Surgery Overview

GENERAL INFORMATION
 

• Dehydration and hypokalemia should be identified and treated prior to surgery.
• Place stay sutures to assist with retraction and manipulation of the stomach. This will also help minimize contamination of the surgery site.
• The gastric incision should be made away from the pylorus and large gastric vessels, in a hypovascular area on the ventral gastric surface, midway between the greater and lesser curvature.
• The color of the mucosa is not a good predictor of gastric tissue viability.
• Before closing the abdominal incision, change contaminated gloves and instruments.
• Avoid chromic gut for all gastric surgeries.
  

MOST COMMON COMPLICATIONS AND DIFFICULTY
 

• Abdominal incision is too short or too caudal and does not allow proper exposure of the stomach.
• Spillage into the abdominal cavity due to poor packing off of the surrounding organs increases the risk of post surgical infection.
• Dehiscence and leakage may occur if improper technique is used.
• Be careful to suture well-vascularized tissues and consider using a serosal patch if delayed healing is expected.

"EXPERTS' ADVICE"
 

• If there is no vomiting, begin feeding the day after surgery. If the patient has been without food for several days, this is a good time to place a jejunostomy feeding tube.
• Use ample stay sutures of sufficient length to drape over the abdominal retractor to allow adequate exposure, and use an abdominal retractor!
• Gastric ulcers may not always be evident from the serosal surface.
• Use an endoscope during surgery to help locate ulcers that are difficult to find. Ulcers located at the pyloric outflow tract may best be treated with a serosal patch rather than resection to avoid damaging the common bile duct.

Double layer closure pattern is now the closure pattern of choice. The first layer should consist of an inverting Cushing or Connell pattern which inverts the submucosal and mucosal layers. The second layer should consist of a simple continous or Lembert pattern which engages the seromuscular layer. Lavage carefully between the two closure layers to prevent trapping contamination within the gastric wall. Failure to lavage could result in abscess formation at the gastrotomy site.