Ch 92 small intestine Flashcards

Question

Stapled anastomotic techniques include (4):

Answer 1

- everting, triangulating end-to-end anastomosis (EEA) with a thoracoabdominal (TA) 30 stapler; - inverting end-to-end anastomosis with an EEA stapler; - side-to-side (functional end-to-end) anastomosis using the gastrointestinal anastomosis (GIA) stapler. - Skin staplers have been used experimentally in dogs

Answer 2

- easy, requires few staple cartridges, does not compromise the anastomotic lumen, and can be performed rapidly - luminal disparity is not an issue - A TA 55 (3.5-4.8mm) is placed across the intestinal edges - Partially offsetting the GIA staple lines (so they are not on top of one another) before applying the TA stapler could provide greater protection against suture line leakage - anchoring suture is placed at the base (crotch) of the GIA staple line to prevent tension and separation *modification: GIA stapler, rather than the TA stapler, is used to perform the final closure of the enterectomy*

Answer 3

Along the TA staple line, particularly in area where the TA and GIA staple lines overlap Recommondations: Partially offsetting GIA staple lines before applying the TA stapler Omental patch Serosal patch

Answer 4

- decreased surgery time - minimized bowel manipulation - similar luminal diameter, which is not a concern with these GIA-based stapling techniques disadvantages - large size of the GIA instrument, - extra care required when using the GIA devices in distal jejunum-to-ileum anastomosis

Answer 5

- enterotomy: longitudinal incision is made in the antimesenteric border of the bowel immediately aboral to the foreign object. This ensures that the suture line is placed in healthy bowel that has not undergone pressure necrosis or distention biopsy - If longitudinal closure of the defect compromises the lumen, the defect can be closed transversely - stay suture is placed, a full-thickness wedge of tissue is removed - 6-mm skin punch biopsy instrument

Answer 6

- to decrease the recurrence rate of intussusception. - Complete plication of the jejunum and ileum has been recommended by some authors because intussusception tends to recur at sites away from the initial lesion

Answer 7

Obstruction Perforation Strangulation Generalised ileus Septic peritonitis Intrabadominal abscess formation Localised midjejunal volvulus Complications can occur immediately or weeks to months after surgery. One study has shown that the rate of complication with enteroplication was higher than the rate of recurrence of intussusceptions treated without enteroplication

Answer 8

- septic peritonitis (6%) - adhesions - short bowel - ileus

Answer 9

- dehiscence rate 7% to 16% - full-thickness biopsy up to 11% - risk factors: Hypoalbuminemia, hypotension, blood products, long bowel resected, delayed enteral feeding +/- foreign body - preoperative septic peritonitis important risk factor: developed in 38% of dogs with preoperative peritonitis, only 6% of dogs without - signs occur between 2 and 5 days - increase in the band neutrophil count may be more suggestive - centesis: presence of many intracellular or extracellular bacteria, plant material or other foreign fibers, or huge numbers of degenerate neutrophils - peritoneal fluid must be interpreted cautiously and considered in light of the patient's clinical signs, hemodynamic parameters, and blood test results - broad-spectrum intravenous antibiotics, fluids, inotropic and pressor drugs, plasma - site of dehiscence is surgically repaired or resected and supported with a serosal or omental patch - thoroughly lavaged and drained - closed suction drains: 75-86% survival, risk for contamination and nosocomial infection, - open drainage - closed abdomen - Hypoproteinemia and hypoalbuminemia are common complications of drainage

Answer 10

Ultrasonographic appearance of healthy post-op enterotomy and dehiscense can be similar (echogenic effusion and the presence of fluid adjacent to the surgical site, changes in bowel wall layering) Comparison of peritoneal and periphral glucose and lactate is not reliable in post-op abdomens Peritoneal fluid from closed suction drains in nonseptic dogs after laparotomy can have intracellular and extracellular bacteria for up to 1 week post-op nondegenerate neutrophils predominate in peritoneal lavage fluid for at least 3 days after uncomplicated intestinal anastomosis

Answer 11

Approx 50% survive (Reported mortality rates range from 15-85%) Closed suction drains survival 73-85%

Answer 12

- active fibrinolytic system that usually prevents adhesion formation after laparotomy. - occur when disruption of the equilibrium between normal fibrin deposition and fibrinolysis. - Factors disrupt equilibrium: ischemia, hemorrhage, foreign body, and infection - minimize adhesion: atraumatic tissue handling, moistening of tissues, and strict asepsis - intestinal obstruction can be caused by postoperative adhesions - A single irrigation with normal saline just before closure of the laparotomy incision does not reduce adhesion formation

