Intestinal and Urinary Surgery

Question 1

What are the layers of Intestine/stomach/bladder wall?

Answer 1

1 - Outer serosa (visceral peritoneum)
2 - Muscularis (circular and longitudinal)
3 - Submucosal
4 - Mucosa

Question 2

Which is the most important layer when suturing the stomach/intestine/bladder wall?

Answer 2

Submucosa

Question 3

Gastrotomy

Answer 3

Surgical incision into the stomach
Commonly used for removal of foreign bodies

Question 4

What are stay sutures and what are they used for?

Answer 4

Temporary surgical sutures which are placed during operation to hold or manipulate the operating area
Used to deteriorate stomach or bladder from peritoneal cavity

Question 5

What suture material is used for gastrotomy closure?

Answer 5

Absorbable monofilament
3/0 cats
3/0 or 2/0 dogs
Atraumatic needle

Question 6

What suture pattern is used for gastrotomy closure?

Answer 6

One layer
○ Full thickness
○ Simple interrupted or simple continuous
○ Continuous inverting e.g., Connell, Cushing, Lembert)
Two layers
○ Submucosal / mucosa (first)
○ Seromuscular (second)

Question 7

What is omentalisation

Answer 7

Draping the omentum over the site of incision

Question 8

What does omentalisation do?

Answer 8

Improves vascular supply to area
Brings inflammatory, immunogenic cells
○ Protect area
○ Remove bacteria
○ Encourage neovascularisation
Improves lymphatic drainage

Question 9

What is intussusception?

Answer 9

When part of the intestine slides into an adjacent part of the intestine

Question 10

Intussusceptum

Answer 10

Inner segment of intussusception

Question 11

Intussuscipiens

Answer 11

Portion of bowel containing the intussusceptum
Outer segment

Question 12

What is enterotomy and why would it be used?

Answer 12

Surgical incision into intestines
To reduce intussusception
To remove a foreign body

Question 13

What suture material is used for enterotomy closure?

Answer 13

Absorbable monofilament
3/0 or 4/0
* Smaller than for gastrotomy
Needs good early tensile strength
Needs to resist absorption >21 days
Atraumatic needle

Question 14

What suture patterns are used for enterotomy closure?

Answer 14

Simple interrupted
Simple continuous appositional
2-3mm apart and from edge
Finish with omentalising

Question 15

What should you do after suturing intestines?

Answer 15

Leak test

Question 16

What is leak testing?

Answer 16

Testing to see if intestinal sutures are suitable before reinserting into abdomen

Question 17

How do you carry out leak testing?

Answer 17

Clamp off bowel either side of incision
Inject sterile saline into lumen of intestine
Don’t use too much pressure!

Question 18

What is enterectomy?

Answer 18

Surgical removal of a portion of the intestines

Question 19

What suture pattern do you use for enterectomy closure?

Answer 19

Anastomose two ends - join as a loop
Use same suture material as enterotomy
Simple interrupted
Simple continuous - quicker and less traumatic
Omentalise

Question 20

Subtotal Colectomy

Answer 20

Semi-removal of colon
Same closure as enterectomy
Bacterial load is higher so think about antibiotics for anaerobic bacteria

Question 21

What should you do for post-operative feeding?

Answer 21

Do not withhold food!
This can be detrimental:
○ Villous atrophy
○ Ulceration
○ Breakdown in gut barrier
○ Ileus - lack of contractions of intestines

Question 22

Cystotomy meaning and reasons for

Answer 22

Surgical incision into bladder
Calculi (urolithiasis)
Biopsy
Tumour
Ureteral ectopia

Question 23

Where are stay sutures placed for cystotomy?

Answer 23

2 either side
One at pole

3 in total

Question 24

What suture material would you use for cystotomy closure?

Answer 24

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

Question 25

What suture pattern would you use for cystotomy closure?

Answer 25

One layer
Full thickness
Simple interrupted
Simple continuous
Continuous inverting
E.g. Connell, Cushing, Lembert
Two-layer
Submucosal / mucosa
Seromuscular