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Gastrointestinal surgery

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Abstract

Exploratory laparotomy or coeliotomy is commonly performed in order to establish or confirm a diagnosis, to determine the extent of involvement of abdominal organs by disease processes, to treat diseases and to ascertain a prognosis. This chapter covers abdominal exploration, gastrointestinal biopsy, hepatic and pancreatic biopsy, partial pancreatectomy, insulinoma and surgical treatment of pancreatitis.

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Figures

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5.1 Simple continuous closure of the external rectus sheath/linea alba. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.2 (a–b) A full-thickness longitudinal incision is made in the antimesenteric border of the intestine with a No. 15 scalpel blade. (b, © John Williams) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.3 (a–c) Longitudinal intestinal incisions are closed transversely with 1.5 metric (4/0 USP) absorbable suture material. (b, c, © John Williams) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.4 A 4 mm skin punch biopsy instrument being used to obtain a full-thickness antimesenteric intestinal biopsy sample. Care must be taken to ensure that the mesenteric wall is not damaged.
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5.5 Guillotine technique for liver biopsy. (a) A loop of absorbable suture material is placed around a small portion of the tip of a liver lobe. The suture is tied tight to cut through the parenchyma and occlude the blood vessels and bile duct. (b–c) Using a sharp scalpel blade, the hepatic tissue is cut approximately 3–5 mm distal to the ligature. To avoid crushing, the sample should not be handled with tissue forceps. (Reproduced from the ) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.6 Crushing technique for liver biopsy. (a) A pair of haemostatic forceps is placed across the lobe proximal to the lesion. (b) Several overlapping mattress sutures are placed through the liver just proximal to the site of the proposed lobectomy incision. It is important to ensure that the entire width of the hepatic parenchyma is included in the suture and that a stump of crushed tissue is left distal to the ligatures. After tightening the sutures, a sharp scalpel blade is used to remove the hepatic tissue distal to the ligatures, allowing a stump of crushed tissue to remain. (Reproduced from the ) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.7 A core biopsy needle or skin biopsy punch can be used to obtain small pieces of liver tissue. This technique is useful for hepatic lesions located away from the periphery of the lobe. (a) The focal lesion is identified. (b) The skin biopsy punch is pushed into the parenchyma to cut a core sample. (c–d) The biopsy site can be packed with a small piece of Gelfoam or omentum following removal of the hepatic tissue, to facilitate haemostasis. (Reproduced from the )
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5.8 Anatomy of and blood supply to the pancreas and adjacent structures. (Reproduced from the ) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.9 Anatomy of the pancreatic ducts in the dog. (Reproduced from the ) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.10 Suture fracture technique. (a) Tightening of the ligature crushes the pancreatic parenchyma. (b) Pancreatic tissue distal to the ligature is transected. (Reproduced from the ) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.11 Partial pancreatectomy using the (a) dissection and (b–c) ligation techniques. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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