- 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.
- 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:
- Has been used for jejunocecostomy .
- 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.
- Excessive resection may → malabsorption or other gastrointestinal disturbances.
- Anastomosis may → smaller gut lumen → site predisposed to obstruction.
- Laparotomy surgical kit.
Ideal equipmentIntestinal 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.
- Suture materials .
- Fluids for lavage .