Chapter 11: Table of Contents
Suture, Leak Test and Omentalize
If working alone, you will need to release the finger grip that obstructed the flow of chyme in order to perform the intestinal wall closure; try to absorb/suction any leakage and prevent contamination during closure. Close the incision in a single layer taking full thickness bites (~2-3 mm from the cut edge); the submucosa is the layer of strength and must be included in each bite. The mucosa often everts and can be trimmed if necessary. Place simple interrupted sutures of 3-0 or 4-0 PDS® or Biosyn® on a taper or taper-cut needle approximately 2-3 mm apart. Do not use chromic gut on the gastrointestinal tract. Appose each suture tightly without crushing the tissues. You can close the incision longitudinally (along the incision line) if the bowel lumen is large or transversely (apposing the incision ends first) if the bowel lumen is small to prevent stricture formation.
Some degree of tissue eversion always occurs during closure; this may lead to adhesions but it is not a serious concern in small animals. Leak test your closure and gently wipe the incision with moistened gauze. Lavage the abdomen (at least locally) if contamination occurred. Omentalize all intestinal biopsy sites and close the abdomen routinely.
Note: closure of enterotomy sites using skin staples and continuous suture lines have been shown to be acceptable (Weisman et al 1999 and Coolman). I use simple interrupted sutures because I prefer this technique.