TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

Teknik Operasi Oesophagotomy dan Oesophagostomy

Oleh :

Nelci Elisabeth Bolla 1709511034

Putu Prema Candrayani 1709511052

Berliani Susi Ester Natara 1709511058

Martina Tiodora Sitohang 1709511063

Agnes Merina Galis Afonso 1709511129

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

TAHUN 2020

i
 RINGKASAN

Oesophagotomy adalah tindakan operasi yang dilakukan dengan mengincisi pada

dinding esophagus untuk membuka lumen esophagus. Indikasi terjadi bila terdapat
obstruksi esophagus atau untuk mengeluarkan benda asing. Tempat operasi dapat
ditentukan dengan cara palpasi untuk menentukan letak sumbatan esophagus oleh adanya
benda asing. Oesophagectomy dapat dilakukan secara longitudinal atau transversal
tergantung dari tujuan dilakukannya esophagotomy tersebut. Incisi sebaiknya di buat pada
bagian esophagus yang sehat dengan panjang incisi yang di sesuaikan dengan kebutuhan
pembedahan. Untuk pengeluaran benda asing tarikan perlahan pada esophagus dapat
dilakukan. Oesophagostomy pada dasarnya memiliki kesamaan dengan esophagotomy,
yang membedakan di antara keduanya adalah hasil akhir dari proses pembedahan tersebut.
Pada esophagostomy pembukaan pada lumen esophagus bertujuan untuk memasukkan
feeding tube atau selang untuk pemberian pakan secara langsung ke lambung

Kata Kunci : Oesophagotomy, Oesophagostomy, Operasi

SUMMARY

Oesophagotomy is a surgical procedure performed by incising the esophageal wall

to open the esophageal lumen. Indication occurs when there is esophageal obstruction or
to remove a foreign object. The operation site can be determined by palpation to determine
the location of the esophageal obstruction by the presence of a foreign object.
Oesophagectomy can be performed longitudinally or transversally depending on the
purpose of the esophagotomy. Incisions should be made in a healthy part of the esophagus
with the length of the incision that is adjusted according to the need for surgery. For
expulsion of a foreign object, a gentle pull on the esophagus can be done. Oesophagostomy
basically has similarities with esophagotomy, the difference between the two is the end
result of the surgery. In esophagostomy, the opening in the esophageal lumen aims to insert
a feeding tube or tube for feeding directly into the stomach

Keywords : Oesophagotomy, Oesophagostomy, Surgical

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 KATA PENGANTAR

Puji syukur kehadirat Tuhan Yang Maha Esa atas segala rahmat dan karunia-Nya
sehingga Paper Ilmu Bedah Khusus Veteriner yang berjudul “Teknik Operasi
Oesophagotomy dan Oesophagostomy” ini dapat tersusun hingga selesai. Tidak lupa kami
juga mengucapkan terima kasih kepada dosen pembimbing atas bimbingannya dan teman
– teman yang telah berkontribusi dalam penyusunan paper ini, sehingga kami dapat
menyelesaikan paper ini.

Tulisan ini dibuat untuk memenuhi tugas Ilmu Bedah Khusus Veteriner. Tetapi
sangat dimungkinkan dalam penyusunan masih banyak kekurangan, baik dalam penyajian
materi maupun dalam penulisan. Karena keterbatasan pengetahuan maupun pengalaman
kami, kami yakin masih banyak kekurangan dalam penyusunan paper ini. Oleh karena itu
kami sangat mengharapkan saran dan kritik yang membangun dari pembaca demi lebih
baiknya tulisan yang selanjutnya. Harapan kami semoga paper ini dapat menambah
pengetahuan dan pengalaman bagi para pembacanya.

Denpasar, 10 Oktober 2020

Penyusun

iii
 DAFTAR ISI

RINGKASAN .................................................................................................. ii

SUMMARY..................................................................................................... ii

KATA PENGANTAR ..................................................................................... ii

DAFTAR ISI ................................................................................................... iii

DAFTAR GAMBAR ....................................................................................... iv

BAB I PENDAHULUAN ................................................................................ 1

1.1 Latar Belakang ..................................................................................... 1

1.2 Rumusan Masalah ................................................................................ 1
1.3 Tujuan Penulisan .................................................................................. 1
1.4 Manfaat Penulisan ................................................................................ 2

BAB II PEMBAHASAN ................................................................................. 3

2.1 Terminologi Oesophagotomy dan Oesophagostomy ............................... 3

2.2 Indikasi Oesophagotomy dan Oesophagostomy ..................................... 4
2.3 Persiapan Operasi Oesophagotomy dan Oesophagostomy ...................... 4
2.4 Teknik Operasi Oesophagotomy dan Oesophagostomy .......................... 5
2.5 Pasca Operasi Oesophagotomy dan Oesophagostomy ............................ 9

