through A Ventral Midline
Abdominal Incision That Extends From The Xiphoid Process Of The Sternum To A Point Well Caudal Of The
Umbilicus And, In Many Instances, Extending To The Pubis
In Rare Instances When Exposure Of Only A Portion Of The Stomach Is Required, A Paracostal Approach May
Be Used. This Is Achieved By Making A Curved Incision Approximately 2 Cm Caudal To The Last Rib
La v a g e
The Abdominal Cavity Should Be Lavaged With Sterile Saline Or Lactated Ringer’s Solution And Suctioned
Dry After The Gastrointestinal Tract Is Closed. Temperature Recommendations For Lavage Solution Vary, With
37°C To 39°C (98.6°F To 102.2°F) Most Commonly Reported.

Ga st ric C lo sure
The Closure Technique Used For Gastric Surgery Depends On The Incision Location And Indication For The Initial
Incision Or Resection. Routine Closure Of A Gastric Body Incision May Be Achieved With A Continuous Double-layer
Inverting Closure In Which The First Suture Line Is Full Thickness And The Second Line Incorporates Only The Serosa
And Muscular Layers. Alternatively, The First Suture Line May Appose Only The Mucosa And The Adherent Layer Of
Submucosa, And The Second Line Inverts The Remaining Layers Of Gastric Tissue. Inverting Patterns Used For These
Applications Include Cushing, Connell, And Lembert Patterns. A Two-layer Closure Technique Is Advantageous Because
The Inner Layer Provides Hemostasis Of Gastric Mucosa And Submucosa And The Outer Layer Provides An Additional
Seal Against Gastric Content Leakage.
Sut ure M a t eria l
The Choice Of Appropriate Suture Material For Closure Of The Stomach Is Dictated By The Need For A Material That
Resists Rapid Degradation In The Acid- And Enzymerich Environment Of The Gastric Lumen For The 14 Days Necessary
To Regain Gastric Wall Strength. Most Commonly, Monofilament Absorbable Materials Such As Polydioxanone,
Polyglyconate, Or Poliglecaprone 25 Are Used.
G E N E R A L S U R G I C A L P R I N C I P L E S

Ga st ric Bio psy
Gastric Biopsy Is Indicated In The Presence Of Gross Disease Of The Stomach And When Clinical Signs Are
Consistent With Upper Gastrointestinal Disease. Endoscopic Gastric Biopsy Is Associated With A Low Morbidity
And A Low Risk For Complications. However, In Instances When The Disease Is Submucosal Or Scirrhous In
Nature, Endoscopic Biopsy Is Inadequate Because Of The Inability To Obtain A Full-thickness Gastric Wall Sample.
A Simple Stab Incision May Be Made Into The Lumen Of The Stomach While Providing Upward Retraction With
Appropriate Thumb Forceps. The Incision Is Then Extended With Metzenbaum Scissors, And One Edge Of The
Incision Is Removed To Provide A Full-thickness Tissue Sample. Closure Of The Biopsy Site Is Most Commonly
Achieved With A Two-layer Pattern.
G E N E R A L S U R G I C A L TECHNIQUES

Ga st ro tomy
The Stomach Is Isolated From The Remainder Of The Abdomen With Moistened Laparotomy Sponges, And
Stay Sutures Are Placed At The Appropriate Points. A Gastrotomy Is Performed On The Ventral Surface Of
The Stomach Midway Between Its Lesser And Greater Curvatures In The Area With The Least Vascularity.
The Underlying Reason For The Gastrotomy Dictates The Location And Length Of The. Closure Of The
Gastrotomy Incision Is Accomplished In The Same Fashion As Described For Closure Of A Gastric Biopsy.
Pa rt ia l Ga st rect omy
• Partial Gastrectomy Is Most Frequently Performed To Remove Necrotic Stomach Wall Associated With Gastric
Dilatation Volvulus Or To Resect A Neoplasm.
• Blood Supply To The Spleen Should Be Evaluated To Determine Whether It Should Be Removed Concurrently.
• Depending On The Shape Of The Resulting Defect, The Closure May Occur Perpendicular Or Parallel To The Long
Axis Of The Stomach.
• Omentum Can Be Tacked Over The Site To Provide Additional Blood Supply And Seal The Area.

