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This Concept Map, created with IHMC CmapTools, has information related to: intestinal ressection and anastomosis procedure, Step 8- Transect the intestine with either a scalpel blade or Metzenbaum scissors along the outside of the forceps. Make the incision either perpendicular or oblique to the long axis of the intestine. Use a perpendicular incision at each end if the luminal diameters are equal in size. Step 9- When luminal diameters are not equal use a perpendicular incision across the intestine with the larger diameter and an oblique incision (45 to 60 degrees) across the intestine with the smaller luminal diameter to help correct size disparity. Step 10- Make the oblique incision so that the antimesenteric border is shorter than the mesenteric border. If necessary trim the everted mucosa with Metzenbaum scissors just before beginning the end-to-end anastomosis. In cases of peritonitis or neoplastic disease polypropylene or nylon is recommended., INTESTINAL RESSECTION AND ANASTOMOSIS PROCEDURE Step 1- Make an abdominal incision long enough to allow exploration of the abdomen. This usually requires an incision from xphoid to pubis. Step 2- Exteriorize and isolate the diseased intestine from the abdomen by packing with towels or laparotomy sponges., Step 6- Gently milk chyme from the lumen of the identified intestinal segment and occlude the lumen at both ends of the segment to minimize spillage of intestinal contents. Step 7- Place forceps across each end of the diseased bowel segment. These forceps may be either crushing (Carmalts) or noncrushing (Doyens) because this segment of bowel will be removed. Step 8- Transect the intestine with either a scalpel blade or Metzenbaum scissors along the outside of the forceps. Make the incision either perpendicular or oblique to the long axis of the intestine. Use a perpendicular incision at each end if the luminal diameters are equal in size., Step 10- Make the oblique incision so that the antimesenteric border is shorter than the mesenteric border. If necessary trim the everted mucosa with Metzenbaum scissors just before beginning the end-to-end anastomosis. In cases of peritonitis or neoplastic disease polypropylene or nylon is recommended. Step 11- Place simple interrupted sutures through all layers of the intestinal wall and angle the needle so the serosa in engaged slightly further from the edge than the mucosa, which helps prevent muscosal evertion. Step 12- Tie each suture carefully to appose all layers of the intestine with the knots located extraluminally. A simple continuous pattern is used., Step 12- Tie each suture carefully to appose all layers of the intestine with the knots located extraluminally. A simple continuous pattern is used. Step 13- Pulling continuous sutures too tight will have a purse-string effect, which may compromise intestinal lumen diameter leading to stenosis or obstruction. Step 14- Appose intestinal ends by first placing a simple interrupted suture at the mesenteric border. This is an important suture because most intestinal dehiscence occurs at the mesenteric border. It may be necessary to dissect some of the mesenteric fat to properly visualize and place this suture., Step 18- The mesenteric defect should be closed with a simple interrupted or continuous pattern of 4-0 PDS or Maxon on a swagedon taper needle. It is imperative that you do not penetrate or damage the arcadial vessel near the defect. Step 19- The abdomen should be thoroughly lavaged with warm saline and the anastomotic site before abdominal closure. Post-OP, Step 14- Appose intestinal ends by first placing a simple interrupted suture at the mesenteric border. This is an important suture because most intestinal dehiscence occurs at the mesenteric border. It may be necessary to dissect some of the mesenteric fat to properly visualize and place this suture. Step 15- Next, place a second suture at the antimesenteric border approximately 180 degrees from the first suture. This divides the suture line into equal halves. If the luminal diameters are of equal diameter, space additional sutures between the first two sutures approximately 2 mm from the edges and 2 to 3 mm apart. If minor disparity exists between lumen sizes, space sutures around the larger lumen slightly further apart than the sutures in the intestine with the smaller lumen. Step 16- To correct luminal disparity that cannot be accommodated by first angling the incision or by suture spacing, resect a small wedge (1 to2 cm long and 2 mm wide) with Metzenbaum scissors from the antimesenteric border of the intestine with the smaller luminal size. This will enlarge the perimeter of the stoma, giving it an oval shape., Step 4- Double ligate using the simple interrupted suture and transect the arcadial mesenteric vessels from the cranial mesenteric artery that supplies the segment of intestine that will be removed. Step 5- Next double ligate the terminal arcade vessels within the mesenteric fat at the points of proposed intestinal transection. Step 6- Gently milk chyme from the lumen of the identified intestinal segment and occlude the lumen at both ends of the segment to minimize spillage of intestinal contents., Step 16- To correct luminal disparity that cannot be accommodated by first angling the incision or by suture spacing, resect a small wedge (1 to2 cm long and 2 mm wide) with Metzenbaum scissors from the antimesenteric border of the intestine with the smaller luminal size. This will enlarge the perimeter of the stoma, giving it an oval shape. Step 17- After suture placement, inspect the anastomosis and check for leakage as performed for enterotomies. This is a subjective test because all anastomoses can be made to leak if enough pressure is applied. Place additional sutures if leakage occurs. Step 18- The mesenteric defect should be closed with a simple interrupted or continuous pattern of 4-0 PDS or Maxon on a swagedon taper needle. It is imperative that you do not penetrate or damage the arcadial vessel near the defect., Step 2- Exteriorize and isolate the diseased intestine from the abdomen by packing with towels or laparotomy sponges. Step 3- Assess intestinal viability and determine the amount of bowel that needs to be resected. Color, palpation and the "pinch test" determine intestinal viability. Pinching a section of bowel to see if a peristaltic wave can be initiated is called the "pinch test". Step 4- Double ligate using the simple interrupted suture and transect the arcadial mesenteric vessels from the cranial mesenteric artery that supplies the segment of intestine that will be removed.