BAB III PENUTUP ......................................................................................... 10

3.1 Kesimpulan .......................................................................................... 10

3.2 Saran .................................................................................................. 10

DAFTAR PUSTAKA ...................................................................................... 11

LAMPIRAN .................................................................................................... 12

iv
 DAFTAR GAMBAR

Gambar 1 ........................................................................................................ 3

Gambar 2 ........................................................................................................ 6

Gambar 3 ........................................................................................................ 7

Gambar 4 ........................................................................................................ 7

Gambar 5 ........................................................................................................ 8

Gambar 6 ........................................................................................................ 8

Gambar 7 ........................................................................................................ 9

Gambar 8 ........................................................................................................ 9

Gambar 9 ........................................................................................................ 9

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 BAB I

PENDAHULUAN

1.1 Latar Belakang

Sistem digesti (digestive system) adalah sistem organ dalam tubuh hewan yang
menerima makanan, mencernanya menjadi energi dan nutrisi, serta mengeluarkan sisa
proses tersebut melalui rectum. Sistem digesti antara satu hewan dengan yang lainnya
berbeda-beda.
Secara spesifik, sistem digesti berfungsi untuk mengambil makanan,
memecahnya menjadi molekul nutrisi yang lebih kecil, menyerap molekul tersebut ke
dalam alirah darah, kemudian membersihkan tubuh dari sisa-sisa makanan.
Organ-organ yang termasuk di dalamnya yaitu : mulut, faring, esofagus,
lambung, usus halus serta usus besar. Dari usus besar makanan akan dibuang keluar
tubuh melalui rektum.
Bedah sistem digesti adalah bedah yang dilakukan pada pasien (hewan) yang
mengalami gangguan atau kelainan pada sistem digesti. Salah satunya yaitu
Oesophagotomy dan Oesophagostomy yang merupakan pembedahan pada
esofagus. Oleh karena itu, dalam paper ini akan membahas tentang teknik operasi
Oesophagotomy dan Oesophagostomy pada hewan.
1.2 Rumusan Masalah
1.2.1 Apa yang dimaksud dengan teknik operasi Oesophagotomy dan
Oesophagostomy?
1.2.2 Apa saja tujuan dan manfaat dari teknik operasi Oesophagotomy dan
Oesophagostomy?
1.2.3 Bagaimana persiapan operasi pada operasi Oesophagotomy dan
Oesophagostomy?
1.2.4 Bagaimana teknik operasi Oesophagotomy dan Oesophagostomy?
1.2.5 Bagaimana perawatan pasca operasi Oesophagotomy dan Oesophagostomy?
1.3 Tujuan Penulisan
1.3.1 Untuk mengetahui definisi dari Oesophagotomy dan Oesophagostomy
1.3.2 Untuk mengetahui tujuan dan manfaat dari operasi Oesophagotomy dan
Oesophagostomy
1.3.3 Untuk mengetahui pre-operasi, teknik operasi, dan perawatan pasca operasi
Oesophagotomy dan Oesophagostomy

1
1.4 Manfaat Penulisan
Setelah melakukan penulisan diharapkan para mahasiswa dapat mengerti dan
mengetahui manfaat dan kegunaan operasi Oesophagotomy dan Oesophagostomy.
Selain itu diharapkan mahasiswa mengerti dan mengetahui bagaimana tata cara
pelaksanaan operasi Oesophagotomy dan Oesophagostomy.

2
 BAB II

PEMBAHASAN

2.1 Terminologi Oesophagotomy dan Oesophagostomy

Oesophagotomy adalah tindakan operasi yang dilakukan dengan mengincisi
pada dinding esophagus untuk membuka lumen esophagus (Sudisma, 2016).
Oesophagectomy adalah tindakan operasi dengan melakukan reseksi parsial seluruh
atau sebagian esophagus. Indikasi dari teknik operasi ini adalah bila terdapat obstruksi
esophagus atau untuk mengeluarkan benda asing. Tempat operasi dapat ditentukan
dengan cara palpasi untuk menentukan letak sumbatan esophagus oleh adanya benda
asing. Indikasi lain seperti adanya kanker atau tumor pada daerah esophagus sebelum
menyebar pada daerah atau bagian lainnya. Oesophagectomy juga dilakukan untuk
penyakit akut serperti atresia esophagus, achalasia atau cedera kaustik.
Oesophagostomy pada dasarnya memiliki kesamaan dengan esophagotomy,
yang membedakan di antara keduanya adalah hasil akhir dari proses pembedahan
tersebut. Pada esophagostomy pembukaan pada lumen esophagus bertujuan untuk
memasukkan feeding tube atau selang untuk pemberian pakan secara langsung ke
lambung. Kelebihan penggunaan feeding tube dibandingkan dengan penggunaan
infuse adalah komplikasi pasca pemasangan infus seperti infeksi akibat cateter yang
tidak steril. Pemasangan feeding tube pada esophagus lebih dipilih karena kemudahan
dalam proses pemasangan dan juga sedikitnya komplikasi yang akan terjadi, dan juga
karena proses pemberian pakan dapat dilakukan oleh pemilik hewan.