D e t e r m i n i n g Ti s s u e Vi a b i l i t y
Pa rt ia l Ga st rect omy
When Performing Partial Gastrectomy, It Is Critical That All Nonviable Tissue Be Excised.
Viability Of Gastric Mucosa Does Not Predict Overall Health Of The Gastric Wall; Thus
Other Criteria Must Be Used To Assess Gastric Wall Viability. Subjective Criteria Include
Gastric Wall Thickness, As Measured By Palpation; Serosal Surface Color; Evidence Of
Serosal Capillary Perfusion; And Presence Of Peristalsis.

Ga st ric Wa ll R esect io n A nd C lo sure
The Closure Technique Used For Partial Gastrectomy Depends On The Anatomic Location Of The Portion To
Be Resected And The Remaining Lumen Diameter. When The Lumen Diameter Permits And The Presence Of
Inverted Tissue Does Not Increase The Potential For Pyloric Outflow Obstruction, A Two-layer Inverting
Pattern Is Appropriate. When The Lumen Diameter Is Not Adequate To Allow Inverting Closure, A Simple
Continuous Suture Pattern Is Most Appropriate.

Ga st ric Wa ll Inv a g ination
• Invagination Has Been Proposed As An Alternative To Partial Gastrectomy In Cases With Areas Of Questionable
Viability.
• A Simple Continuous Or Inverting Suture Pattern And A Second Inverting Suture Pattern, With Bites Placed In
Healthy Tissue On Each Side Of The Necrotic Portion Of The Stomach, Are Placed To Invaginate The Unhealthy
Gastric Wall.
• The Result Is Apposition Of Healthy Tissue Over Necrotic Tissue Without Penetration Into Gastric Lumen, Thereby
Decreasing The Risk For Gastric Contents Spillage. The Devitalized Area Of Stomach Wall Is Then Sloughed Into
The Gastric Lumen And Digested.

Ga st ro pex y
Gastropexy Is The Creation Of A Permanent Adhesion Of The Stomach To The Adjacent Body Wall.
Gastropexy Is Most Commonly Performed For Prevention Of Gastric Dilatation Volvulus But Is Also
Used In The Treatment Of Hiatal Hernia.
• Gastropexy For Prevention Of Gastric Dilatation Volvulus Is Performed Between The Pyloric
Antrum And The Right Abdominal Wall.
• A Variety Of Gastropexy Techniques Have Been Reported With Varying Degrees Of Success.
Techniques Include Incisional, Beltloop, Circumcostal, Endoscopically Assisted, And Laparoscopic
Gastropexy.

The Results Of Biomechanical Testing For Commonly Used Open Gastropexy Techniques Are Similar
Quantitative Results Of Biomechanical Testing Must Be Interpreted Carefully Because The Absolute Strength Of
Gastropexy Required To Prevent Development Of Gastric Dilatation Volvulus Is Unknown. There Has Not Been
An Experimental Study Of Strength Of Incorporating Gastropexy.

Incisio na l Ga st ro pexy
 Incisional Gastropexy For Prevention Of Gastric Dilatation Volvulus Is Performed By Creating A 4- To 5-cm
Seromuscular Incision In The Gastric Antrum Either Parallel Or Perpendicular To The Long Axis Of The
Stomach.
 Care Should Be Taken To Avoid Penetration Of The Gastric Mucosa.
 A Second Incision Is Made Through The Peritoneum And The Transversus Abdominis Muscle On The
Lateral Or Ventrolateral Right Abdominal Wall Approximately 2 To 3 Cm Caudal To The Last Rib.
 Gastric And Abdominal Wall Incisions Are Apposed Using 2-0 Monofilament Absorbable Suture In A
Simple Continuous Suture Pattern, Beginning With The Craniodorsal Edges Of The Incision

The Technique For Incisional Gastropexy For Treatment Of Hiatal Hernia Is Similar
In All Respects Except That It Is Performed On The Left Side Of The Abdomen.
Incisions Are Made Through The Seromuscular Layer Of The Fundus And
Correspondingly Through The Peritoneum And Transversus Abdominis Muscle On The
Left Side Of The Abdominal Wall Caudal To The Last Rib.

