THE ESOPHAGUS AND STOMACH surgery Animals.pptx

GASTROINTESTINAL SYSTEM�THE ESOPHAGUS AND STOMACH
Esophagotomy
Esophagectomy
Gastrotomy
Partial gastrectomy: Resection of a portion of the stomach.
Esophagotomy;Indications: Foreign bodies (usually bones, rarely needles, hooks), Strictures, neoplasia, granulomas, perforations & bolus type foreign bodies.
Esophagectomy;
Indications:Removal of devitalized or diseased segment.
The Stomach;
Gastrotomy: Incision through the stomach wall into the lumen.
Partial gastrectomy: Resection of a portion of the stomach.
Pyloromyotomy: Incision through serosa & muscularis but not through mucosa
Pyloroplasty: Full thickness incision & tissue reorientation
Billroth I: Pylorectomy and gastroduodenostomy
Billroth II: Gastrojejunostomy (partial gastrectomy including pylorectomy)





Pyloromyotomy,
Pyloroplasty,
Billroth I: Pylorectomy and gastroduodenostomy
Billroth II

1. GASTROINTESTINAL SYSTEM THE ESOPHAGUS AND STOMACH Dr.Aman Ullah Zubair [DVM][RVMP]

2. Esophagotomy (1) Esophagus: Musculo -membranous tubular organ. Three portions: cervical, thoracic, abdominal. No serosal covering; segmental blood supply. Arterial Supply: Cervical Part: Esophageal branches of inferior thyroid artery Thoracic Part : Broncho-esophageal artery & branches from thoracic aorta Abdominal Part: Esophageal branches from inferior phrenic & left gastric and variable number of other arteries. Venous Drainage : cervical Part : Inferior thyroid Thoracic Part: Hemi- azygous and azygous (systemic circulation) Abdominal Part: Left gastric (portal circulation)

3. Esophagotomy ( 2 ) Indications: Foreign bodies (usually bones, rarely needles, hooks), Strictures, neoplasia , granulomas , perforations & bolus type foreign bodies. Signs: Vary depending upon type, site and duration. Dysphagia , excessive salivation, regurgitation, leakage of saliva into surrounding tissue. Diagnosis: Radiography, esophagoscopy . Most common sites are Pharyngeal esophagus, thoracic inlet, base of the heart and the esophageal hiatus.

4. Esophageal Foreign Body (a fish hook in a dog)

5. Esophageal Foreign Body

6. Esophagotomy (3) Treatment: 1. Conservative: During endoscopy; catheter (with balloon retraction); Pushing gently into the stomach (small F.B. may pass out or remove through gastrotomy ).

7. Esophagotomy (3) 2. Surgical: (Cervical Part): Midline approach pass a stomach tube or esophageal stethoscope for easy identification Incise and retract the platysma muscle and subcutaneous tissues Separate the paired sternohyoid muscles along the midline to expose the underlying trachea Retract the trachea to the right to expose the adjacent anatomic structures, including the esophagus Exteriorize the esophagus, pack it off, give esophagotomy incision preferably caudal to the obstruction and remove the F.B. (Thoracic Part): Left 4 th intercostal space if at the base of heart Right 8 th or 9 th intercostal space if b/t base of heart & esophageal hiatus.

8. Sternohyoid muscle Esophagus

9. Esophagotomy (4) Closure: One or two layers closure. Two layers closure better. Suture material: PGA ; USP-3/0 or 4/0 S uture Pattern: S.I; Place suture 2mm from incision edge and 2-3mm apart. First layer through mucosa; knots inside the lumen. Second layer through adventitia, muscularis and submucosa ; knots outside. Check closure integrity.