Answer 13

- characterized by malabsorption and malnutrition - due to reduced mucosal surface area, gastric and intestinal hypersecretion, bacterial overgrowth, and decreased intestinal transit time - Persistent watery diarrhea with progressive weight loss treatment - Meals should be small, frequent (six to eight per day), and highly digestible - Fiber (10% to 15% on a dry matter basis) - Animals may require injections of fat-soluble vitamins until diarrhea resolves - antidiarrheal drugs such as loperamide - Bacterial overgrowth can be treated with amoxicillin, tetracycline, metronidazole - may take several weeks to months prognosis - ~50% removed, 80% good outcomes (many still soft and foul-smelling stools) - chronic diarrhea, weight loss, and dehydration > euth - individual | Contrast agent, per os, reaches the colon within 5 to 12 minutes

Answer 14

Resection of 50% of the bowel can result in short bowel syndrome (some have recovered well from 85%…) Proximal resection is better tolerated

Answer 15

- common - caused by overactivity of the sympathetic nervous system - Diffuse intestinal dysmotility during functional or mechanical ileus can result in intestinal dilation, increased intraluminal pressure, and bacterial translocation - exacerbated by opioid - Treatment of ileus includes correction of any underlying disorders - Early postoperative ambulation and feeding - Metoclopramide (1 to 2 mg/kg/d) is a prokinetic drug that increases duodenal and jejunal peristalsis and amplitude and tone of gastric contractions and decreases pyloric sphincter tone and duration of gastric emptying and intestinal transit

Answer 16

- Approximately two-thirds lodge in the small intestines, particularly the jejunum, compared with other digestive tract locations - results in partial or complete intestinal luminal obstruction, tissue necrosis, intestinal perforation - obstruction results in dysmotility; excessive intraluminal fluid; malabsorption of water and solute, fluid, electrolyte, and acid–base disturbances; and proliferation and translocation of luminal bacteria

Answer 17

- up to 50% of cats, the linear foreign body is attached around the base of the tongue - radiographic sign of mechanical obstruction is the presence of multiple loops of gas-dilated small intestine - up to 30% of obstructed dogs do not have radiographic signs - inear foreign bodies, the small bowel appears plicated - Contrast radiography can also be used to provide a definitive diagnosis of intestinal obstruction - Abdominal ultrasonography has greater accuracy, fewer equivocal results, and provide better diagnostic confidence (97%) for identifying small intestinal obstruction compared with radiography (limitations are gas and experience) - lack of significant increase in diagnostic accuracy using follow-up radiographs in cases of occult obstruction, other diagnostic options should be used

Answer 18

Dogs - intestinal diameter to the height of L5 body at narrowest point. Ratios <1.6 are unlikely to be obstructed whereas ratios >2 are highly likely to be obstructed. Sensitivity and specificity of 66% Cats - Comparing the maximal SI diameter to the height of the L2 cranial end plate. Ratios <2 are likely non-onstructive, ratios >3 have a higer liklihood of obstruction

Answer 19

47% This is not considered a good option for dogs as 40% have peritonitis at the time of surgery and their overall prognosis is more guarded with 30% having gross contamination at time of surgery and 40% requiring resection and anastomosis

Answer 20

- bowel healthy, the object is removed through a longitudinal, antimesenteric enterotomy aboral to the obstruction. - bowel wall is necrotic, resected, and an end-to-end anastomosis is performed. - partially obstructive foreign body may pass into the large intestine - linear foreign body can be removed by using a single enterotomy catheter technique (The catheter is then milked aborally through the intestines and out to the anal orifice, carrying the foreign body with it) or through multiple enterotomies - perforations of the mesenteric border of the plicated bowel may not become apparent until the tension on the string is released - areas of questionable viability throughout the entire length of the bowel > second celiotomy can be planned 24 hours later (rather than short bowel risk)

Answer 21

- Mortality rates of 1% to 8% are reported following surgical treatment, with financial concerns and sepsis commonly cited as factors contributing to euthanasia and death - linear FB in dogs more guaraded > more often have intestinal perforations, and more than 40% require intestinal resection and anastomosis - Intestinal perforations, which are uncommon in cats, are more likely to be associated with death after surgery