The Body Wall Is Retracted After The Balfour
Retractor Is Removed To Facilitate Visualization.

After Determining The Appropriate Position Based On The Normal Anatomic
Location Of The Stomach, An Incision Is Made Through The Transversus
Abdominis Muscle Caudal To The Last Rib. A Second Incision Is Made Through
The Serosa And Muscular Layers Of The Stomach On The Ventral Surface Of The
Pyloric Antrum. The Mucosa Will Bulge From The Incision.

The Incisions In The Body Wall And Stomach Are Apposed Using Two
Continuous Suture Lines With The Most Dorsal Incision Closed First To
Facilitate Visualization.

Completion Of The Second Suture Line.

Belt - Lo o p Ga st ro pex y
 Belt-loop Gastropexy Is A Variation On Incisional Gastropexy. With The Belt-loop Technique A
Seromuscular Flap Is Elevated From The Pyloric Antrum And Passed Through A Tunnel Created
Between Two Parallel Incisions In The Abdominal Wall.
 The Seromuscular Gastric Flap Is Based Along The Greater Curvature Of The Stomach And Incorporates
Branches Of The Gastroepiploic Artery In Its Origin.
 The Flap Is Created By Making Two Parallel Incisions Approximately 4 Cm Long And 3 Cm Apart And
Connecting These Incisions At Their Most Cranial Aspect.

 The Resultant Seromuscular Flap Is Undermined From The Mucosal Layer Below. Next, Two 5-cm-
long Abdominal Wall Incisions That Penetrate The Peritoneum And Transversus Abdominis Muscle Are
Made Approximately 3 Cm Apart.
 Muscle Between The Two Incisions Is Undermined, Creating A Tunnel Through Which The
Seromuscular Gastric Flap Is Passed.

 The Gastric Flap Is Passed Through The Tunnel By First Bringing The Stomach Close To The Body Wall
To Decrease Tension Applied To The Flap As It Is Passed And Then Using A Stay Suture Placed In The
Free End Of The Flap To Direct The Flap Through The Tunnel.
 The Flap Is Sutured Back To The Site From Which It Was Elevated Using A Simple Interrupted Or
Continuous Pattern Of 2-0 Or 3-0 Absorbable Monofilament.

A Seromuscular Flap Is Raised, Originating From The Pyloric Antrum And
Incorporating A Blood Supply In The Base Of The Flap.

Parallel Transverse Incisions Are Made In The Transversus
Abdominis Muscle.

The Seromuscular Flap Is Advanced Through The “Belt Loop” Created In The
Abdominal Wall. The Stomach Should Be Held In Close Approximation To The Body
Wall As This Is Accomplished To Minimize Trauma To The Flap. The Flap Is Then
Sutured Back Into The Area It Originated From On The Stomach

C ircumco st al Ga st ropexy
 A Seromuscular Flap Is Raised From The Pyloric Antrum Similar To The Belt-loop Gastropexy
Technique.
 The Seromuscular Flap May Be Double Or Single Hinged. When A Single-hinged Flap Is Used, It Is
Based From The Lesser Curvature Of The Stomach And Undermined Below The Level Of The
Muscularis Layer, Taking Care Not To Penetrate The Gastric Lumen.

 A 5- To 6-cm Incision Is Made Directly Over The Eleventh Or Twelfth Rib At The Level Of The
Costochondral Junction.
 A Plane Of Blunt Dissection Is Then Established Circumferentially In Close Association With The Rib.
 Care Must Be Taken To Avoid Creation Of Pneumothorax Or Fracture Of The Rib

 The Seromuscular Gastric Flap Is Then Passed Cranial To Caudal Through The Tunnel Surrounding The Rib
 Stay Sutures Placed In The Leading Edge Of The Flap Facilitate Passage Around The Rib.
 The Seromuscular Flap Is Sutured Back To Its Origin Using 2-0 Or 3-0 Absorbable Suture Material.

