Vet Tips

Surgical Tips-Enterotomy
03/25/2009

The most diagnostic sample of the feline intestine is the full thickness biopsy.

The simple continuous suture pattern using a synthetic absorbable suture material, is safe, fast, easy and cheaper than simple interrupted closure in the abdominal wall.

In abdominal closure in cats, use a 2 layer closure: abdominal wall and skin only (not subcutaneous)

Enterotomy tips:
1. cut and sew tissue that is normal so that it will not leak
2. never make an incision on the oral side of a foreign body
3. make a cut of generous length
4. place sutures 3 mm behind the cut edge and 2 mm apart.
5. Use 3-0 suture in dogs and 4-0 synthetic absorbable in cats
6. Penetrate all layers to engage the collagen in the submucosa
7. Place SC appositional snug, not crushing sutures.
8. Snug=appose edges to create a water/air tight seal without ishemia
9. Snug=edges kiss with a little bit of passion
10. when suturing enterotomies, start and end the suture line off commissure
11. check for leaks visually and fill in with SI sutures where needed
12. Extra SI sutures are needed if not 2 mm apart and 3mm from the cut margin
13. lavage gut with sterile saline and replace
14. change gloves and lavage abdominal cavity with sterile saline
15. close abdominal wall and skin
16. as you check for viability of the gut ask yourself:
Does the gut have areas of necrosis in the oral portion?
How does it look compared with normal aboral intestine?

17. Lavage solutions of choice in the peritoneal cavity is sterile saline without any additives
(Antibiotics would be better in the veins than in the abdominal cavity)
18. Use copious amounts of fluids: the solution to pollution is dilution

Purpose of the omentum is to bring blood supply to the affected area.
Sew omentum to prostatic cysts and abcesses and pancreatic cysts and abcesses

All lymph nodes are encased in peritoneum.
To biopsy a lymph node, incise the peritoneum, filet out the lymph node and suture the peritoneum closed.

The small intestine regains 70% of its unwounded tensile strength in 2 weeks.

The rectus sheath regains 50% of its unwounded tensile strength in 80-90 days.

Submitted by:
Dr. Howard Seim III, DACVS