Gambar 1. Oesophagotomy. A: Insisi pada Ventral Midline Cervic. B dan C:

Preparasi Muskulus. (Sumber : Fossum, 2009).

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2.2 Indikasi Oesophagotomy dan Oesophagostomy
Indikasi terjadi bila terdapat obstruksi esophagus atau untuk mengeluarkan
benda asing, selain itu untuk membantu hewan yang mengalami anoreksia, atresia
esophagus, achalasia atau cedera kaustik hewan yang mengalami trauma pada faring
(cedera faring) dan dapat di lakukan pada hewan yang mengalami mucositis.
2.3 Persiapan Operasi Oesophagotomy dan Oesophagostomy
Sebagaimana tindakan operasi atau pembedahan pada umumnya, untuk
melakukan esophagotomy dan esophagostomy diperlukan persiapan yang harus
dijalankan terlebih dahulu. Persiapan harus dilakukan agar proses pembedahan dapat
dilaksanakan sebaik mungkin dan dapat meminimalisir terjadinya komplikasi yang
tidak diinginkan pasca operasi. Persiapan operasi yang harus dilakukan adalah seperti
(1) persiapan pasien atau hewan yang akan dioperasi dan operator; (2) persiapan
ruangan, alat, bahan, dan obat; serta (3) premedikasi dan anestesi.
2.3.1 Persiapan Pasien dan Operator
Hewan yang akan diberi tindakan esophagotomy dan esophagostomy
diharuskan telah menjalankan pemeriksaan yang dilakukan oleh dokter hewan.
Rangkaian pemeriksaan yang dapat dilakukan adalah anamnesa, pemeriksaan
klinis, dan juga pemeriksaan laboratorium. Pemeriksaan laboratorium yang
dilakukan misalnya yaitu pemeriksaan menggunakan Roentgen ataupun
ultrasonografi. Esophagotomy dan esophagostomy dilakukan apabila telah
dinyatakan sesuai dengan indikasi yang ditetapkan agar tidak memperburuk
kondisi hewan atau pasien tersebut. Kondisi pasien harus disiapkan terlebih
dahulu agar siap diberi tindakan operasi dengan cara dipuasakan 12 jam sebelum
diberi tindakan operasi. Hewan dalam posisi lateral recumbency kanan dan
dilakukan intubasi untuk pemasangan selang esophagostomy. Sebelum
dilakukan operasi, bagian tubuh hewan sebagai daerah operasi dibersihkan dan
disiapkan secara aseptis sehingga rambut di sekitarnya harus dicukur untuk
mencegah terjadinya kontaminasi.
Selain hewan, operator juga harus disiapkan. Operator atau dokter hewan
yang melakukan tindakan operasi menggunakan pakaian steril yang lengkap
mulai dari kepala hingga kaki. Kondisi fisik dan psikis operator sebaiknya dalam
kondisi yang baik sehingga operasi dapat dilakukan sebagaimana mestinya
berdasarkan pengetahuan dan keterampilan yang telah dikuasai oleh operator
tersebut.

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 2.3.2 Persiapan Ruangan, Alat, Bahan, dan Obat
Ruangan sebagai tempat operasi sebaiknya dalam keadaan bersih dan
memiliki fasilitas memadai sehingga dapat menunjang pelaksanaan operasi
esophagotomy dan esophagostomy. Alat yang disiapkan untuk melakukan
operasi esophagotomy dan esophagostomy yaitu seperti bak instrumen steril,
handuk steril, hemostatic forceps, curved forceps, blade, scalpel holder, scalpel
blade, mayo scissor, jarum operasi yang telah disterilkan, needle holder, dan
aplikator jika melakukan esophagostomy.
Bahan-bahan yang disiapkan untuk melakukan operasi yaitu masker
bedah, sepasang sarung tangan steril, masker bedah, kain kasa steril, kain
surgery drape, spuit, akuades, tampon, dan benang operasi. Pada operasi
esophagostomy diperlukan bahan tambahan yaitu selang atau tabung
esophagostomy. Obat yang harus disiapkan yaitu premedikasi, anestesi, dan
antibiotik sebagai tambahan jika diperlukan.
2.3.3 Premedikasi dan Anestesi
Premedikasi dilakukan beberapa saat sebelum obat anestesi diberikan
kepada hewan dan dapat berfungsi untuk menginduksi jalannya anestesi.
Premedikasi yang dapat diberikan adalah acepromazine 0,02 mg/kg BB dan
bruphenorphine 0,02 mg/kg BB melalui intramuscular (IM) atau pada anjing
yang akan diberi tindakan esophagotomy diberikan diazepam 0.25 mg/kg berat
badan dan butorphanol 0.2 mg/kg berat badan melalui intravena
(Gokulakrishnan et al., 2020).
Anestesi yang digunakan dalam melakukan esophagotomy dan
esophagostomy yaitu menggunakan anestesi umum. Anestesi dapat
menggunakan ketamin dan xylazine atau dapat mengggunakan isofluran dengan
oksigen pada anjing yang akan dilakukan esophagotomy (Gokulakrishnan et al.,
2020).
2.4 Teknik Operasi Oesophagotomy dan Oesophagostomy
2.4.1 Teknik Operasi Oesophagotomy
Operasi Oesophagotomy dapat dilakukan secara longitudinal atau
transversal tergantung dari tujuan dilakukannya esophagotomy tersebut. Incisi
sebaiknya di buat pada bagian esophagus yang sehat dengan panjang incise yang