Answer 22

- Entrapment usually occurs within traumatic body wall hernias; however, entrapments in omental tears, congenital hernias, or mesenteric rents - intestinal lumen may become constricted> incarceration can rapidly progress to strangulation with subsequent intestinal ischemia and septic or endotoxic shock (bacterial translocation) - Surgery should not be delayed if strangulation or necrosis is suspected. If herniated intestines are necrotic, resection and anastomosis may be necessary

Answer 23

Ineffective aboral intestinal propulsion, resulting in clinical and radiographic signs of obstruction in the absence of an occluding lesion Prognosis is grave with euthanaisa usually opted for due to chronicity and recurrence of signs despite attempted treatment (Usually non-responsive to medical management for ileus, if focal resection and anastomosis may be temporarily palliative, antibiotics may help with bacterial overgrowth)

Answer 24

- Affected animals are often younger than 1 year of age - cylindrical mass in the cranial to midabdomen is often palpable. - ultrasonography an intussusception appears as a series of concentric rings in the transverse image or parallel lines in a longitudinal image - surgical reduction or resection is usually required - multiple intussusceptions can occur simultaneously - Enteroplication, particularly if generalized enteritis is present (contraversial) - Spontaneous reduction of intestinal intussusception has been reported in young dogs - should be tested and treated for endoparasites - Intussusceptions often reoccur at a site proximal to the initial

Answer 25

Parasites Virus Linear FB Caecal inversion Previous abdominal Sx Post-parturient queen Intestinal neplasia

Answer 26

6-27% Can occur within 3d or up to 3wk post-op Laparoscopic assisted - successful in 26/27 dog with average time of 2.5-4.0 minutes. Perforation occured in 1 dog and recurrence in another

Answer 27

- rare and often fatal condition in which the bowel twists on its mesenteric axis, resulting in strangulating mechanical obstruction and ischemia of the small intestines - cause of mesenteric volvulus is unknown; enteritis,carcinoma, foreign bodies, surgery, blunt trauma, GDV - peracute to acute, with rapidly progressive abdominal distention and hematochezia - ddx GDV - The uniform and extensive nature of the small intestine distention and normal position of the stomach differentiate to FB - Unfortunately, by the time the diagnosis, most of the intestinal tract is ischemic and necrotic, and the animals often die or must be euthanized - reperfusion injury with derotation - duodenoileal anastomosis was performed without derotation - If the torsion is segmental, resection and anastomosis can have a good prognosis.

Answer 28

GSD English Pointers Ischaemic necrosis of distal duodenum, jejunum, ileum, caecum, ascending colon, and proximal descending colon

Answer 29

- bite wounds, gunshot injuries, and motor vehicle impact. - mesentery of a segment of jejunum can become avulsed at the mesenteric border of the small intestine - may lead to development of septic peritonitis - Blunt probing of the wound can also be inaccurate; the sensitivity for diagnosis of peritoneal penetration was only 60% in one study - abdominocentesis may help ID perforation

Answer 30

Adenocarcinoma Lymphoma (most common in cats 55%) - solitary or part of multicentric dz Mesenchymal tumours (GIST, GIST-like, leiomyoma, leiomyosarcoma) Non-neoplastic inflammatory lesions can mimic neoplasia including haematomas, abscess, progranuloma and sclerosis

Answer 31

- Ultrasonography is a sensitive diagnostic test for identifying mass lesions and other neoplastic changes - acilitates evaluation of regional lymph nodes and other abdominal organs - Cytology can help differentiate between tumor types - Thoracic radiographs should be performed in all dogs and cats with intestinal tumor - En bloc resection is performed to include the affected bowel, at least 3 cm of grossly normal bowel in each direction, and a similar margin of mesentery - Small intestine resection and anastomosis has been successfully performed in cats with alimentary lymphoma and is associated with good short-term outcomes > long term outcome beneft is less known, unsure if has place in tx - Adjuvant chemotherapy is often recommended following resection of solid neoplastic intestinal masses; however, few studies of any kind exist to support benefit prognosis - carcinomas, lymph node metastasis is associated with poorer prognosis, - Dogs with completely excised intestinal smooth muscle tumors can experience long-term tumor control, with up to 67% experiencing 2 years

Answer 32

Cats - Small cell lymphoma has a better prognosis than large cell but response to treatment is the most importatn prognostic factor. Small cell lymphoma MST 22-25m Large cell lymphoma MST 5-7m Dogs have a poor prognosis with GI lymphoma with survival times days - weeks regardless of treatment. MST 14d

