Gastrointestinal Surgical Techniques in Small Animals. Группа авторов
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1 Bellenger, C. (1982). Comparison of inverting and appositional methods of anastomosis of the small intestines in cats. Vet. Rec. 110: 265–268.
2 Chassin, J.L., Rifkind, K.M., and Tumer, J.W. (1984). Errors and pitfalls in stapling gastrointestinal tract anastomoses. Surg. Clin. North Am. 64: 441–459.
3 Chung, R.S. (1987). Blood flow in colonic anastomoses. Effect of stapling and suturing. Ann. Surg. 206: 335–339.
4 Davis, D.D., Demianiuk, R.M., Musser, J. et al. (2018). Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs. A retrospective review of 210 anastomoses. Vet. Surg. 47: 125–129.
5 Ellison, G. (1989). Healing in the gastrointestinal tract. Semin. Vet. Med. Surg. (Small Anim.) 4: 287–293.
6 Getzen, L.C., Roe, R.D., and Holloway, C.K. (1966). Comparative study of intestinal anastomotic healing in inverted and everted closures. Surg. Gynecol. Obstet. 123: 1219–1227.
7 Goligher, J.C., Lee, P.W., Simpkins, K.C. et al. (1977). A controlled comparison of one‐ and two‐layer techniques of suture for high and low colorectal anastomoses. Br. J. Surg. 64: 609–614.
8 Graham, M.F., Diegelmann, R.F., Elson, C.O. et al. (1988). Collagen content and types in the intestinal strictures of Crohn's disease. Gastroenterology 94: 257–264.
9 Halstead, W.S. (1887). Circular suture of the intestine. An experimental study. Am. J. Med. Sci. 94: 436–461.
10 Hamilton, J.E. (1967). Reappraisal of open intestinal anastomoses. Ann. Surg. 165: 917–924.
11 Hogstrom, H., Haglund, U., and Zederfeldt, B. (1990). Tension leads to increased neutrophil accumulation and decreased laparotomy wound strength. Surgery 107: 215–219.
12 Hunt, T.K., Cederfeldt, B., and Goldstick, T.K. (1969). Oxygen and healing [review]. Am. J. Surg. 118: 521–525.
13 Jansen, A., Becker, A.E., Brummelkamp, W.H. et al. (1981). The importance of apposition of the submucosal intestinal layers for primary wound healing of intestinal anastomoses. Surg. Gynecol. Obstet. 152: 51–58.
14 Kieves N., Thompson D.A. and Krebs A.I. (2014). Comparison of ex vivo leak pressures for single‐layer enterotomy closure between novice and trained participants in a canine model. Scientific Presentation Abstracts: 2014 ACVS Surgery Summit October 16–18, San Diego, CA.
15 McAdams, A.J., Meikle, A.G., and Taylor, J.O. (1970). One layer or two layer colonic anastomoses? Am. J. Surg. 120: 546–550.
16 Moy, R.L., Waldman, B., and Hein, D.W. (1992). A review of sutures and suturing techniques. J. Dermatol. Surg. Oncol. 18: 785–795.
17 Orr, N.W.M. (1969). A single‐layer intestinal anastomosis. Br. J. Surg. 56: 771–774.
18 Sajid, M.S., Siddiqui, M.R.S., and Baig, M.K. (2012). Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database Syst. Rev. 18 (1): CD005477. https://doi.org/10.1002/14651858.CD005477.
19 Snowden, K.A., Smeak, D.D., and Chiang, S. (2016). Risk factors for dehiscence of stapled functional end‐to‐end intestinal anastomoses in dogs: 53 cases (2001–2012). Vet. Surg. 45: 91–99.
20 Thornton, F.J. and Barbul, A. (1997). Healing in the gastrointestinal tract. Surg. Clin. N. Am. 77: 549–573.
21 Udenfriend, S. (1966). Formation of hydroxyproline in collagen [review]. Science 152: 1335–1340.
22 Weisman, D.L., Smeak, D.D., Birchard, S.J. et al. (1999). Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991–1997). J. Am. Vet. Med. Assoc. 214: 1507–1510.
4 Feeding Tubes
Eric Monnet
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
Enteral feeding is an important component of the treatment of critically ill patients, and for the support of patients with anorexia related to chronic conditions. Different type of feeding tubes are available to the surgeons to support the patients according to their need and underlying conditions (Armstrong et al. 1990a; Abood and Buffington 1992; Marks 1998).
Each of those feeding tubes has its advantages and disadvantages. The choice of feeding tube is based on the underlying disease, the goal of the enteral nutrition, and the length of time the tube will be needed. Combination of tubes is also possible. It is not rare to combine a gastrostomy tube with a jejunostomy tube to support a patient in the short term and the long term. The jejunostomy tube will be used in the short term to support the patient in the recovery phase of the surgery, especially if the patient is vomiting, while the gastrostomy tube will be used in the long term to support the patient if still anorexic.
Enteral feeding is also very important to support the integrity of the gastrointestinal tract. The enterocytes are getting their nutrient directly from the metabolite present in the lumen of the gastrointestinal tract.
4.1 Nasoesophageal and Nasogastric Tubes
Nasogastric or nasoesophageal feeding tubes can be used in dogs and cats. Since the tubes are of a small diameter they can be advanced in the stomach without increasing the risk of gastric reflux and esophagitis (Crowe 1986; Armstrong et al. 1990a; Abood and Buffington 1991; Yu et al. 2013; Herring 2016).
4.1.1 Indications
Nasoesophageal and nasogastric tubes are mostly used for the short‐term support of a patient. It is an interesting tube for a patient that may not tolerate general anesthesia since it can be placed with only local anesthesia.
It can be used to feed a patient with a liquid diet since the tubes are of a small diameter. This tube is more efficient for small dogs and cats than for large‐breed dogs, since only liquid can be used.
It can also be used to keep the stomach decompressed or empty to prevent gastroesophageal reflux, regurgitation, and/or vomiting (Crowe 1986).
Nasoesophageal tubes are contraindicated if the patient has esophageal motility disorders. Nasogastric tubes are contraindicated for patients with esophageal strictures.
Feeding with these tubes should not be attempted if the patient is vomiting or lateral recumbent because it will increase the risk of aspiration pneumonia. However, a nasogastric tube can still be used to keep the stomach decompressed as mentioned above.
4.1.2 Materials and Equipment
Feeding tube of small diameter is required. Size 5 or 6 Fr is commonly used in dogs and cats. Polyurethane or silicone tubes are used. The tube needs to be long enough to reach the stomach. Weighted tubes can be used to facilitate their migration in the stomach (Figure 4.1). Because of the size of the tube only liquid diet can be used.
Local anesthetic mixed with a lubricant is needed to facilitate the placement of the tube. Usually 1 ml of 0.5% bupivacaine can be mixed with 1 ml of water‐soluble lubricant.
General anesthesia is not required to place a nasoesophageal or nasogastric tube. Heavy sedation might be required.
4.1.3 Surgical