BASIC ABDOMINAL SURGICAL GUIDELINES
Daniel Brehm, VMD Dip ACVS

This essay is a short overview of some of the basic guidelines for common abdominal surgical procedures.  There are rarely hard and fast rules that apply to surgical techniques (there are many acceptable variations), but the following are some tips based on the approaches used here at SouthPaws.
Stomach
When performing a gastrotomy, I will normally use stay sutures or Babcock forceps to elevate the stomach and then moistened laparotomy sponges to isolate the stomach from the abdominal cavity.  I will usually make the incision in the mid ventral fundus, about midway from cranial to caudal.  The entire stomach lumen can usually be reached from this incision.  Closure should be in two layers, usually a simple continuous pattern in the serosa/muscularis and an overlying inverting pattern (Cushing or Connell).  If the incision is made in the antrum near the pylorus, I will usually perform a simple continuous pattern in the mucosa/submucosa and a simple interrupted appositional pattern in the serosa/muscularis (excessive inversion of the stomach wall in this area can partially obstruct the pyloric outflow tract).  I prefer PDS or Maxon suture for gastric and intestinal surgery.

Intestines
For enterotomies, the incision should be longitudinal at the antimesenteric border.  Closure can be done by apposing the cut edges using a simple interrupted pattern.  It is preferable to invert the closure some to get serosa-serosa contact, but this is difficult and there seems to be no significant compromise in healing if mucosa protrudes somewhat between the sutured edges.  I have only extremely rarely found it necessary to close intestinal incisions transversely, and I do not believe it is necessary as routine practice for simple enterotomy incisions.

For anastomoses, a simple interrupted pattern is usually the most effective with a similar comment about mucosal eversion.

If there is concern about healing of the intestinal wound closure, omentum can be wrapped around the surgery site.  For greater support, a serosal patch can be performed.  In this procedure, free intestinal loops are laid along each side of the intestine and sutured near the mesenteric border orad and anad to the surgery site.  The neighboring intestinal loops are then sutured to each other over the operated intestinal segment, providing structural support, a fibrin seal, and a source of additional blood supply.

Large intestinal incisions can in almost all cases be closed with a single layer, appositional pattern using a long lasting, monofilament absorbable suture material (PDS or Maxon).  Avoid penetrating into the lumen if possible, but do be certain to include the submucosa.

Liver
Liver biopsies can be obtained by "lassoing" a free edge of one of the lobes using absorbable suture material.  A hemostat can be used

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