Answer 33

Nodular, proliferative, eosinophilic inflammatroy lesion associated with GIT and alimentary lymph nodes Intralesional bacteria are identified in up to 70% of cases, and most cats also have a peripheral eosinophilia Persians and Siamese Most commonly gastroduodenal and ileocolic regions Surgical excision and prednisolone therapy | histo: eosinophilic inflammation,reactive fibroblasts, dense collagen

Answer 34

Hypereosinophilia (T-cell lymphoma) Hypoglycaemia and nephrogenic DI (dogs with smooth muscle tumours)

Answer 35

- intestinal diverticula and duplication

Answer 36

Ex vivo, feline cadavers leak pressure of hand-sewn and skin staple HSA took twice as long as SSA with no difference in intraluminal pressures. HSE had higher intraluminal pressures. stapled anastomosis may be an alternative to hand sewn but not recommended intestinal enterotomy closure. SSE > leakage in over one-third of constructs was very concerning for use in live cats. Some degree of mucosal eversion is reported with both SSA and HSA > likely more with staples eversion > mucosal ischemia and necrosis > delayed secondary healing > lower bursting strengths during the healing lag phase and increased risks for leakage STUDY: Clinical significance: Cadaveric canine and feline intestinal specimens tested immediately after collection or after chilling for 24 hours should be recommended STUDY: staples used successfully clinically in cats

Answer 37

leak pressure of five intestinal anastomosis techniques in cats (1) hand-sewn anastomosis – simple interrupted (HSA-SI), (2) hand-sewn anastomosis – simple continuous (HSA-SC), (3) functional end-to-end stapled anastomosis (FEESA), (4) functional end-to-end stapled anastomosis with oversew (FEESA-O), (5) skin stapled anastomosis (SS). there was no difference in Initial Leak P or Max Intralumunial P All anastomosis techniques provide resistance to leakage that is supraphysiological HSA take longer to complete than stapled anastomoses transverse staple line in FEESA constructs > no statistical difference was found in increase leaking in this study select green TA staples green (2.0 mm closed staple height) for use in the duodenum, jejunum, and ileum blue TA staple cartridges (1.5-mm closed staple height) for use on the feline stomach. purple/black GIA cartridge selection size distinction of 2.25 mm

Answer 38

Conclusion: Reinforcement of a sutured enterotomy closure with cyanoacrylate was easy to perform and resulted in significantly increased initial leak pressures in cadaveric jejunum. synthetic sealants may have the potential to decrease postoperative intestinal leakage or dehiscence

Answer 39

Retrospective. FGESF 60 cats Ragdolls (25%) Eosinophilia was present in 50% and hypoalbuminemia in 28% of cats. The mass was removed surgically in 37% of cases. Most cats (98%) were treated with corticosteroids. Survival was not statistically different between cats treated with surgical resection and cats treated with medical therapy alone, 88% of the cats were still alive at the time of writing follow surgery with corticosteroid therapy > 85% recurrence of clinical signs.

Answer 40

A submucosal vascular network was evident in all the casts, with a prominent venous plexus seen exclusively in the first half inch of the duodenum. In clinical cases, on endoscopic examination, the duodenal ulcer was located at the proximal part of the duodenum, involving the mesenteric portion of the wall. The dogs not responding to medical treatment (6/12) were treated with endoscopic electrocauterisation, surgical coagulation or resection

Answer 41

370 PWDs (82 with and 288 without PLG). Prophylactic gastropexy may be associated with an increased risk for MV. However, patients without prophylactic gastropexy are at risk for gastric dilatation and volvulus, which is more common than MV. Therefore, the authors continue to recommend prophylactic gastropexy to decrease the risk for gastric dilatation and volvulus.

Answer 42

3 dogs and 17 cats There were no complications associated with the needle-core biopsy. The diagnoses resulting from both techniques were 100% concordant for the distinction between inflammatory bowel disease and intestinal lymphoma

Answer 43

20 constructs were created through repair of large, open duodenal defects with circumferential suturing of an intact jejunal segment (jejunal serosal patch). Constructs were randomly assigned to have the serosal patch anastomosed to the duodenal segment by a simple continuous or simple interrupted suture pattern. Jejunal serosal patches adequately sealed large, open duodenal defects and prevented leakage in these constructs. Constructs with simple continuous or simple interrupted suture patterns withstood physiologic and supraphysiologic intraluminal pressures, although constructs with a simple interrupted suture pattern initially leaked at higher pressures cautioned before in vivo testing has been demonstrated to yield successful outcomes.

