Excessive use of tap water on the serosal surface can lead to blanching and a mottled appearance of the serosa [ 7 ] . Therefore , warm sterile isotonic fluids are preferable to tap water for intermittent lavage once the gross contamination has been removed [ 7 ] . The contents of the colon are collected into large bin buckets or buckets with built-in filter baskets to prevent gross contamination of the surgery suite and avoid blockage of the hospital drains by large particles [ 12 ] . Once empty , the colon should be lavaged thoroughly with sterile saline – before , during and after closure of the enterotomy [ 12 ] . The enterotomy should be closed using a separate sterile instrument kit and absorbable USP 2-0 ( 3 metric ) monofilament suture material such as polydioxanone [ 13 , 19 ] . Before returning to the sterile abdominal field , the VS should discard their contaminated gloves and gown and proceed to sterile hand preparation and sterile gowning and gloving [ 7 ] . blood flow and reduce contamination [ 20 ] . Commonly used intestinal staplers are Covidien TA Autosuture 90 mm × 4.8 mm for transection , and Covidien GIA Autosuture 100 mm × 4.8 mm for end-to-end or sideto-side anastomosis [ 20 ] ( Figure 8 ). Copious amounts of lavage using sterile saline is required to reduce contamination of the site [ 12 ] .
Resection and anastomosis
Regardless of the cause , severe intestinal obstruction or strangulation can lead to a compromised vascular supply to the intestines [ 20 ] . This causes substantial intestinal injury , eventually resulting in necrosis of the intestine [ 20 ] . In these severe cases , depending on the site of the injury , a resection and anastomosis may be required [ 20 ] . A resection is the removal of the affected intestines , and an anastomosis is the surgical connection of the two remaining ends [ 20 ] .
Prior to resection , mesenteric vessels can be ligated using polydioxanone suture material . The mesentery can then be transected using an electrocautery cutting device , such as the Ligasure [ 20 ] . Doyen or Fogarty bowel clamps or Penrose drains can be used to clamp the intestines during the resection , to minimise leakage of intestinal contents into the surgical field [ 20 ] . During the resection , there is significant risk of contamination of the surgical field and abdomen , so it is important to use additional draping on the site of the resection , which can then be removed and discarded once the procedure is complete [ 20 ] .
To minimise contamination of the main instrument table and abdomen , the authors recommend using a separate basic kit and instrument table to carry out the resection and anastomosis . This also applies to any procedure where the intestinal lumen is entered , including enterotomies , enterectomies and anastomoses . After the procedures , the VS should discard their contaminated gloves and gown and proceed to sterile hand preparation and sterile gowning and gloving [ 7 ] .
Laparotomy sponges can be used to drape the bowel prior to resection , to help contain contamination [ 20 ] . For the anastomosis , absorbable suture material such as polydioxanone PDS ( size USP 3-0 ( 2 metric ) in adults ) can be used to align the resected ends [ 20 ] . Alternatively , intestinal staplers can be used to reduce surgery time , minimise tissue handling , improve
Figure 8 . Use of a TA-90 intestinal stapler on the small intestine . Note the use of a sterile impervious drape to protect the surrounding surgical field , and the Poole Suction Tip in the foreground . VSs wear sterile rectal sleeves as additional impervious barriers over their arms .
Recovery
Before moving the horse from the surgical theatre to the recovery stall , it is advisable to attempt to clean and dry the floors , to minimise the risk of an accident during transit . During the anaesthetic recovery process , the wound undergoes maximum stress and strain [ 7 ] . An adhesive drape can be applied over the wound stent to protect it from dirt and sweat [ 7 ] . In addition , a protective abdominal bandage should be applied to further protect the wound during recovery from anaesthesia .
The horse should be recovered in a padded stall using a rope-assisted recovery system , which should improve the quality of the recovery [ 21 ] . The floor should be kept clean and dry , to help prevent the horse slipping and falling [ 14 ] . In a case where the horse is unable to stand up after anaesthesia , the Large Animal Lift sling could be used to assist the horse to stand [ 22 ] ( Figure 9 ). This sling does not apply direct pressure to the horse ' s abdomen and abdominal wound [ 22 ] . A protective reusable abdominal bandage , such as the Kruuse Post Colic Surgery Kit , or an Elastoplast bandage , can be applied to protect and support the wound during the postoperative period [ 14 ] .
30 Veterinary Nursing Journal