Page 128 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 9 · Surgery of the oesophagus

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Aorta

(a)

Diaphragm
Oesophagus

(a)

(b)

Two-layer closure

(c)
A 5-year-old Yorkshire Terrier had been observed swallowing a
9.3
fish ith the fishhook and line attached. n attempt had been
made to remove the fishhook by applying traction to the fishing line.
a Lateral thoracic radiograph sho ing the fishhook lodged in the
cranial thoracic oesophagus. ndoscopic retrieval of the fishhook as
unsuccessful. (b) A cranial sternotomy revealed a large haematoma and
the barb of the fishhook protruding from the oesophagus. The fishhook
(c) was removed and the lacerated left subclavian vein ligated.
(Courtesy of the Veterinary Imaging Database, University of California, Davis)
Single-layer closure
(b)
The length of the oesophagus that can be resected
Oesophagotomy. (a) The caudal thoracic oesophagus is
9.2 approached via an intercostal thoracotomy and a longitudinal without undue risk of dehiscence is limited by anastomotic
incision is made into the oesophagus. (b) The oesophagotomy is closed tension; resection of >3–5 cm of oesophagus has been
with a single- or two-layer simple interrupted suture pattern (see text for associated with increased risk of dehiscence. Circum-
details). ferential partial myotomy may reduce anastomotic tension.
The outer longitudinal muscle layer is incised 2–3 cm prox-
imal and/or distal to the anastomosis, leaving the inner
Fishhooks: Penetrating oesophageal fishhooks (Figure circular muscle layer and submucosal blood supply intact
9.3) can be treated by a combination of surgery and (Muangsombut et al., 1974). Separation of the muscle layers
endoscopy. The oesophagus is approached through a may be facilitated by injecting saline into the muscularis.
surgical incision, and the barb is manipulated through A small amount of oesophageal mobilization during
the oesophageal wall and cut. The shank of the hook can surgery is necessary, but excessive mobilization should be
then be retrieved with the endoscope and forceps. avoided to prevent compromise to the segmental oesopha-
geal blood supply. The oesophagus is isolated with mois-
Debridement, resection and anastomosis: If areas of tened laparotomy sponges and the lumen occluded with
oesophageal perforation or necrosis are observed, these the fingers, umbilical tape or non-crushing clamps. The
should be debrided. Up to one quarter of the circum- diseased portion of the oesophagus is resected. Stay
ference of the oesophagus can be resected and a primary sutures are placed to facilitate gentle tissue handling and
longitudinal closure performed. Large necrotic areas or maintain alignment. The remaining segments are reapposed
extensive perforations are treated by oesophageal resec- with a single- or two-layer suture pattern as described for
tion and anastomosis. oesophagotomy, with the far oesophageal wall being

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