Make A Single- Or Double-layered Hinged Seromuscular Flap
In The Pyloric Antrum.

Make An Incision Over The Eleventh Or Twelfth Rib At The
Level Of The Costochondral Junction.

Form A Tunnel Under The Rib Using A Carmalt Clamp Or Hemostat.

Pass The Gastric Antral Flap Craniodorsal Under The Rib And Suture It To The
Original Gastric Margin Or To The Other Flap.

Ga st ro colopexy
 Creation Of A Suture Line Between The Greater Curvature Of The Stomach And The Transverse
Colon Has Been Described To Prevent Recurrence Of Gastric Dilatation Volvulus.
 Gastrocolopexy As Reported Does Not Include Incision Into The Seromuscular Layer Of Either The
Stomach Or The Colon; Instead, The Surfaces Are Scarified And Then Apposed With Nonabsorbable
Sutures. Whether A Permanent Adhesion Is Created Is Unknown.

Py lo ro my oto my And Py lo ro pla sty
 Pyloric Surgical Techniques Are Focused On Removing Outflow Obstruction And
Normalizing Gastric Outflow.
 Several Techniques Have Been Described, Including The Fredet-ramstedt
Pyloromyotomy, Heineke-mikulicz Pyloroplasty, And Y-u Pyloroplasty.

Fredet - R a mst edt Py lo ro my oto my
 Fredet-ramstedt Pyloromyotomy Is Performed By Making A Longitudinal Incision Through Serosa And
Muscularis Of The Ventral Pylorus.
 The Incision Should Be Centered Over The Pylorus And Extend 1 To 2 Cm Orad And Aborad.
 When Performed Correctly, The Gastric Mucosa Is Not Penetrated; However, Its Submucosal Surface
Should Protrude Through The Incision. This Partial-thickness Incision Is Left Open, Permitting
Enlargement Of The Pylorus In Cases In Which Restriction Is Limited To The Serosa Or Muscularis.
 Because Pyloromyotomy Does Not Allow Visualization Of The Gastric Mucosa, Relieve Restrictions
Associated With Mucosal Or Submucosal Disease, Or Provide A Means For Full-thickness Biopsy Of
The Stomach Wall, Its Use Is Limited.

Myotomy Is Considered For Pyloric Widening If
Pyloric Musculature Is Thickened But Mucosa
And Submucosa Are Normal.

A Longitudinal Incision Is Made Through The
Muscular Layer, And All Muscular Fibers Are
Transected.

When Properly Performed, Mucosa And
Submucosa Bulge Through The Incision.

Heineke - M ikulicz Py lo ro pla sty
 Heineke-mikulicz Pyloroplasty Is Similar To Pyloromyotomy In That A Longitudinal Incision Is Made In
The Ventral Surface Of The Pylorus; However, The Incision Is Created Full Thickness And Then Closed
Transversely.
 Stay Sutures Can Be Placed In The Middle Of Either Side Of The Longitudinal Incision And Retracted
To Reorient The Tissues For The Transverse Closure; Alternatively, Stay Sutures Can Be Placed At Each
End Of The Incision And Pulled Together To Provide The Same Effect.
 Closure Is Achieved With 2-0 Or 3-0 Absorbable Monofilament Suture Material In An Interrupted
Appositional Pattern.
 Heineke-mikulicz Pyloroplasty Permits Full-thickness Gastric Wall Biopsy And Resection Of Small
Masses Or Thickened Tissues Along The Incision.

A Full-thickness Longitudinal Incision, Centered Over The
Pylorus And Extending 1 To 2 Cm Orad And Aborad, Is Made.
The Pyloric Area Is Inspected Visually, And Tissue Is Taken
For Histopathologic Examination.

Stay Sutures Placed At The Midpoint Along Each Side Of The
Incision Are Retracted. The Incision Is Closed Transversely
Using An Appositional Closure Pattern.
Finished Closure Of The Pyloroplasty.

