A practical review of small intestinal anastomosis for the small animal practitioner

Small intestinal surgery is commonly performed in first opinion practice. It may be indicated for biopsy, removal of foreign body obstruction or resection of neoplasia, non-viable tissue or irreparable injury. The consequences of postoperative intestinal leakage are significant morbidity and mortality, necessitating revision surgery or euthanasia. Enterotomy (a simple incision into the intestinal lumen) and enterectomy (removal of a length of intestine) followed by anastomosis (re-apposition of the cut gut ends) are the most frequently performed procedures, with enterectomy anastomosis having a reported dehiscence rate between 7 and 16% (and higher if there is pre-existing septic peritonitis).

There are multiple factors that may increase the risk of postoperative leakage and subsequent septic peritonitis. It can be helpful to classify risk into three major groups to identify them logically, help recognise animals at greatest risk of dehiscence and, if possible, address the potential causes (Table 1). This article focuses on practical procedural considerations that are applicable to general practice, and highlights methods of optimising the biological and mechanical environment of the intestinal surgical site for healing.