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The Labrador and the Corn Cob

Lecture by

Dr Arthur House

Reviewed by

Jacqui Letondeur

This lecture is presented by specialist surgeon Dr Arthur House. In this lecture, Dr House provides the general practitioner with practical advice on how to improve diagnosis, treatment, and management of gastrointestinal obstruction. He delves into the surgical principles and techniques of performing gastrointestinal surgery with special regards to enterotomy, resection & anastomosis, linear foreign bodies, and intussusception. But don’t be fooled, the lecture really refreshes your memory about the basics; from which antibiotics to use when, to the best suture material to use and how best to flush an abdomen. I found it particularly helpful having surgical techniques and suture patterns clearly demonstrated by videos, photos and live drawings.

The top 5 takeaways to incorporate into your practice are:

Key Point #1

Diagnosis of a GI obstruction is aided by sedating your patient. The sedation should incorporate an analgesic agent (such as an opioid or an alpha 2 agonist) as painful, tense abdomens are difficult to palpate thoroughly and therefore can lead to a missed diagnosis.
Key Point #2

Barium contrast studies should be strongly considered when faced with a possible GI foreign body. And remember, it’s the xray you take the next day that will yield the most information – in a non-obstructed patient, all of the contrast should be in the colon by this point. Also worthwhile keeping in mind that the use of barium is not contraindicated when there is risk of GI perforation as it will allow for quicker identification and treatment.
Key Point #3

When performing GI surgery, DO use abdominal wall retractors and large swabs to pack off the abdomen, DON’T use rat tooth forceps, and ensure your Doyens are fit for purpose by checking they stay ratcheted on the first click!
Key Point #4

Always use PDS or Biosyn suture. Other suture such as Monosyn isn’t suitable as it potentially dissolves before the diseased gut has healed properly. On that, use size 3/0 for medium to large dogs and 4/0 for cats and small dogs.
Key Point #5

Full thickness simple continuous or interrupted suture patterns can be used to close your enterotomy or anastomosis; begin the closure 3-4mm away from the edge of the incision, and then 3-4mm apart along the length. Be sure to not overcrowd the site with suture as this can potentially compromise and delay healing time.

Key Point #1

Diagnosis of a GI obstruction is aided by sedating your patient. The sedation should incorporate an analgesic agent (such as an opioid or an alpha 2 agonist) as painful, tense abdomens are difficult to palpate thoroughly and therefore can lead to a missed diagnosis.

Key Point #2

Barium contrast studies should be strongly considered when faced with a possible GI foreign body. And remember, it’s the xray you take the next day that will yield the most information – in a non-obstructed patient, all of the contrast should be in the colon by this point. Also worthwhile keeping in mind that the use of barium is not contraindicated when there is risk of GI perforation as it will allow for quicker identification and treatment.

Key Point #3

When performing GI surgery, DO use abdominal wall retractors and large swabs to pack off the abdomen, DON’T use rat tooth forceps, and ensure your Doyens are fit for purpose by checking they stay ratcheted on the first click!

Key Point #4

Always use PDS or Biosyn suture. Other suture such as Monosyn isn’t suitable as it potentially dissolves before the diseased gut has healed properly. On that, use size 3/0 for medium to large dogs and 4/0 for cats and small dogs.

Key Point #5

Full thickness simple continuous or interrupted suture patterns can be used to close your enterotomy or anastomosis; begin the closure 3-4mm away from the edge of the incision, and then 3-4mm apart along the length. Be sure to not overcrowd the site with suture as this can potentially compromise and delay healing time.

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