10. Esophagotomy Closure

11. Esophagotomy (5) Complications: Esophagitis Ischemic necrosis Dehiscence Leakage Infection Fistula Esophageal diverticula Stricture formation Mediastinitis , Pleuritis , Pyothorax

12. Esophagectomy Indications: Removal of devitalized or diseased segment Surgical Technique: Stabilize the esophageal segment Resect the diseased portion Apply three equally placed stay sutures at each end to facilitate suturing Anastomotic sutures in four steps (S.I. sutures; PGA 2/0) a. Appose the adventitia & muscularis on far side b. Appose submucosa & mucosa on far side c. Appose submucosa & mucosa on near side d. Appose the adventitia & muscularis on near side

13. Stay Sutures to stabilize the esophagus

14. End to End Anastomosis

15. THE STOMACH Gastrotomy: Incision through the stomach wall into the lumen. Partial gastrectomy: Resection of a portion of the stomach. Pyloromyotomy: Incision through serosa & muscularis but not through mucosa Pyloroplasty: Full thickness incision & tissue reorientation Billroth I: Pylorectomy and gastroduodenostomy Billroth II : Gastrojejunostomy (partial gastrectomy including pylorectomy )

16. Gastrotomy (1) Surgical Anatomy: Cardia , fundus , body, pyloric antrum , pyloric canal & pyloric ostium . 1. Common indication: Foreign Body removal. Surgical Tech: Midline laparotomy from xyphoid to umbilicus; may extend down if needed Isolate the stomach with laparotomy pads Place stay sutures to assist manipulation Incision through hypovascular area on ventrolat aspect b/t greater and lesser curvature; make sure incision is not near the pylorus. Two layer closure; inverting pattern (2/0 PGA preferred) Routine abdominal closure Note: Always better to examine whole intestinal tract to check for any other abnormalities, especially when dealing with foreign body.

17. Gastrotomy (incision & closure)

18. Partial Gastrectomy (1) Indications: Necrosis, ulceration or neoplasia involving the greater curvature or middle portion of the stomach. Surgical Tech: To remove greater curvature, ligate vessels (branches of left gastroepiploic or short gastric brances or both) along section of the stomach to be removed. For lesions else where, ligate the respective vessels supplying the region. Remove necrotic /neoplastic / ulcerated tissue leaving margin of normal, actively bleeding tissue to suture. Close the stomach in two layer inverting pattern (refer to gastrotomy ).

19. Pyloromyotomy (1) Used to increase the diameter of the pylorus in chronic antrum hypertrophy / pyloric stenosis . However, is not used frequently; gastric emptying time may be stimulated with drugs like ‘ Metoclopramide & erythromycin in low doses’. Fredet-Ramstedt Pyloromyotomy: A longitudinal incision on the ventral surface of pylorus through the serosa , muscularis & submucos but not through mucosa. Mocosa bulges into the incision site.

20. Fredet-Ramstedt Pyloromyotomy

21. Pyloroplasty (1) Heineke-Mikulicz Pyloroplasty : Full thickness longitudinal incision, place traction sutures at the center of the incision margins to orient and suture the incision transversely. One layer closure with 2/0 or 3/0 absorbable suture.

22. Heineke-Mikulicz Pyloroplasty

23. Billroth-I Indications: Neoplasia , outflow obstruction dt pyloric muscular hypertrophy, ulceration. Surgical Tech: Stay sutures in the prox duodenum and pyloric antrum . Ligate respective B.Vs. Occlude the stomach & duodenum prox & distal to the area to be resected . Excise the area of pylorus to be removed. Perform one or two layer end to end anastomosis wd S.I crushing, simple cont (2/0 or 3/0 absorbable material).

24. Billroth -I Procedure

25. Billroth-II Indications: If the extent of lesion precludes Billroth -I surg. Surgical Tech: Perform pylorectomy ; Close distal stomach & prox pylorus in a two layer pattern. Incorporate mucosa & submucosa in first layer. Use inverting pattern in 2 nd layer ( seromuscular ) Attach jejunum to diaphragmatic surface of the stomach with side to side anastomosis . Suture one half of the seromuscular layer of antimesenteric border of the intestine to the stomach wall in a simple cont pattern. Make a full thickness, longitudinal incision into the stomach and intestinal lumens near the suture line. Suture the mucosa and submucosa of stomach and intestine and then appose the seromuscular layers. Procedure can also be done as side to end anastomosis

26. Bilroth -II Procedure Side to side anastomosis Side to end anastomosis

27. Billroth - II Procedure