Answer 44

A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB. No cats developed postoperative septic peritonitis, and all cats survived. The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%. Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs (43%)

Answer 45

20 dogs and 15 cats that underwent ICJ resection Ten of 20 dogs (50%) and 11/15 cats (73%) were reported by their owners to have a good long-term outcome based on the lack of long-term gastrointestinal sign CLINICAL RELEVANCE Owners should be informed of the possibility of long-term gastrointestinal clinical signs and the potential need for long-term nutritional management after ICJ resection.

Answer 46

effect of foreign body obstruction and enterectomy technique on GIT microvasculature. 24 FB 30 control Sidestream dark field videomicroscopy can identify obstructed intestine and quantitate the severity of microvascular compromise. Handsewn and stapled enterectomies equally preserve perfusion. increased morbidity associated with foreign body obstructions may be primarily attributed to the surgeon’s inaccurate subjective assessment of intestinal viability.

Answer 47

unidirectional barbed sutures in GIT dogs and cats: retrospective 26 None developed leakage, dehiscence, or septic peritonitis 2 dog > intestinal obstruction > strictures (11%) Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary

Answer 48

In this population, the rate of dehiscence of GI incisions in cats was exceedingly low (0.8%) but not absent. Likewise, patient mortality was higher than expected at 18.2%. PSP was associated with decreased patient survival, 23 died, nine died spontaneously and 14 were euthanized. Date of death ranged from the day of surgery to 9 days (median 3) postoperatively. Eighteen cats died while hospitalized and five died following hospital discharge

Answer 49

randomized, experimental. Sample population: Chilled jejunal segments from 3 adult dogs (1) no crotch suture (NCS); (2) simple interrupted crotch suture (SICS); (3) two simple interrupted crotch sutures (TCS) placed laterally on opposing jejunal limbs; (4) simple continuous crotch suture (SCCS) augmentation. Augmenting the FEESA with crotch suture(s) improved the resistance of the jejunal anastomosis to leakage in normal cadaveric segments. Placing 2 crotch sutures or use of a simple continuous pattern for anastomotic augmentation appeared to be superior to the placement of a single suture.

Answer 50

Nineteen out of twenty-four (79.2%) samples had at least one probe drop, and four out of twenty-three (17.4%) samples leaked intraoperatively. PT did not identify the IG quadrant in 3/16 (20%) samples, which means this method also missed some 4 mm gaps. PT was highly sensitive at detecting gaps compared with LT The diagnostic value of PT appears adequate to recognize gaps in cadaveric small intestinal anastomoses. PT offers surgeons an alternative to detect suture gaps | probing with fine mosquito hemostat

Answer 51

131 cases. Sewn or stapled. Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence (9% overall dehiscence rate) intraoperative anastomotic leak testing > greatest clinical usefulness for novice surgeons in helping eliminate poor surgical technique Mullen retrospective 144 anastomoses: no significant difference in dehiscence rate in tested versus untested segments or those tested positive versus negative

Answer 52

enterotomy closures leak at lower pressure (ILP 68.5mmHg) with air injection - max intraluminal pressure 78.3mmHg - air insufflation may be more sensitive and easier to identify (bubbles in saline filled abdo) is leaking through the suture tract significant? Cannot correct this by placing additional sutures..

Answer 53

Dehiscence rates were 3.8% (7/183) and 18.2% (8/44) for enterotomy and IRA, respectively Patients undergoing IRA were at a significantly higher risk of intestinal dehiscence, compared with patients undergoing enterotomy

Answer 54

ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage

Answer 55

median age 10m, ileocolic most common (43%), most no identifiable cause (67%) - 29/153 (19%) surgical procedure within 30 days of intussusception - resection anastomosis in 84%; enteroplication in 18% - intra-op complications: 7% - 7/7 intestinal damage during reduction - post-op complications: 35%, 14% life-threatening - 2.6% recurrence (4/4 within 72 hour post-op) – 2/4 had partial enteroplication - 14 day mortality rate 6% According to two reports of previous retro spective studies, EP did not influence recurrence rates. EP dd not result in any complication other than recurrence

Answer 56

Experiemental. Influence of oversewing the transverse staple line during functional EEA FEESA alone, FEESA + Cushing oversew, or FEESA +simple-continuous oversew of the transverse staple line with 3-0 polydioxanone. results support oversewing the transverse staple line after FEESA. Doing so may reduce the occurrence of postoperative dehiscence > need prospective study. advantages of FEESA: - decreased surgical time, - preservation of intestinal blood supply, - reduced soft tissue handling and manipulation of the bowel, - ability to deal with luminal disparity, - higher wound tensile strength during the late inflammatory phases - decreased inflammation and necrosis.2-7 Sumner 2019 Study design: Retrospective observational study. Sample population: Seventy-seven client-owned dogs that underwent 78 FEESA reinforced (n = 30) or not reinforced (n = 48) with suture at the transverse staple line. Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence.