5
di sesuaikan dengan kebutuhan pembedahan. Untuk pengeluaran benda asing
tarikan perlahan pada esophagus dapat dilakukan.
Sebelum lakukan operasi hewan harus di persiapkan terlebih dahulu, bulu
di cukur dan kulit dipersiapkan secara aseptis. Setelah teranestesi hewan di
baringakan pada posisi dorsal recumbency (hewan kecil) dan dibaringkan ke
sebelah kanan (hewan besar). Pada hewan kecil dilakukan irisan pada bagian
tengah ventral leher (ventral midline cervicalis) dari larynx ke sternum.
Muskulus strenohyoidus dan sternocleidomastoidus kiri dan kanan
dipreparasi secara tumpul sehingga terlihat trachea. Esophagus terletak
disebelah kiri daripada trachea dan dengan preparasi tumpul terlihat lebih jelas.
Irisan pada esophagus dibuat secara longitudinal dan benda asing (corpora
aliena) dikeluarkan. Esophagus dijahit dengan 4-0 chromic catgut secara simple
interrupted. Muskulus tidak perlu dijahit, kulit dijahit dengan benang non
absorbable secara simple interrupted. Apabila kelainan terjadi pada cervikal
esophagus dilakukan insisi melalui ventral midline cervical (hewan kecil) atau
pada lateral cervical (hewan besar). Sedangkan kelainan pada thoracic
esophagus dilaukan insisi melalui lateral thoracotomi. Tetapi bila kelainan
terjadi pada abdominal esophagus dapat dilakukan insisi melalui midline
celiotomy.

Gambar 2. Irisan Midline Ventral Cervicalis

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 Gambar 3. Muskulus strenohyoidus dan sternocleidomastoidus kiri dan kanan
dipreparas

Gambar 4. Irisan pada esophagus dibuat secara longitudinal

2.4.2 Teknik Operasi Oesophagostomy

Pada esophagostomy pembukaan pada lumen esophagus bertujuan untuk
memasukkan feeding tube atau selang untuk pemberian pakan secara langsung
ke lambung. Kelebihan penggunaan feeding tube dibandingkan dengan
penggunaan infuse adalah komplikasi pasca pemasangan infus seperti infeksi
akibat cateter yang tidak steril maupun karena ketidakseimbangan elektrolit
pada tubuh hewan tersebut.
Pemasangan feeding tube pada esophagus lebih dipilih karena kemudahan
dalam proses pemasangan dan juga sedikitnya komplikasi yang akan terjadi, dan
juga karena proses pemberian pakan dapat dilakukan oleh pemilik.
Persiapan hewan memiliki kesamaan dengan prosedur pada
esophagotomy yaitu hewan di baringkan secara lateral recumbency dan semua
rambut yang mungkin mengkontaminasi daerah insisi atau dapat mengganggu
daerah insisi dapat di cukur. Untuk menentukan bagian yang di insisi dapat
dimasukkan forceps kedalam rongga mulut menuju esophagus.

7
 Setelah berada di esophagus forceps di angkat ujungnya untuk membuat
benjolan pada esophagus yang menandakan bagian yang akan di insisi. Insisi
dilakukan untuk membuka kulit dan kemudian esophagus yang besar sayatannya
bergantung pada besaran tube yang akan dipasang. Tube dimasukkan dengan
bantuan forceps tadi kemudian di balikkan menuju lambung. Setelah itu tube
dapat di fiksasi dengan menggunakan bantuan perban ataupun plester agar tidak
bergerak ataupun berpindah.

Gambar 5. Aplikator esophagus tube

Gambar 6. Membuat sayatan kecil sampai mengenai ujung forceps bagian

kanan

8
 Gambar 7. Membuka forceps, pegang ujung distal dari saluran
esophagostomy dan mengunci forceps

Gambar 8. Gunakan hemostat untuk meligasi saluran esophagus

Gambar 9. Ketika sudah ditempatkan dengan benar, akhir feeding selang akan
"dibengkokkan" dari caudal ke cranial.

2.5 Pasca Operasi Oesophagotomy dan Oesophagostomy

Setelah operasi oesophagotomy, hewan dipuasakan selama 4-6 hari, diberi
makanan secara parental (infuse), dan diberi pengobatan. Pada operasi
oesophagostomy dilakukan pemantauan peletakan feeding tube dan perawatan luka
pasca operasi. Untuk mencegah infeksi dapat diberikan antibiotik secara intramuskuler
maupun multivitamin untuk menjaga kondisi tubuh.

