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Abdominal Surgery – Deciding When, What and How to Biopsy

Jason Mouatt, BVSc FANZCVS​

Lecture Summary

Importance of Biopsies

  • Purpose: Provide tips and guidance on abdominal surgery, specifically on when and how to perform biopsies
  • Emphasize developing a habit of considering biopsies for better patient outcomes
  • Address common reasons for avoiding biopsies: habit, lack of awareness, assumptions, laziness, costs, fear
  • Encourage overcoming barriers and highlight benefits of biopsies in diagnosis and treatment decisions

Surgical Techniques and Considerations

  • Thorough exploration during surgery
  • Use of retractors
  • Need to biopsy various organs in the abdominal cavity
  • Tips on performing biopsies in the stomach and small intestine
    • Techniques using biopsy punches or incisions
  • Risks and complications associated with biopsies
    • Dehiscence, breakdown
    • Factors increasing risk: pre-op septic peritonitis, intraoperative hypertension, hypoalbuminemia
  • Importance of obtaining tissue samples for diagnosis and treatment planning

Suturing Techniques

  • Different suturing techniques for closing incisions, especially in the gastrointestinal tract
  • Use of Gamby sutures to pull mucosa back into the lumen [Gamby sutures – it’s a simple interrupted suture where you take a bite full thickness and then just come back up and grab the mucosa and come from in the lumen back through the mucosa, and then that pulls the mucosa back down into the lumen essentially, and then you take your bite on the other side and you go down through the mucosa into the lumen and then back up full thickness]
  • Trimming excess everted mucosa
  • Continuous sutures to roll mucosa back in

Kidney Biopsies

  • Feasibility of using a biopsy punch for focal kidney disease
  • Use of small biopsy needle or punch
  • Use of gel foam to reduce hemorrhage
  • Caution on profuse and persistent bleeding in the kidney

Antibiotics for Liver Biopsies

  • Choice of antibiotics based on underlying disease and concern
  • Recommendation of broad-spectrum intravenous antibiotics like cephalothin or cephalexin
  • Addition of metronidazole based on specific cytology, histology, or culture results

Antibiotics for Liver Biopsies

  • Practical tips and recommendations for surgical techniques and considerations in veterinary medicine
  • Announcement of next lecture on septic peritonitis