Читать книгу Gastrointestinal Surgical Techniques in Small Animals - Группа авторов - Страница 80

Three separate cannulas are used. One cannula is placed where the jejunostomy tube is placed in the right side of the abdominal cavity (Figure 4.9). A single‐access port can also be used and it is inserted in the middle of the right side of the abdominal cavity. The port is placed lateral to the rectus abdominalis muscle.

After insufflation of the abdominal cavity a 5 mm rigid endoscope and two 5 mm grasping forceps are used to visualize and manipulate the loop of jejunum. After identifying the most proximal loop of jejunum it is brought against the abdominal wall and the single‐access port is removed (Figure 4.9a). The oral and aboral orientation of the loop of jejunum should be identified. A stay suture is placed in the wall of the jejunum. A 4‐0 monofilament absorbable suture is then used to place a purse‐string suture in the wall of the jejunum (Figure 4.9b). A #11 blade is used to puncture the center of the purse‐string suture. The jejunostomy tube is then introduced in the lumen of the jejunum in the aboral direction (Figure 4.9c). Usually 15–20 cm of the tube is placed in the jejunum. The purse‐string suture is tightened around the tube. Four pexy sutures are placed between the wall of the jejunum and the transverse abdominalis muscle (Figure 4.9d and e). A 4‐0 monofilament absorbable suture is used for the pexy. The subcutaneous tissue and skin are closed in a routine fashion around the tube (Figure 4.9f and g).

Figure 4.8