9
 BAB III

PENUTUP

3.1 Kesimpulan
Oesophagotomy adalah tindakan operasi yang dilakukan dengan mengincisi
pada dinding esophagus untuk membuka lumen esophagus. Indikasi terjadi bila
terdapat obstruksi esophagus atau untuk mengeluarkan benda asing. Pada
esophagostomy pembukaan pada lumen esophagus bertujuan untuk memasukkan
feeding tube atau selang untuk pemberian pakan secara langsung ke lambung.
Persiapan operasi yang harus dilakukan adalah seperti persiapan pasien atau
hewan yang akan dioperasi dan operator, persiapan ruangan, alat, bahan, dan obat;
serta premedikasi dan anestesi.Operasi Oesophagotomy dapat dilakukan secara
longitudinal atau transversal tergantung dari tujuan dilakukannya esophagotomy
tersebut. Incisi sebaiknya di buat pada bagian esophagus yang sehat dengan panjang
incise yang di sesuaikan dengan kebutuhan pembedahan.
Setelah operasi oesophagotomy, hewan dipuasakan selama 4-6 hari, diberi
makanan secara parental (infuse), dan diberi pengobatan. Pada operasi
oesophagostomy dilakukan pemantauan peletakan feeding tube dan perawatan luka
pasca operasi
3.2 Saran
Hewan pasca operasi sebaiknya dirawat dengan baik dan dilakukan pemantauan.
Dapat disarankan juga kepada pemilik hewan untuk selalu memperhatikan hewan agar
tidak menelan beda asing disekitarnya yang menyebabkan hewan kesakitan. Terima
kasih

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 DAFTAR PUSTAKA

Bhattacharya, S., Monsang, S. W., Lalzawmliana, V., Baishya, M. P., & William, J. B.
(2019). Oesophagotomy for Management of Foreign Body Obstruction in a Non-
Descript Cow. Int. J. Pure App. Biosci, 7(3), 346-349.

Fink, L., Jennings, M., & Reiter, A. M. (2014). Esophagostomy feeding tube placement in
the dog and cat. Journal of veterinary dentistry, 31(2), 133-138.

Gokulakrishnan et al. (2020). Retrieval of a Foreign Body through Thoracic

Oesophagotomy in a Shih Tzu Dog. International Journal of Science and Research,
Vol. 9(2): 93-94.

Kangmaruf. 2016. Teknik Operasi Oesophagotomy, Oesophagostomy, dan

Oesophagectomy pada Hewan (Bedah Sistem Digesti).
https://mydokterhewan.blogspot.com/2016/05/teknik-operasi-
oesophagotomy.html. Diakses pada 07 Oktober 2020

Monnet E dan Smeak DD. 2020. Gastrointestinal Surgical Techniques in Small Animals.
Hoboken, NJ: John Wiley & Sons.

Santos, C. E. M. D., Rahal, S. C., Damasceno, D. C., & Hossne, R. S. (2009).

Esophagectomy and substitution of the thoracic esophagus in dogs. Acta Cirurgica
Brasileira, 24(5), 353-361.

Sudisma, I.G.N., Jaya, A.A.G.W., Putra, I.G.Ag.P., Gorda, I.W. 2016. Buku Ajar
IlmuBedah Veteriner dan Teknik Operasi. Penerbit Universitas Udayana.
Denpasar

Vigano F, DVM, SCMPA, Cert EM & S, Lorenzo S, DVM, N Carminati, DVM. 2017. A
New and Easy Procedure to Place an Esophagostomy Tube into Dogs and Cats.
Topics in Compan An Med 32.118–120

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STEP-BY-STEP
Esophagostomy Feeding Tube Placement in the Dog and Cat
Lisa Fink, DVM; Michael Jennings, VMD; Alexander M. Reiter, Dipl. Tzt., Dr. med. vet.

Partial or complete anorexia can occur in dogs and cats secondary to extensive oral and
maxillofacial trauma, intraoral pathology, and following extensive oral and maxillofacial
surgery or radiation therapy. Providing adequate nutritional support is imperative if anorexia has
been present for longer than 3 to 5-days or the patient is not expected to eat within 2 to 3-days
postoperatively.1 Feline patients with hepatic lipidosis and those at risk for developing hepatic lipidosis should have nutritional
support implemented without delay.2 In dental and oral surgical patients, placement of a feeding tube in anticipation of anorexia
or inability to prehend (e.g., with maxillomandibular stabilization as part of jaw fracture repair) is recommended as part of a
comprehensive treatment plan. Client communication and involvement in the decision-making process is paramount and should be
started early on, as pet owners will be required to provide at-home feedings and tube care.1,3 While there can be a negative stigma
associated with feeding tubes for some clients, their undeniable benefits for the patient should be emphasized. It may be helpful to
show clients photographs of what is to be expected or introduce them to other clients who have had similar experiences.1

Figure 1
Photograph showing the basic supplies needed to place an esophagostomy feeding tube. On the tray are various types of tubes
including a red rubber cathetera (A) and a silicone feeding tubeb (B). Also shown are scalpel blades (C), sterile surgical gloves (D),
a large, curved forcepsc (E), a needle holder (F), 3-0 non-absorbable nylon sutureg (G), and a “Christmas tree” adaptord (H) with
an injection cape (I) (for use with a red rubber catheter).