Answer 57

40 cats. gastrointestinal lymphoma masses treated with surgical * 36/40 (90%) survival to discharge * MST 185d * large intestinal mass (colon)→ longer survival * complete excision → longer survival (MST 370d vs 83) * adjuvant therapy → no improvement in survival Most cats in this population survived the perioperative period, with MST similar to those reported historically with medical management. cats with feline GI large-cell LSA is less predictable, with overall response rates to chemo ranging from 30% to 75%

Answer 58

22-G needle reduced frequency of leakage after leak testing - 20mL injection → higher frequency of leakage - smaller syringe size with 22G needle may lower frequency of leakage from injection site - influence on leak testing unknown

Answer 59

8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge. Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge.

Answer 60

- overall MST 544d; 1y survival 60%, 2y survival 36% - px factors for survival: age only - <8y → MST 1193d vs >8y (488d - survival not associated with LN metastasis, adjuvant chemotherapy, NSAID administration or any other variables

Answer 61

dehiscence: overall 11.4%, pre-op septic peritonitis 21.1%, no septic peritonitis 6.6% - indication for anastomosis not associated with dehiscence - risk factors: septic peritonitis and hand-sewn anastomosis - stapled anastomosis less likely to dehiscence with septic peritonitis (9.7% vs 28.9%)

Answer 62

Retrospective study. Animals: Client-owned cats (n = 169). RRCT was successful in 20/24 attempts of LFBO removal Postoperatively, two cats (DFBO) experienced intestinal dehiscence and two cats (DFBO) died or were euthanized. Survival to discharge (p = 1.0000) and postoperative complications (p = .1386) did not differ between LFBOs and DFBOs Cats with LFBOs and DFBOs have similar postoperative complication rates and survival to discharge when preoperative septic peritonitis is not present. Intestinal dehiscence is rare, which is important when discussing surgical prognosis with owners. A RRCT can be considered to remove LFBOs when there is concern for multiple enterotomies.

Answer 63

Retrospective observational study. Sample population: Dogs and cats (n = 81) with gastrointestinal FBs In 5/40 cases conversion required Laparotomy-assisted endoscopic removal allowed complete or partial removal of FBs in 35/40 dogs The presence of intestinal wall damage (p = .043) was associated with the conversion to an enterotomy. Group 1 required a shorter postoperative hospital stay (p = .006), less need for analgesia (p < .001), and experienced a faster resumption of spontaneous feeding (p = .012), and similar complication rate to Group 2. Subgroup B included 17 cases (17/40), and at least one enterotomy was required the procedure started with a celiotomy in order to assess the possibility of moving the FB into the stomach; if possible, then this was followed by endoscopic removal.

Answer 64

FEEA with endovascular GA staplers in 25 cats and small dogs 5 minor postoperative complications, including 3 SSI. No major postoperative complications were reported. Normal small intestinal diameter in cats < 12 mm. Endovascular GIA staplers are smaller devices (45-to 60-mm) compared to standard GIA staplers. 60-mm > lead to an excessively long anastomotic site > accumulation of intestinal content Fifteen > open lumen technique, whereas 10 > one-stage technique

Answer 65

Stapled compared with sutured enterectomy: retrospective 54 cats significant difference in surgical time. Stapled 34.3 ± 9.274 mins faster Unique complications reported for the SFEEA > haemo abdomen and anastomotic stricture. (93%) survived to discharge overall complication rate 19.2%, with a complication rate after EEA of 14.3% and after SFEEA of 29.2%. dehiscence: SFEEA was 4.2%, no cats dehisced after suture Fixed staple heights > may fail to incorporate the submucosa and this can result in iatrogenic damage due to compression and local ischaemia, If the staple height is too large, the staple may not form a leakproof seal or close vessels, leading to bleeding

Ch 92 small intestine Flashcards

(93 cards)