الفهرس 
ACKNOWLEDGEMENT
GastrotomyOnly 14 pages are availabe for public view
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Abstract
The most common indications for gastrointestinal surgery include gastrointestinal foreign bodies, neoplasia, gastric dilatation-volvulus, and surgical biopsies. Moreover, the most common reason for performing gastrotomyis to remove gastric foreign bodies.Many surgical techniques have been described for closure of gastrointestinal incisions, including different suture materials and patterns, anastomotic rings, skin staplers, and linear stapling devices. Wound breakdown and leakage are the most serious and catastrophic complications of surgery on the gastrointestinal tract. Many suture materials have been used successfully to close the stomach. The synthetic monofilament absorbable suture materials are preferable.The stomach is capable of rapid healing, due its rich blood supply and paucity of intraluminal bacteria.
Available literatures lack a detailed study to compare different techniques of closure of gastrotomy wound in dogs is not reported. Consequently, the present study aims to compare between four double-layer closure methods for canine gastrotomy; procedure time, clinically, grossly and histopathologically.
Twenty adult healthy mongrel dogs of both sexes (13 males and 7 non-pregnant, non-lactating females) were prepared aseptically for pre-umbilical celiotomy. Gastrotomy incision (5 cm) was induced midway between lesser and greater curvature. Dogs were then randomly allocated into four treatment (A, B, C and D) groups (n=5 in each group) according to closure technique. In group A, both the first and second layers were closed using simple continuous sutures. In group B, both layers were closed using inverting sutures. In group C, the first layer was closed by inverting sutures while the second by simple continuous sutures. In group D, the first layer of the stomach was closed by simple continuous sutures while the second was closed by skin staplers. In all dogs, exteriorized stomach was flushed by sterile warm normal saline and reduced into the abdomen. Abdominal wall was sutured in 3 layers.Physiological parameters were taken pre and postoperatively. Procedure times, time of returning to eating and postoperative complications were recorded. Dogs were euthanatized 14 days, postoperatively. Inspection of gastrotomy site for presence of adhesions, wound healing, leakage of gastric contents, wound dehiscence, peritonitis and inspection of gastrotomy site from the mucosal aspect for the wound healing and presence of ulcerations. Tissue samples were collected for histopathology. A score system was developed to evaluate stages of wound healing in different groups.The data were expressed as mean±SE and were analyzed by ANOVA.
Results revealed some changes in body weight and physiological parameters of dogs during the study. The procedure time lasted the longest time in dogs of group B, while the procedure time was the shortest in dogs group D. The variations in procedure time were significant among dogs of different groups.Gastrotomy procedures were tolerated by all dogs. Inspection of gastrotomy site showed normal wound healing with no leakage of gastric contents, wound dehiscence or peritonitis except that one of the dogs in the treatment group (B) died from peritonitis. In group (D), no staples were missing from the incision site. The score of adhesions between gastrotomy site and omentum was the highest in dogs of group C, while the lowest score of adhesions was recorded in dogs of groups A and D. Histopathological examination revealed different degrees of inflammation and connective tissue proliferation in the submucosa and musculosa. However, gap formation was recorded in dogs of group C and remodeling stage was observed in dogs of group D. In conclusion, using double layer closure technique for gastrotomy wound was beneficial because the first suture line (first layer) provides homeostasis of the mucosa and submucosa, and the second suture line (outer layer) prevents leakage of gastric contents. The different closure techniques of gastrotomy wound in the present study gave satisfactory results, however, closing the first layer by simple continuous suture and the second layer skin staplers is considered to be the superior.