Intestine: resection and anastomosis

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Introduction

  • Resection/anastomosis, intestinal decompression    and enterotomy    are the most common techniques used in the surgical treatment of bowel disease.
  • The stomach, small intestine, cecum and colon of the horse differ in size, shape and digestive function, but in intestinal wall structure and blood supply they follow a similar basic design.
  • Accordingly the principles for intestinal resection and anastomosis are similar for all segments of the intestinal tract.

Uses

  • End-to-end anastomosis:
    • When bowel segments of equal diameters are being united, eg jejunum    , small colon or small segments of the left dorsal or ventral colon.
  • Side-to-side anastomosis:
    • Used to unite bowel segments with unequal diameters or adjacent segments of the large colon that cannot be positioned end-to-end due to short mesocolon.
    • Commonly used in jejunocecostomy    , ileocecostomy, gastrojejunostomy and colostomy  [Colon: resection]  .
    • Some surgeons prefer side-to-side techniques for jejunal anastomosis  [Jejunum: jejunojejunostomy]  .
  • End-to-side anastomosis:

Advantages

  • Allows complete removal of a section of diseased bowel.
  • Similar technique may be used for various diseases, eg strangulation/necrosis, intussusception or neoplasia.
  • Re-establishes functional bowel.

Disadvantages

  • Excessive resection may   →   malabsorption or other gastrointestinal disturbances.
  • Anastomosis may   →   smaller gut lumen   →   site predisposed to obstruction.

Requirements

Materials required

Minimum equipment

  • Laparotomy surgical kit.

Ideal equipment

Intestinal stapling instruments
  • Wide acceptance in human and veterinary surgery.
  • Generally quicker than hand suturing and reduce surgical contamination, especially when accessibility is restricted.
  • Disposable, human staplers can be expensive.
  • 2 basic types:
    • Thoracic abdominal stapler.
    • Gastrointestinal stapler.
  • Thoracic abdominal stapler (TA30, TA60, TA90):
    • Forms a double row of staples 90 mm long.
    • Used to close stumps of bowel, eg ileum/large colon, or perform ovariectomies  [Ovary: ovariectomy - laparotomy approach]  .
    • Particularly useful where surgical exposure is poor.
    • The thickness of the bowel MUST NOT exceed the limits of the instrument which is designed for human surgery.
    • Scalpel blade transection is required after the stapler is fired.
  • Gastrointestinal stapler (GIA 75, 90, 110):
    • Produces 2 double rows of staples of varying lengths.
    • Automatically divides the tissues between the double rows with a sliding knife.
    • Often used to create side-to-side anastomoses of jejunocecostomy    , ileocecostomy, jejunojejunostomy    and cecocolostomy/colocolostomy  [Colon: resection]  .
    • Two overlapping firings are required with the smaller length instruments to produce an adequate stoma.
    • Single firings of the newer longer instruments is adequate.
    • Multiple firings are necessary for large bowel techniques.

Minimum consumables

Preparation

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