Intestinal and Urinary Surgery Flashcards
What are the layers of Intestine/stomach/bladder wall?
1 - Outer serosa (visceral peritoneum)
2 - Muscularis (circular and longitudinal)
3 - Submucosal
4 - Mucosa
Which is the most important layer when suturing the stomach/intestine/bladder wall?
Submucosa
Gastrotomy
Surgical incision into the stomach
Commonly used for removal of foreign bodies
What are stay sutures and what are they used for?
Temporary surgical sutures which are placed during operation to hold or manipulate the operating area
Used to deteriorate stomach or bladder from peritoneal cavity
What suture material is used for gastrotomy closure?
Absorbable monofilament
3/0 cats
3/0 or 2/0 dogs
Atraumatic needle
What suture pattern is used for gastrotomy closure?
One layer
○ Full thickness
○ Simple interrupted or simple continuous
○ Continuous inverting e.g., Connell, Cushing, Lembert)
Two layers
○ Submucosal / mucosa (first)
○ Seromuscular (second)
What is omentalisation
Draping the omentum over the site of incision
What does omentalisation do?
Improves vascular supply to area
Brings inflammatory, immunogenic cells
○ Protect area
○ Remove bacteria
○ Encourage neovascularisation
Improves lymphatic drainage
What is intussusception?
When part of the intestine slides into an adjacent part of the intestine
Intussusceptum
Inner segment of intussusception
Intussuscipiens
Portion of bowel containing the intussusceptum
Outer segment
What is enterotomy and why would it be used?
Surgical incision into intestines
To reduce intussusception
To remove a foreign body
What suture material is used for enterotomy closure?
Absorbable monofilament
3/0 or 4/0
* Smaller than for gastrotomy
Needs good early tensile strength
Needs to resist absorption >21 days
Atraumatic needle
What suture patterns are used for enterotomy closure?
Simple interrupted
Simple continuous appositional
2-3mm apart and from edge
Finish with omentalising
What should you do after suturing intestines?
Leak test
What is leak testing?
Testing to see if intestinal sutures are suitable before reinserting into abdomen
How do you carry out leak testing?
Clamp off bowel either side of incision
Inject sterile saline into lumen of intestine
Don’t use too much pressure!
What is enterectomy?
Surgical removal of a portion of the intestines
What suture pattern do you use for enterectomy closure?
Anastomose two ends - join as a loop
Use same suture material as enterotomy
Simple interrupted
Simple continuous - quicker and less traumatic
Omentalise
Subtotal Colectomy
Semi-removal of colon
Same closure as enterectomy
Bacterial load is higher so think about antibiotics for anaerobic bacteria
What should you do for post-operative feeding?
Do not withhold food!
This can be detrimental:
○ Villous atrophy
○ Ulceration
○ Breakdown in gut barrier
○ Ileus - lack of contractions of intestines
Cystotomy meaning and reasons for
Surgical incision into bladder
Calculi (urolithiasis)
Biopsy
Tumour
Ureteral ectopia
Where are stay sutures placed for cystotomy?
2 either side
One at pole
3 in total
What suture material would you use for cystotomy closure?
Absorbable monofilament
Smaller than in gastrotomy but same as enterotomy
4/0 or 3/0 in cats
Sometimes also 2/0 in dogs
Atraumatic needle
What suture pattern would you use for cystotomy closure?
One layer
Full thickness
Simple interrupted
Simple continuous
Continuous inverting
E.g. Connell, Cushing, Lembert
Two-layer
Submucosal / mucosa
Seromuscular
