Staplers Flashcards
5 main kinds of staplers we use:
1. 2. 3. 4. 5.
- GIA = gastro-intestinal-anastomosis
aka Intra Luminal Anastomosis (ILA) - TA = Thoracoabdominal
- LDS = Ligating-Dividing-Stapler
- EEA = End-End-Anastamosis
- Skin Stapler
T/F: You can autoclave staplers
F, you can’t. Use gas sterilizer if you can.
Average number of times you can re-use staplers?
12 times.
Advantages of stainless steel stapler?
they can be autoclaved for re-use.
T/F: There are no staplers made specifically for large animals.
T. We can use TA 90s if we need to.
GIA Staplers require there are a minimum of how many staple lines?
2
TA 90: what does the 90 mean in the name?
The staple line is 90 mm (9 cm). It’s the largest one available
T/F: There is no cutting action when using the TA 90
True, just crushing. Run a scalpel blade close to the edge of the crushed tissue by hand.
LDS comes in handy because it can perform _______ during what kind of procedure?
isolate blood vessels bowel resections (where you can see the BVs very easy.
Staples in the LDS: purpose behind mechanism?
LDS ligates/crushes the lumen of vessels
Identifying characteristic of EEA stapler?
Large wingnut at the end.
What shape staple line does an EEA stapler make?
Diameter of staple line?
How many rows of staple lines?
circular
21.2 mm
two
What is a “good night stitch”?
What is the consequence of not putting one in?
A stay suture placed via GIA stapler during a bowel anastamosis
The staple line can open up like a zipper
Functional End-To-End Anastamosis of bowel requires using what two staplers?
GIA and TA90
Jejunocecostomy is what type of anastamosis?
End-to-Side or Side-to-side
What stapler can you use for jejunocecostomy?
GIA,
What stapler is most often used for resection of the colon in a horse?
TA 90. You’ll need multiple cartridges
What stapler is most often used for creation of a pelvic flexure after colon resection in a horse?
GIA
Cecocolon anastamosis - Describe the procedure?
make an additional opening between cecum and the large colon using GIA with stab incision, helps the cecum empty easier to avoid impaction.
Equine-cecal resection is usually performed when?
When the tip of the cecum goes inside the cecum like an inverting sock, and the cecum starts to auto-digest itself.
What stapler is used for equine-cecal resection?
TA90. Staple that part of the cecum off.
Broad Causes of Left Displaced Abomasum:
- Abomasal ____
- decreased ______
- _____
- Abomasum changes in ___, ___, ____
- time periods?
- Atony
- decreased rumen volume
- calving
- dimensions, position, volume
- last 3 months of gestation, first 3 months of lactation
4 common causes of abomasal atony that can lead to LDA:
- increased abomasal VFA
- Hypocalcemia
- metritis
- mastitis
Mean incidence of LDA in herds?
1-5%, but may exceed 15% in some herds.
Clinical symptoms of LDA:
- refuse ____
- Temp? Defecation?
- ____ in left flank
- refuse grain
- normal temp, still passing feces
- tympany
4 surgical procedures used to correct LDA:
1.
2.
3.
4.
- Right flank omentopexy
- Left flank abomasopex
- Right paramedian abomasopexy
- closed suture or bar techniques
In right paramedian abomasopexy, the animal is in ____ recumbancy.
Sedation (is/is not) required?
dorsal
Is! Heavily sedated!
Nerve block options for right flank omentopexy:
1.
2.
3.
4.
- Proximal paravertebral block (T13-L2)
- Distal paravertebral block (T12-L2)
- Inverted L block
- Line block
Right flank omentopexy:
Initial incision into ____, located between the ____ and ____.
paralumbar fossa between last rib and tubor coxae
3 muscle layers you cut through in right flank omentopexy:
internal, external and transverse abdominal oblique muscles.
Abomasum is supposed to be where, relative to the rumen?
ventral to the rumen.
Why do you insert a large cannulated needle first into an incision site for a right flank omentopexy?
to relieve the gas bubble that has accumulated (it pulls the abomasum more and more dorsally between rumen and bodywall and we need to get rid of that gas)
Which of these procedures is performed “blind”?
Right flank omentopexy
or
Left flank celiotomy
right flank omentopexy
Use what instruements to keep the abomasum in the incision site for a right flank omentopexy?
grasping forceps
1st part of suturing for right flank omentopexy:
- Place (small/large) sutures though the ____, than through the _____.
- Suture pattern used?
- Immediately after finishing the first suture, you should do what?
- large
body wall, then the portion of omentum (sows ear) and out. - Horizontal mattress
- do it again in reverse order on the other side.
2nd part of suturing for right flank omentopexy:
- continue the pattern into the ____.
- In a standing cow, you should start suturing (ventrally/dorsally). Why?
- on the peritoneum
2. ventrally. You want to avoid some of the other bowel spilling out.
Other structures to palpate from a right flank celiotomy
- 2.
3.
- Liver
- Left and right kidneys
- Urinary bladder
What equipment should you have prepared specifically for a left flank abomasopexy?
2 straight intestinal needles with 3 feet of suture in-between
What suture pattern should you perform on the abomasum in a left flank abomasopexy?
simple continuous
After suturing at the greater curvature, what broad area do you take the needle to in a left flank abomasopexy?
right paramedian area
Peforming left flank abomasopexy when in the right paramedian area:
- Push needle through ______
- Make sure you don’t hit the _____
- Direct assistant to do what?
- abdominal wall
- milk vein
- push with second needle at the same time as you, but 6 inches caudally.
Describe the incision for a right paramedian abomasopexy
- length?
- location?
- 20 cm long incision
between midline and right SQ abdominal vein. Incision started 8 cm behind the xiphoid
T/F: You will likely have to search around for abomasum after making the initial incision in a right paramedian abomasopexy.
F: it will probably be right under your incision b/c it is full of gas
In a right paramedian abomasopexy, the (medial/lateral) aspect of the ______ of the abomasum is sutured to the _____
lateral
greater curvature
peritoneum
Suture technique for right paramedian abomasopexy?
3 mattress sutures (along the greater curvature) already in place through entire body wall
What method of LDA correction involved “Shaking” to properly replace the abomasum?
Closed Suture or Bar Technique
With the closed suture or bar technique, the ping should be where if you have properly replaced the abomasum?
in the right paramedian area
Right sided “ping” indicates….
right displaced abomasum
RDA simple displacement can be treated ______ or ______
medically (via Ca2+/dextrose, or exercise) or surgically
In a right sided abomasal displacement, the ping foes from _____ to ____
paralumbar fossa to rib 8
