GI surgery stomach

Question 1

Most patients requiring GI surgery require pre-operative stabilization, including:

Answer 1

-Fluid therapy
-Correct electrolyte imbalances
-Assess other body systems

Question 2

Perioperative antibiosis:
- what used

Answer 2

-First-generation cephalosporin usually used
-For septic abdomen use broader spectrum antibiosis

Question 3

ASSESSMENT OF INTESTINAL VIABILITY
- how?

Answer 3

Still performed using rudimentary techniques:
-Color
-Consistency
-Motility
-Bleeding/perfusion
()
Other techniques have been tried such as surface oximetry or Fluorescein infusion but clinically not practical

Question 4

FACTORS THAT AFFECT CLOSURE CHOICES
- holding layer? material?

Answer 4

Holding Layer = Submucosa
Suture material – absorbable monofilament (polydioxanone - PDSTM or similar)

Question 5

how to close esophagus?

Answer 5

1-layer simple continuous appositional

Question 6

how to perform gastric closure

Answer 6

Gastric Closure: 2-layers
1. Submucosa + Mucosa
2. Muscularis and serosa

Question 7

Factors affecting esophageal healing

Answer 7

▸ No serosal coverage
▸ Constant motion
▸ Tension
▸ No omentum

Question 8

Surgical approaches:for esophagus

Answer 8

▸ Cervical: ventral midline
▸ Cranial thoracic: left or right 4th IC thoracotomy
▸ Caudal thoracic: left 7-9th IC thoracotomy

Question 9

laparotomy excision extends form

Answer 9

Xiphoid to caudal abdominal incision

Question 10

what are balfour retractors

Answer 10

• improve visualization for open abdomen
  -Extremely helpful for solo surgeons

Question 11

GASTROTOMY - most common indication? how do we isolate stomach? where to cut?

Answer 11

• Foreign body most common indication!
• Isolate stomach with sponges and stay sutures
• Linear foreign body: Gastrotomy first to “release” the remaining FB
• Incise in between greater and lesser curvatures

Question 12

gastrotomy - where do we put our dirty surgical instruments? how big should hole be?

Answer 12

“Dirty” instruments separated from rest of surgical table
Make gastrotomy only as big as needed to pull out FB

Question 13

gastrotomy closure:
- how to do first layer of closure for gastrotomy what layers of tissue? what suture?
- what about second layer?

Answer 13

• First layer:
• submucosa and mucosa - you will see a clear separation between layers
• simple interrupted
• Tension on suture 3-0 PDS (or similar)
• INDIRECT handling of gastric edges
  ()
  2nd layer:
• Inverting (Cushing or Lembert)
• NOT full thickness
• Does this layer provide additional strength to closure?
• Omentalize
  > Do not need to suture it in

Question 14

GDV mortality

Answer 14

• Mortality – 10-33%

Question 15

GOALS OF SURGERY FOR GDV

Answer 15

• Gastric derotation
• Evaluate gastric wall integrity
• Evaluate splenic (vasculature) integrity
• Prevent recurrence (—->gastropexy)

Question 16

INCISIONAL GASTROPEXY
- what do we do?

Answer 16

• Full thickness incision in transversus abdominis
• Partial thickness incision through seromuscular layer of pyloric antrum