Y- U Py lo ro p la sty
 Y-U Pyloroplasty Increases Pyloric Outflow Tract Diameter By Advancing A Portion Of The Pyloric
Antrum Into The Region Of The Pyloric Sphincter.
 A Y-shaped Full-thickness Incision Is Centered Over The Pylorus. The Fullthickness Incision For The
Body (Or Main Stem) Of The Y Is Made Through The Ventral Antimesenteric Aspect Of The Duodenum
And Pyloric Sphincter, And The Incisions For The Arms Of The Y Extend Into The Pyloric Antrum.
 The Arms Of The Y Should Curve Slightly To Form A U-shaped Flap Instead Of A Sharp V To Maximize
Vascular Supply To The Flap.

 The Pyloric Region Is Examined To Verify That Patency Will Be Maintained After Closure.
 A Full-thickness Margin Of The Incision Is Harvested For Biopsy, And Mucosa And Submucosa Are
Resected As Needed.
 The U-shaped Flap Is Then Advanced Forward, Using Stay Sutures At Its Tip, To The Base Of The Y
And Sutured Into The Most Aboral Portion Of The Incision At The Duodenum With 2-0 Absorbable
Monofilament Suture Material In An Appositional Pattern.

The Pylorus Is Identified And Isolated
Using Moistened Laparotomy Sponges.
The Full-thickness Y Incision Is Made. The Body
Of The (Y)Begins 1 To 2 Cm Aborad From The
Pylorus And Extends Through The Pylorus, And
The Arms Of The (Y) Extend Onto The Pyloric
Antrum.
After removal of tissue for biopsy, the curved center
of the (U) is advanced into the farthest extent of the
original incision and sutured into place using an
appositional pattern.

Ga st ro duodenal A na st o mosis
 Pylorectomy With Gastroduodenal Anastomosis (Billroth I) Is Performed In Animals With Pyloric Outflow
Obstruction That Cannot Be Treated With Routine Pyloroplasty Techniques.
 Indications Include Neoplasia Confined To The Pyloric Region, Ulceration Of The Outflow Tract, And Some Cases
Of Pyloric Hypertrophy. When Neoplasia Is Suspected, A 1- To 2-cm Margin Of Normal Tissue Should Be Removed
With The Abnormal Tissue.
 Pyloric Resection Is Technically More Challenging Than Other Techniques Involving The Pylorus And Requires
Detailed Knowledge Of Regional Anatomy. The Bile Duct, Pancreatic Ducts, And Vascular Supply To The Stomach
And Duodenum Must Be Identified Before Any Surgical Excision

 The Bile Duct Is Best Identified By Manual Expression Of The Gallbladder: Bile Can Be Detected As It Descends
Through And Dilates The Bile Duct As It Approaches The Duodenum.
 Stay Sutures Are Placed In The Duodenum And Stomach To Facilitate Retraction And Minimize Potential Leakage.
 Atraumatic Tissue Forceps Are Used Proximal And Distal To The Site Of Resection To Minimize Leakage Of
Gastrointestinal Contents.
 The Hepatogastric Ligament Can Be Transected To Facilitate Caudoventral Retraction Of The Pylorus; However, Care
Should Be Taken To Avoid Bile Duct Transection Deep And Lateral To This Area.

 A Minimum Of 5 To 10 Mm Of Healthy Tissue Should Be Maintained Between The Duodenal Level Of Excision
And The Opening Of The Bile Duct To Prevent Inadvertent Damage Or Obstruction.
 Branches Of The Right Gastric And Right Gastroepiploic Blood Vessels Supplying The Area To Be Resected Are
Ligated And Transected.
 Omental And Mesenteric Attachments Are Ligated And Divided.
 After Making Sure The Area Is Packed Off From The Rest Of The Abdomen With Laparotomy Sponges, The Pylorus
Is Removed With Metzenbaum Scissors Or A Scalpel.

