Gastrointestinal Surgery

Common medical conditions that would require the need for gastrointestinal surgery include:

• Ingestion of a foreign object that is causing obstruction of the stomach and/or intestinal tract
• A mass or tumor present involving the stomach or intestinal tract
• The need for gastric and/ or intestinal biopsies to determine the underlying cause for a pets clinical signs like chronic vomiting, diarrhea and/or weight loss.

If an incision is made into the stomach to remove a foreign body, this is called a gastrotomy. If there is a mass present or a diseased portion of the stomach that is not viable, it is removed via a gastrectomy.

A single incision into the intestine for removal of a foreign body or to collect intestinal biopsies is called an enterotomy (see below).

If there is a mass in the small intestine or a segment of the small intestine that is not viable, then a resection and anastomosis is performed. This procedure consists of removing the diseased intestinal tissue, and then sewing two healthy portions of the intestine back together to recreate a patent lumen of a continuous intestinal tract.

Surgical risks for any abdominal surgery include anesthesia, bleeding, swelling and incisional infection of the body wall. Additional risks are based on the underlying reason that has led to a recommendation for gastrointestinal surgery:

• For suspected foreign body obstruction: Exploration of the abdomen could be negative (ie no foreign body found), despite having a suspicion for a foreign body based on imaging (xrays and/or ultrasound). There is also a risk of the foreign object severely damaging the segment of bowel effected by the obstructive object resulting in the need for a bowel resection and anastomosis.
• For a mass or tumor present: The mass could be a cancerous disease process that has a risk of spreading elsewhere in the body.
• For intestinal biopsies: Samples may show a non-curable disease such as cancer.

The main risk that is associated with ANY gastrointestinal surgery is dehiscense.

Wound dehiscence is when the surgical incision opens, causing ingesta and the normal bacteria flora to leak into the abdomen. Should leakage of a gastrointestinal incision occur, a patient would become very sick with septicemia (severe bacterial infection that enters the bloodstream). Risk for dehiscense is greatest at 3-5 days after the initial surgery. This period of time is the weakest during wound healing. Typically at this point in the post-operative recovery, the patient is already home receiving continued care from their owners. Owners would notice anorexia or a decline in appetite compared to the day before. Animals suffering from septicemia will also be extremely lethargic and may have vomiting/ regurgitation. Seek veterinary care immediately if these symptoms are noticed. Unfortunately, if septicemia occurs, an additional abdominal surgery to address the source of leakage is required and the condition is considered a surgical emergency.

Fortunately, wound dehiscence is uncommon. In the veterinary literature, the risk is reported to occur in less than 10% of the population undergoing gastrointestinal surgery, regardless of the underlying cause for the procedure.  The risk of dehiscence is greater in patients that are suffering from low protein levels, prolonged anorexia and/or concurrent endocrinopathies that could hinder healing.

Ideally, most pets will stay hospitalized after the procedure until they are eating on their own without any vomiting or regurgitation. In addition, the pet must be comfortable on oral pain medication.

Once home from the hospital, discharge instructions will include:

1. ACTIVITY RESTRICTION: Please keep your pet quiet and confined for the next 2 weeks. No running, jumping or playing until the incision is healed and the sutures or staples are removed.  Short leash walks are fine for dogs. All cars should be confined indoors during the two week recovery period.
2. INCISION CARE: Observe the incision daily for signs of redness, swelling or discharge. If any of these are seen, please contact your veterinarian for advice. An E-collar will be necessary to prevent licking or chewing at the incision. Alternatively, sometimes a t-shirt or surgical recovery suit can be worn instead of an ecollar to protect the incision. However, an e-collar is still advisable whenever not directly supervising your pet.
3. SUTURE/STAPLE REMOVAL:
   1. If skin stitches or staples were placed, then a recheck appointment for their removal should be scheduled with your primary care 10-14 days following surgery.
   2. If the skin stitches were buried under the skin, they will absorb. However, 10-14 days of strict activity restriction is still required to ensure appropriate healing.

For foreign body obstructions, the long-term outcome for these pets is excellent. Owners may need to modify some of their household habits to avoid patients ingesting additional foreign material in the future.

For intestinal biopsies and mass resections, prognosis will be dependent on the diagnosis acquired from the tissue samples submitted to the pathologist for analysis. Your primary care will guide you through additional recommendations for long-term care of your pet. This may include referral to a specialist in internal medicine or oncology if indicated.