J VET DENT Vol. 31 No. 2 Summer 2014 133

 Esophagostomy tubes in particular are an excellent option
for patients with insufficient caloric intake, requiring temporary
enteral nutritional support while circumventing the oral cavity
to allow for healing, or as part of end-of-life care.4 Unlike
gastrostomy or jejunostomy tubes, esophagostomy tubes are
inexpensive, easy to place, and require a short anesthesia time
for placement.3,5 While nasoesophageal feeding tubes are easy
to place and do not require general anesthesia, their small bore
requires an all liquid diet, making administration of medications
difficult.2 Additionally, nasoesophageal feeding tubes are only
selected for patients that require short-term nutritional support
(< 10-days duration) and would not be appropriate for an animal
in need of mid- to long-term nutritional support.2 If a feeding
tube is indicated, placement can be coupled with anesthesia
for oral and maxillofacial surgery and should be done prior
to maxillomandibular stabilization or any procedure where
wide mouth opening will be compromised. Esophagostomy
tubes can readily be maintained for up to 8-weeks with proper
home care.1 Contraindications for esophagostomy feeding tube
placement include esophageal disease or dysfunction (such
as megaesophagus, esophagitis, or stricture), uncontrolled
vomiting, reduced gag reflex, or reduced consciousness.1,3,4
Active vomiting while an esophagostomy tube is in place can
lead to aspiration pneumonia or necessitate replacement of
the displaced device under general anesthesia.5 Complications
associated with esophagostomy tubes include infection or
swelling at the stoma site, gastroesophageal reflux (due to
placement of the tube across the lower esophageal sphincter),
removal of the tube by the patient, kinking or obstruction of the
tube, esophageal perforation, and swelling of the head and neck
due to overly tight neck wrap placement.2,4-6 Standard red rubber
cathetersa or specific silicone or polyurethaneb feeding tubes can
be used (Fig. 1).1,3 Appropriate tube size will vary depending
on the size of the patient. Size 12-14 French are recommended
for cats and small dogs, while sizes 14-18 French can be used
for larger canine patients.1 The patient’s nutrition plan can be
individually customized based on its energy requirements using
resting energy requirement formulas or via consultation with a
veterinary nutritionist.
After being placed under general anesthesia, the dog or
cat should be positioned in right lateral recumbency. While
esophagostomy tubes can be placed from either side of the
neck, the cervical esophagus is left of the midline and thus
more accessible from the left side. Prior to esophagostomy tube
placement, the lateral neck, extending from the ramus of the
mandible to the thoracic inlet, should be clipped and the skin
aseptically prepared for surgery (Fig. 2).4 Some clinicians prefer
to enlarge the pre-made orifices on the distal aspect of the tube
in order to avoid future clogging by food.6 The jugular vein and
wing of the atlas (1st cervical vertebra) can be used as anatomic
landmarks for the initial incision, which should be made in the
skin dorsal to the jugular vein but ventral to the wing of the
atlas (Fig. 2).4,7 A large, curved forcepsc is placed through the
mouth and into the esophagus. The tip of the forceps is pushed
laterally to make a small tent in the skin dorsal to the jugular
vein, but ventral to the wing of the atlas (Fig. 3). A #10 or #15
scalpel blade is used to make a 5-mm full thickness incision
134 J VET DENT Vol. 31 No.2 Summer 2014
directly over the protruded tips of the forceps through the
skin, subcutaneous tissues, and into the esophagus (Fig. 4).3,4
The incision should continue until the metal of the tips of the
forceps is seen, but should be kept small in order to keep the
stoma tight around the tube.2 The tips of the forceps can now
be pushed out through the incision (Fig. 4). The tube should
be measured and marked from the proposed insertion site to
the seventh to ninth intercostal space to ensure that the end of
the catheter is placed in the distal esophagus and not across the
lower esophageal sphincter (Fig. 5).3,5 The distal aspect of the
feeding tube is placed into the jaws of the forceps, the forceps
are locked, and the distal aspect of the tube is pulled orally
and out through the mouth (Fig. 6). This step ensures that the
tube is placed in the esophagus and not inadvertently tunneled
in the subcutaneous tissues.4 The distal end of the tube is then
redirected (taking care not to loop it under the cord that secures
the endotracheal tube in position) and pushed down into the
esophagus at which point the external portion of the tube flips
from pointing caudally to pointing rostrally (Fig. 7).4 The tube
is then inserted farther until the pre-marked area is at the level
of the stoma. It is sealed with either a pre-existing injection
port cover or a “Christmas tree” adaptord and injection cape. At
this point, the feeding tube placement should be checked with
a lateral thoracic radiograph or via endoscopy to ensure proper
placement in the distal esophagus (and not in the trachea, lower
esophageal sphincter, stomach, or subcutaneous tissues) [Fig. 8].3,4 If
the tube is not radiopaque, a small amount of iodinated contrast
mediumf can be instilled just prior to obtaining a radiograph.3
The esophagostomy tube should be secured in place with a
purse-string suture in the skin surrounding the stoma followed
by a “Chinese finger-trap” suture using 2-0 or 3-0 non-
absorbable nylon sutureg (Fig. 9).3,4,8 The Chinese finger-trap
suture acts as a “friction suture” which allows for tightening
around the tube, as tension is placed on it.8 An extra tacking
suture in the periosteum of the wing of the atlas may be placed
prior to performing the purse-string and finger-trap.9 Once the
tube is secured, a loose neck wrap can be placed using a non-
adherent gauze padh, anti-bacterial ointmenti, cast paddingj,
and a light layer of flexible self-adherent bandage materialk
(Fig. 10).4,5 The bandage should be loose enough to allow the
animal to move its head freely and to prevent neck swelling.4,5
The stoma should be monitored and cleansed daily using dilute
chlorhexidine or povidone-iodine.3 Washable fabric neckwrapsl
have become commercially available for cats and dogs of all
sizes that are esthetically pleasing, and eliminate the need for
bandage changes (Fig. 10). There is a removable protector pad
which can be switched daily at the time of stoma maintenance.
An Elizabethan collar may be necessary to deter the animal
from scratching at, and removing the tube.4,6 Once the patient
is readily eating on its own, the feeding tube may no longer be
required. The sutures can be cut, the proximal tube end kinked
(to avoid movement of any tube content within its lumen), and
the tube removed in the awake patient. The stoma will heal
by second intention and appear closed in 24 to 48-hours.6 The
procedure and anatomic landmarks are the same in the canine
patient. The placement of an esophagostomy feeding tube in a
cat is described step-by-step.
Figure 2
Photographs of the head and neck of a cat showing the area from the ramus of the mandible to the thoracic inlet clipped. The
skin needs to be aseptically prepared prior to incising (A). The ideal incision site for esophagostomy tube placement (B) is
shown (broken line) dorsal to the jugular vein (j, solid lines) and ventral to the wing of the atlas (a).

