Overview of Canine Gastrointestinal Resection & Anastomosis
Gastrointestinal resection and anastomosis, commonly abbreviated and referred to as an R & A, is a surgical procedure in which a section of the dog’s esophagus, stomach and/or intestinal tract is removed and the remaining parts are connected. The “resection” refers to the removal of the abnormal tissue and the “anastomosis” is the procedure where the two parts are reconnected.
This procedure may be performed at any point along the gastrointestinal tract from the esophagus to rectum, and the section removed can vary in length from a few centimeters to very long lengths.
What Are Indications for Gastrointestinal Resection & Anastomosis in Dogs?
Reasons for doing this procedure include:
Animals with these problems may display gastrointestinal symptoms such as vomiting, decreased appetite, weight loss, and/or diarrhea.
Resection and anastomosis is a commonly performed procedure. The success rate is relatively high, but depends on the underlying disease process and region of the gastrointestinal tract that is removed. The surgery can have serious complications if the affected animal does not heal well and the anastomosis comes apart or if a large majority of the intestinal tract is removed.
Diagnosis of Conditions Requiring Resection and Anastomosis in Dogs
Treatment with a Resection and Anastomosis in Dogs
Your dog will often be kept in the hospital for a few days for continued treatment and monitoring after a gastrointestinal resection and anastomosis has been performed. Once your dog is discharged from the hospital you will need to restrict his/her activity for several weeks. You will also need to monitor the skin incision for redness, swelling, or discharge.
Your dog may be sent home on a diet restricted in either volume or type of food fed and/or medications. Your veterinarian will typically ask you to return for a recheck appointment in two weeks so that he/she can monitor your dog’s progress and remove the skin sutures.
Information In-depth on Canine Gastrointestinal Resection & Anastomosis
Gastrointestinal resection and anastomosis is the name given to any surgical procedure in which a portion of the gastrointestinal tract is excised (resected) and the remaining ends of the tract are reattached (anastomosis).
Resection and anastomosis is most frequently done in the small intestines; however, resection and anastomosis of the stomach, colon (large intestines), or rectum is necessary with some diseases. Resection of a portion of the esophagus is less commonly performed.
Ingestion of a foreign body that subsequently becomes lodged in the small intestine is a common condition of dogs that requires resection and anastomosis. The obstruction can lead to necrosis or death of the wall of the intestine and ultimately to intestinal perforation. The entire length of damaged intestine is removed such that the two ends of the reattached intestine are healthy.
Another cause of obstruction is stricture, in which the walls of the esophagus or intestine constrict like a tightening ring, limiting the size of the lumen or opening. Stricture can be the result of previous injury by foreign objects, previous surgery, or tumors.
Intussusception is a condition in which a portion of the gastrointestinal tract advances into the intestine adjacent to it, similar to an old-fashioned telescope. If the intussusception cannot be undone, resection and anastomosis of the affected intestine may be necessary.
Torsion is the abnormal twisting of an organ that can cause disruption of its blood supply. Gastric dilatation/volvulus (GDV) is a condition where the stomach of dogs, typically large breeds, twists on itself. Depending on the duration and severity of the twist a portion of the stomach may be necrotic (unhealthy). If a large portion of stomach is severely damaged, resection and anastomosis may be necessary.
Mesenteric (intestinal) torsion is the twisting of the small intestines on its blood supply. This condition is almost always fatal; however, occasionally when surgery is done quickly a portion of the intestine may be salvageable. The necrotic (unhealthy) portion is removed and an anastomosis is performed.
Neoplasia (cancer) or benign tumors can occur in any region of the gastrointestinal tract. Fortunately the esophagus, which is difficult to operate on and is most prone to complications after surgery, is rarely involved. The stomach, small intestines, large intestines and rectum do develop tumors that may require resection and anastomosis to treat. The rectum is the portion of the colon that passes through the pelvic canal to the anus. It is accessed through an incision near the anus or under the pelvis (the floor of the pelvis must be split to access this area of the rectum).
Tumors of the stomach, small intestine and large intestine within the abdominal cavity are approached through an incision in the animal’s belly. Large tumors of the stomach can be difficult to remove with “clean” margins (lack of tumor cells at the cut edge of the removed tissue). The small and large intestine are much longer and usually allow for several centimeters of unaffected tissue to be excised to maximize the chance for complete tumor removal.
Depending on the underlying condition that requires that resection and anastomosis be performed, the prognosis is variable. For benign conditions (such as foreign body obstruction, intussusception, and benign tumors) the prognosis is generally excellent. If perforation of the gastrointestinal tract has occurred due to any cause the abdominal contents are usually inflamed (peritonitis) and anastomoses may not heal well. Thus, the presence of abdominal infection generally warrants a guarded prognosis. If the blood supply to a region of the gastrointestinal tract has been compromised, such as with torsion, the patient must be monitored closely after surgery because healing may be impaired. Some neoplastic conditions carry a poor prognosis because of possible recurrence, while others may be cured with surgery.
Potential Complications of R & A in Dogs
In-depth Information on Diagnostic Tests with Gastrointestinal Resection & Anastomosis in Dogs
In-depth Information on Treatment With Gastrointestinal R & A in Dogs
Gastrointestinal resection and anastomosis can be performed by hand suturing the two ends of the gastrointestinal tract back together or specialized stapling equipment can be used. The use of stapling equipment can greatly reduce the surgery and anesthesia time, but it may increase the cost.
The removed portion of the gastrointestinal tract is submitted to a laboratory for histopathological examination (biopsy).
Culture of the fluid from the abdominal cavity may be performed to determine an appropriate antibiotic to treat peritonitis.
Your pet is usually kept in the hospital for 1 to 2 days after surgery in order to continue intravenous fluid therapy and to allow antibiotics and pain medications (analgesics) to be administered. Your dog will be closely monitored during this time for evidence of infection or other complications.
Food and water may be withheld from your pet for the first 12 to 24 hours after surgery. If your dog does not vomit after drinking small volumes of water, small amounts of a bland diet can be offered. Once your pet is eating and drinking without vomiting, he may be discharged from the hospital.
Home Care and Recovery of Dogs After
Once your dog has been discharged from the hospital he must be kept quiet to promote healing. Restrict your pet’s activity for at least two weeks after abdominal surgery. Keep your pet confined to a carrier, crate, or small room whenever he cannot be supervised. Do not allow your dog to play or rough-house even if he appears to be feeling well. Confine dogs to a leash when taking them outdoors.
Special instructions may be given for gradually increasing the volume of your dog’s food or for feeding a certain type of food. If your pet is not continuing to improve each day, or begins vomiting or refusing to eat again, contact your veterinarian immediately.
If a culture sample was taken, the specific type of antibiotic that your pet was originally sent home with may need to be changed based upon those results. Antibiotics may lead to decreased appetite or diarrhea. Contact your veterinarian if you note any problems.
The skin incision needs to be monitored daily for signs of excessive swelling or discharge, which may indicate problems with healing or even infection. Contact your veterinarian if you note any abnormalities.
If the resection and anastomosis was performed because of a tumor, the biopsy report will indicate whether the tumor was benign or malignant and if it was completely removed, or not. Your veterinarian will make additional recommendations based on these results and may refer you to a veterinary oncologist for further treatment.