TECHNIQUE

Gastrotomy in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description
Pre-operative
  • Stabilise the rabbit's condition if possible.
  • Note: gastrointestinal obstruction leads to a rabid deterioration in the rabbit's physiological status.
  • If the stomach is distended, decompress the stomach:
Surgical preparation
  • Anaesthetise the rabbit. See: Treatment and Care - Anaesthesia and Chemical Restraint - Lagomorph Anaesthesia
  • Place the rabbit in dorsal recumbency.
    • On a circulating water blanket. (B602.22.w22)
  • Clip and scrub the rabbit's abdomen from the inguinal to midthoracic area for laparotomy. (B602.22.w22)
  • Place an intravenous catheter into a cephalic or lateral saphenous vein. (B602.22.w22)
    • This allows fluid administration and venous access during surgery. (B602.22.w22)
  • Start appropriate prophylactic antibiotics. (B534.43.w43f)
Abdominal incision
  • Make a midline incision through the skin from just caudal to the xiphoid down to the pubis (or from the umbilicus to the pubis). (B601.17.w17)
  • Incise the thin subcutaneous tissue to expose the linea alba. (B601.17.w17)
  • Isolate the linea alba and use fine toothed thumb forceps to tent it away from the abdominal viscera. (B601.17.w17)
  • Using an inverted number 10 or number 15 scalpel blade (cutting edge of the blade directed upwards), make a stab incision through the linea alba, parallel to the linea alba. (B601.17.w17)
    • Care is required to avoid damaging the caecum, which has a thin wall, is usually distended with ingesta, and lies directly under the abdominal wall. (B601.17.w17)
  • Place a small thumb forceps into the abdomen and directed parallel to the linea alba; use this to lift the linea alba away from the underlying viscera. (B601.17.w17)
  • Using a scalpel, cut cranially and caudally along the linea alba between the jaws of the forceps.(B601.17.w17)
    • Or use blunt-topped fine tissue cutting scissors, with one blade inserted into the abdomen parallel to the linea alba and used to lift the abdominal wall away from the viscera while cutting cranially and caudally. (B601.17.w17)
  • Note: the incision should be long enough to allow exploration of the whole gastrointestinal tract.
  • Place laparotomy pads, moistened with saline, along the incision line on both sides and use a retractor (e.g. a Lonestar Veterinary Retractor or Balfour retractor) to give better exposure of the abdomen. (B601.17.w17, B602.22.w22)
Abdominal exploration
  • Palpate the entire gastrointestinal tract from the distal oesophagus to the descending colon, to check there are no foreign bodies elsewhere in the GIT.
  • Check the liver: if this is abnormally yellow or pale, take a liver biopsy for histopathology. (B602.22.w22) See: Liver Biopsy in Rabbits
Gastrotomy
  • Place two stay sutures in the stomach, one at each end of the intended incision site.
  • Gently retract the stomach out of the abdomen.
  • Place moistened laparotomy sponges between the stomach and the remaining abdominal viscera.
    • This prevents contamination of the viscera with gastric contents. (B602.22.w22)
  • Make an incision halfway between the greater and lesser curvatures of the stomach.
    • This area is relatively avascular.
    • Make an initial stab incision then use tissue scissors to extend the incision, following the curvature of the stomach.
    • Make the incision long enough for visualisation and removal of foreign material.
  • Remove the foreign body/material.
    • A sterile surgical spoon can be used.
  • Rinse the stomach lumen with a small amount of warm saline.
  • Check the lumen for abnormalities.
  • Gently palpate the pylorus, checking it is patent.
  • Close the mucosa and submucosa in a simple continuous suture pattern using synthetic absorbable monofilament suture material. 3-0 to 4-0. (B602.22.w22)
    • Preferably go into but not completely through the mucosa. (B602.22.w22)
  • Close the seromuscular layer with an inverting suture pattern - Lembert or Cushing - also using an absorbable synthetic monofilament suture material.
Abdominal closure
  • Close the linea alba in a simple continuous or interrupted pattern. (B601.17.w17)
    • Use a synthetic monofilament absorbable suture material. (B601.17.w17)
  • If there is enough subcutaneous tissue available, close this in a simple continuous suture pattern. (B601.17.w17)
    • Use a synthetic absorbable suture material, monofilament or braided. (B601.17.w17)
    • Braided material is easier to handle but has more drag, so causes more tissue damage, and may allow bacterial growth. (B601.17.w17)
  • Close the skin using a simple continuous subcuticular suture. (B601.17.w17)
    • Use a synthetic monofilament absorbable suture material. (B601.17.w17)
Post-operative care
  • Continue prophylactic antibiotics for five days. (B534.43.w43f)
  • Give post-operative analgesia as indicated by assessment of the injury or surgery. (B602.22.w22)
  • Assess for pain - see Physical Examination of Mammals - Observation
    • e.g. reluctance to move, hunched posture, anorexia, teeth grinding, raised body temperature, increased respiratory rate, unusual aggression and occasionally vocalisation. (B534.43.w43f)
  • Monitor general physical status for the first 24 hours - e.g. body temperature, auscultation of the chest, pulse rate, water and food intake, production of faecal pellets. (B534.43.w43f)
  • See Treatment and Care - Surgery - Post-operative care
Appropriate Use (?) For the treatment of:
  • Confirmed/suspected gastric foreign bodies. (B601.17.w17, B602.22.w22)
  • Complete gastric or pyloric obstruction. (B602.22.w22)
  • Gastric tumours. (B601.17.w17)
  • Disease where histopathological evaluation of the stomach is needed. (B601.17.w17)
Notes --
Complications/ Limitations / Risk
  • Not the treatment of choice for gastric stasis syndrome (previously considered trichobezoar), for which medical management is more appropriate. (B601.17.w17, B602.22.w22)
  • Prognosis is guarded because acute gastrointestinal obstruction is a life-threatening condition.
Equipment / Chemicals required and Suppliers
  • Anaesthetic drugs and equipment.

  • Surgical equipment.

  • Suture materials.

Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience.
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Frances Harcourt-Brown BVSc FRCVS (V.w140)
References B601.17.w17, B602.22.w22, B534.43.w43f, J15.30.w1

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