Presenter – Laurent Findji – Director DVM, MS, Dipl ECVS, MRCVS, European Specialist in Small Animal Surgery, consultant surgeon at VRCC Referral Centre, Laindon, Essex
After Laurent Findji’s webinar on the essentials of gastrointestinal surgery a few weeks ago, I was looking forward to this next session covering colorectal surgery. To be honest this is not an area I dabble in too frequently and generally I pass any surgery involving the lower depths of the bowel to someone I view as having more surgical know-how and expertise. However despite this colorectal fear, Mr Findji’s webinar proved interesting, practical and informative as I always knew it would.
Once again Mr Findji stressed the need for any surgery to be performed as a-traumatically as possible. There are some areas, however, where ‘large is not small’ and consideration needs to be given to the differences between the large and the small intestine.
The bacterial content of the large intestine is far greater than the small intestine and Mr Findji considers large intestinal surgery as contaminated, unlike small intestinal surgery, which is clean. For this reason Mr Findji will always use prophylactic antibiotics given intravenously at induction of general anaesthesia. These antibiotics should be effective against aerobes and anaerobes and include the cephalosporins, the beta lactams, metronidazole and amoxycillin / clavulinic acid. Mr Findji would only follow up with antibiotics post-surgery if he felt there had been massive contamination during the surgical procedure.
The use of preparation solutions such as Colyte and Golytely can be considered, although there is little evidence to support when they should be used. Generally Mr Findji will use these solutions when ‘open’ rectal surgery is being performed but with ‘closed’ colic surgery he finds it easier to prevent contamination when the motions are solid. Warm water enemas can also be given two to three days prior to surgery but they should be used with caution in debilitated patients.
The differences in vascularisation between the small and large intestine also have to be considered. The large intestine has segmental vascularisation whereas the small intestine has arcades of vessels. This makes preserving vascularisation in the large intestine more difficult and a sound knowledge of the vascular supply to the large intestine is essential. This is covered in the webinar where Mr Findji’s explanation is clear and concise. Ultimately, if in doubt, Mr Findji recommends ligating the vasa recta which are the individual vessels supplying each segment of the gut also demonstrated clearly within the webinar.
As always I have only discussed a fraction of the information delivered by yet another impressive webinar by Mr Findji. His key messages when considering colonic surgery are to always keep it simple by doing a one layer full thickness suture into the intestinal wall, to always try and preserve the ileocolic sphincter and, as stated previously, if in doubt ligate the vasa recta. I have only touched on colonic surgery and the latter half of this webinar concentrated on rectal surgery which was equally as useful. This is one of those webinars where I can see myself continually referring to like a textbook and if you decide to take a look I guarantee you will do the same.
The Stethoscope (MRCVS)
If you missed this webinar you can now purchase access to the recording at the link belowhttp://thewebinarvet.com/webinar-archive/