Gastric & Pyloric SX

Question 1

Where is the pancreas located in relation to the stomach?

Answer 1

• Just below the pylors
• L arm → transverse colon
• R arm → descending colon

Question 2

Surgical approach to the Stomach?

Answer 2

• Ventral midline incision
• Incise caudal to the Xiphoid process & extend caudally as far as necessary
• Exteriorize the stomach
• Pack stomach off w/ moist Lap sponges
• Stab incision (scalpel) in the hypovascular area, midway btwn the Greater & Lesser Curvature
  
  • Keep incision away from the pyloric antrum (unless doing pyloric SX)
• Use Metzenbaums to lengthen incision
• Clamp & ligate all bleeding vessels

Question 3

How can you extoriorize the Stomach?

Answer 3

• Babcock forceps
• Stay sutures
  
  • Place far away from incision site

Question 4

What are the 2 options available for closing the stomach?

Answer 4

• 2 perforating inverting layes
  
  • Connell → Cushing or Lembert
• Non-perforating inverting layer
  
  • Simple continous in mucosa/submucosa → Cushing or Lembert

Question 5

Describe the 2 perforating inverting layers technique for closing the stomach.

Answer 5

• Connell (1^st)
  
  • Incorporate ALL layers
  • Begin & end slightly beyond the limits of the incision (1 cm)
  • Provides hemostatis
• Cushing of Lembert (2^nd)
  
  • Incorporate all layers EXCEPT mucosa
  • Begin & end slighlty beyond the limits of the incision (1 cm)

Question 6

What type of suture material do you need when closing the stomach?

Answer 6

Absorbale on both layers

Question 7

How do you avoid Unitented Retention of Foreign Objects (URFOs)?

Answer 7

• Count all sponges/gauze before starting SX & prior to closure
• Check for bleeders
• Lavage abdominal cavity → avoids clinical peritonitis
• Routine abdominal closure

Question 8

What are the Post-Op instructions for Gastric/Pyloric SX?

Answer 8

• NPO for 12-24 hrs
• Give fluids to maintain hydration
  
  • Can offer H₂O PO@ 12-14 hrs
• ø vomitting→ small volume of A/D about 1-2 hrs after NPO period
  
  • small, frequent meals
• vomitting → NPO for several more hrs → try a small amout of H₂O, etc
• Gradually return to normal diet over 2-3 d.
• Can use prophylactic antibiotics
  
  • Not required