Читать книгу Gastrointestinal Surgical Techniques in Small Animals - Группа авторов - Страница 66

The length of the tube is measured from the proximal part of the esophagus to the level of the 8th or 9th rib. The appropriate length is marked on the tube.

A long curved forceps is introduced through the oral cavity in the proximal esophagus (Figure 4.4a). The tip of the forceps is palpated percutaneously in the proximal part of the neck.

A small skin incision is made over the tip of the forceps (Figure 4.4b). It is important to tent the soft tissue of the neck while the instrument is tipped up in the neck. This minimizes the risk of stabbing the jugular vein or the carotid artery. The tip of the forceps is then exposed after incising the wall of the esophagus. The incision should be long enough to advance the tip of the forceps through the wall of the esophagus. A large incision will result in leakage of saliva around the tube in the subcutaneous area, inducing cellulitis.

Figure 4.3

Figure 4.4

The tip of the esophagostomy tube is then grabbed and pulled in the oral cavity (Figure 4.4b and c). The tube is then reinserted in the esophagus (Figure 4.4d). It is important not to wrap the esophagostomy tube around the endotracheal tube. The tube is advanced until it passes the point of insertion in the esophagus. Then it can be pushed in the esophagus to the desired length.

As an alternative technique a special trocar can be used to place the esophagostomy tube. The tube is first introduced in the esophagus through the mouth (Figure 4.5a). Then the distal end of a special curved trocar is advanced in the proximal esophagus. The skin and the wall of the esophagus are incised over the tip of the trocar (Figure 4.5b). The esophagostomy tube is attached to the distal end of the trocar (Figure 4.5c). The trocar is then pulled through incision in the neck, dragging the esophagostomy tube with it (Figure 4.5d–g).

The tube is secured in placed with 2‐0 nylon suture as a Chinese finger trap (Song et al. 2008).

It is paramount that the placement of the tube is confirmed prior to feeding of the patient. A lateral radiograph is used to confirm the placement of the tip of the esophagostomy tube in the distal esophagus (Figure 4.5g). If the tube is in the stomach, it needs to be pulled back in the esophagus.

The tube can be removed eight days after placement if it is not needed. The finger‐trap suture is just cut and the tube is pulled out. The stoma is left to heal by second intention. The dog or cat can eat immediately.