Figure 3
Photograph showing a large, curved forcepsc being placed
through the mouth and into the esophagus. The tip of the
forceps is pushed laterally to make a small tent in the skin
(broken line) dorsal to the jugular vein (j) and ventral to the
wing of the atlas (a).

Figure 4
Photographs showing a #10 scalpel blade being used to make a 5-mm, full-thickness incision directly over the protruded tips
of the forceps through the skin, subcutaneous tissues, and into the esophagus (A). The incision should continue until the metal
of the tips of the forceps is seen, but be kept small in order to maintain tightness of the stoma around the tube (B).

J VET DENT Vol. 31 No. 2 Summer 2014 135

 Figure 5
Photograph showing measurement of the tube
from the incision site to the 8th intercostal space
(marked with white tape). The tube can be
marked using a permanent marker or by utilizing
the existing numbers on the tube as a landmark.

Figure 6
Photographs showing the distal aspect of the feeding tube being placed into the jaws of the forceps (A). The
forceps are then locked, and the distal aspect of the tube is pulled orally and out through the mouth (B). This step
ensures that the tube is placed in the esophagus and not inadvertently tunneled in the subcutaneous tissues.

Figure 7
Photographs showing the distal end of the tube being
pulled out through the mouth (A) prior to being redi-
rected and pushed down into the esophagus with the
operator’s fingers (B), at which point the external por-
tion of the tube flips from pointing caudally to pointing
rostrally (C).

136 J VET DENT Vol. 31 No.2 Summer 2014

Figure 8
Prior to securing the tube with sutures, proper esophagostomy
tube placement should be confirmed with a lateral thoracic
radiograph (A) or via endoscopy (B, C). On the thoracic radio-
graph, the radiopaque endotracheal tube can be seen in the
thoracic inlet (large white arrow), and the tip of esophagostomy
tube can be seen in the 8th - 9th intercostal space (arrowhead).

Figure 9
Photographs showing the suture technique to secure the tube in position after proper placement is confirmed. The tube is sutured
around the stoma using 2-0 or 3-0 nylon sutureg in a purse-string pattern (A). This is followed by a “Chinese finger-trap” suture pattern
to provide secure anchorage of the tube to the skin (B).

J VET DENT Vol. 31 No. 2 Summer 2014 137

 Figure 10
Photographs showing bandage materials used to wrap the neck after the tube is secured in place. A loose neck wrap can
be placed using a non-adherent gauze padh, anti-bacterial ointmenti, cast paddingj, and a light layer of flexible self-adherent
bandage materialk (A). Washable fabric neck wrapsl have become commercially available for cats and dogs of all sizes, are
esthetically pleasing, and eliminate the need for bandage changes (B).

