Читать книгу Gastrointestinal Surgical Techniques in Small Animals - Группа авторов - Страница 81

Jejunostomy tubes are frequently placed during a laparotomy. During laparotomy the tubes are placed either very proximal in the jejunum or distal to a surgical site to bypass it.

A #11 blade is then used to penetrate the abdominal wall from the skin surface on the right or left side of the abdominal cavity. The blade is introduced in the middle of the abdominal wall lateral to the rectus abdominalis muscle. A mosquito forceps grabs the blade in the abdominal cavity. The blade is withdrawn from the abdominal wall with the forceps. The forceps then grabs the feeding tube and pulls inside the abdominal cavity (Figure 4.10a).

A purse‐string suture with 4‐0 monofilament absorbable suture is placed in the wall of the jejunum.

A puncture is made in the center of the purse‐string in the wall of the jejunum (Figure 4.10b). The jejunostomy tube is then introduced in the lumen of the jejunum in the aboral direction. The tube is advanced over 20 cm and the purse‐string is tightened (Figure 4.10c). Four pexy sutures are placed between the wall of the jejunum and the transverse abdominalis muscle around the jejunostomy tube (Figure 4.10d and e). A 4‐0 monofilament absorbable suture is used for the pexy sutures. A finger‐trap suture with 3‐0 nylon is placed on the skin to secure the tube (Figure 4.10f).

The laparotomy is closed in a routine fashion.