 If A Significant Discrepancy In Lumen Diameter Is Created By This Resection, The Surgeon May Choose To Incise
The Antimesenteric Border Of The Duodenum To Increase Its Diameter Or Close A Portion Of The Gastric Antrum To
Narrow Gastric Diameter To Facilitate Anastomosi

 End-to-End Anastomosis Of The Stomach And Duodenum Is Performed With A One- Or Two-layer Appositional
Pattern Using A Simple Interrupted Or Simple Continuous Pattern Of 2-0 Or 3-0 Absorbable Monofilament Suture.
 If Biliary Obstruction From Regional Swelling Is A Concern, The Common Bile Duct And Its Opening Can Be
Stented With A Piece Of Red Rubber Catheter, Which Is Secured To The Interior Of The Duodenum With Absorbable
Suture, Before The Anastomosis Is Completed.
 The Prognosis After Pylorectomy And Gastroduodenostomy Depends On The Underlying Disease

 Partial Gastrectomy With Gastrojejunal Anastomosis (Billroth II) May Be Performed When Gastric Neoplasia
Precludes End-to-end Anastomosis Of The Pyloric Antrum To The Duodenum.
 Steps To Perform Gastrojejunal Anastomosis Are Similar To Gastroduodenal Anastomosis, Including Careful
Identification Of The Regional Anatomy And Extent Of The Lesion.
 In This Technique The Resulting Openings Into The Stomach And Duodenum Are Closed, And A Loop Of Jejunum Is
Anastomosed To The Greater Curvature Of The Stomach In A Side-to-side Fashion.
 Cholecystoenterostomy Is Often Required To Permit Biliary Flow.
 Prognosis Is Very Poor After This Procedure.

P y l o re c t o m y Wi t h E n d - t o - e n d G a s t ro d u o d e n o s t o m y
The Offending Section Of The Pylorus Is Resected
Along The Gastric And Duodenal Margins.

The Resulting Incisions Are Evaluated For
Comparable Circumferences.

If The Gastric Margin Is Of A Larger
Circumference Than The Duodenal Margin, The
Gastric Margin Is Reduced In Circumference From
The Lesser Curvature Toward The Greater
Curvature With A Simple Interrupted Or
Continuous Appositional Pattern; An Additional
Inverting Pattern May Be Applied If Feasible.

The Duodenal And Gastric Margins Are Apposed
With A Single-layer Simple Interrupted
Appositional Pattern.

Alternatively, This Procedure Can Be Performed
With Stapling Equipment. The End-to-end
Anastomosis Is Achieved When The Circular
Stapling Device Is Made To Exit The Gastric
Remnant Through The Stoma Left Open At The
Greater Curvature Margin Of The Gastric
Resection.

G E N E R A L P O S T O P E R A T I V E C O N S I D E R A T I O N S
 After Gastric Surgery, Fluid Therapy Is Continued Until The Animal Is Eating And Drinking Adequately.
 Oral Intake Of Food And Water May Be Initiated As Early As 12 Hours After Surgery In Patients That Are
Not Actively Vomiting, Regardless Of The Surgical Procedure Performed.
 If Vomiting Is Present, Investigation Of The Cause Is Indicated.

 If Loss Of Intestinal Motility Is Suspected, Electrolytes (Particularly Potassium And Magnesium) Should
Be Evaluated And The Patient Examined For Evidence Of Peritonitis Or Obstruction.
 If No Underlying Cause Can Be Detected, Treatment With A Prokinetic Agent Such As Metoclopramide
Or Cisapride May Be Effective To Resolve The Ileus.

 In Severe Cases Of Ileus, A Nasogastric Tube May Be Used To Intermittently Decompress The Stomach
And Trickle Feed The Patient, Which May Stimulate Gastric Motility
 When Vomiting Or Regurgitation Is Noted, Administration Of Proton Pump Inhibitors Or Histamine2
(H2) Receptor Antagonist Agents Reduces Production Of Gastric Acid And May Decrease The Risk For
Damage To The Esophagus.

 Animals That Are Anorexic Before Surgery Or Anticipated To Have Prolonged Anorexia After Surgery
Should Have Some Form Of Feeding Tube Placed To Supplement Their Caloric Intake.
 The Specific Route Of Feeding Is Based On The Underlying Disease Process And The Surgical Procedure
Performed.
 If A Tube Feeding Is Predicted, A Nasoenteric Tube Can Be Placed During Surgery, With Manual
Advancement Of The Tube From The Stomach Into The Duodenum Assisted By The Surgeon.

Basic of Small Animals Stomach Surgery

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