____________________________________________________
a Kendall feeding tube and urethral catheter, Covidien LLC., Mansfield, MA
b Surgivet feline esophagostomy tube, Smiths Medical, Dublin, OH
c Curved Rochester-Carmalt forceps, Integra Miltex, York, PA
d BD catheter adapter, BD, Franklin Lakes, NJ
References
1. Larsen JA. Enteral nutrition and tube feeding. In: Fascetti AJ, Delaney SJ, eds. Applied
veterinary clinical nutrition. Hoboken: Wiley Blackwell, 2012; 329-334.
2. Perea SC. Critical care nutrition for feline patients. Top Comp Anim Med 2008; 23: 207-215.

e Male adaptor plug, Abbott Laboratories, N. Chicago, IL 3. Bexfield N, Watson P. How to place an oesophagostomy tube. BSAVA Comp 2010; 51: 12-16.

f Omnipaque (Iohexal), GE Healthcare, Princeton, NJ
g Ethilon (Nylon suture), Ethicon Inc., Somerville, NJ
h Curad non-adherent pad, Medline Industries, Inc., Mundelein, IL
i Triple antibiotic ointment, Perrigo, Allegan, MI
j Specialist cast padding, Johnson & Johnson, New Brunswick, NJ
k 3M Vetrap bandaging tape, 3M, Minneapolis, MN
l Kitty Kollar, Jorgensen Laboratories, Inc., Loveland, CO
4. Kahn SA. Placement of canine and feline esophagostomy feeding tubes. Lab Anim 2007;
36: 25-26.
5. Levine PB, Smallwood LJ, Buback JL. Esophagostomy tubes as a method of nutritional
management in cats: a retrospective study. J Am Anim Hosp Assoc 1997; 33: 405-410.
6. Devitt CM, Seim HB. Clinical evaluation of tube esophagostomy in small animals. J Am Anim
Hosp Assoc 1997; 33: 55-60.
7. Formaggini L. Normograde, minimally invasive technique for oesophagostomy in cats. J Feline
Med Surg 2009; 11: 481-486.

8. Smeak DD. The Chinese finger trap suture technique for fastening tubes and catheters. J Am

Author Information
Anim Hosp Assoc 1990; 26: 215-218.

9. Mathews KG. Surgical placement of feeding tubes. In: Proc North Am Vet Conf 2006;
From the Ryan Veterinary Hospital of the University of Penn- 20: 1419-1422.
sylvania, 3900 Delancey Street, Philadelphia, PA, 19104. Email:
LFink@vet.upenn.edu

138 J VET DENT Vol. 31 No.2 Summer 2014

Bhattacharya et al Int. J. Pure App. Biosci. 7 (3): 346-349 (2019) ISSN: 2320 – 7051
Available online at www.ijpab.com
DOI: http://dx.doi.org/10.18782/2320-7051.7316 ISSN: 2320 – 7051
Int. J. Pure App. Biosci. 7 (3): 346-349 (2019)
Case Study

Oesophagotomy for Management of Foreign Body Obstruction in

a Non-Descript Cow
Sabyasachi Bhattacharya1, Shongsir Warson Monsang2*, V. Lalzawmliana1, M. P. Baishya1 and
Justin B. William3
1
Assistant Professor, 2Associate Professor, 3Professor
Department of Surgery & Radiology, College of Veterinary Sciences & A. H., R. K. Nagar, Tripura (W), India
*Corresponding Author E-mail: warsonmonsang@gmail.com
Received: 23.02.2019 | Revised: 30.03.2019 | Accepted: 7.04.2019

ABSTRACT
A non-descript free ranging milch cow reported with the history of profuse salivation, inability to
swallow, respiratory distress, abdominal distension was diagnosed clinically as cervical
oesophageal obstruction. Surgery was aseptically done under proper sedation and foreign body
was removed without any complications until 6 months of postoperative follow-up.
Key words: Oesophagotomy, Sedation, Xylazine, Cow.

INTRODUCTION coconut5, palm kernels2, medicated boluses,

Oesophageal obstruction or choke which is
considered as one of the most important
disorder or disease of cattle and horses may be
either intraluminal or extra luminal based on
the type of obstruction3. In cattle, it commonly
occurs at the pharynx, the cranial aspect of the
cervical oesophagus, the thoracic inlet, or the
base of the heart7 and obstruction of the
oesophagus prohibits the process of eructation
which may lead to development of severe free
gas bloat. Long standing cases of formation of
bloat can be life threatening if not treated in
time9, due to increase in the intra-abdominal
pressure which may result in respiratory
distress of the animal.
Many authors retrieved foreign objects
like large feedstuff, vegetables,
phytobezoars , pieces of leather or rubber12,
15
and trichobezoars1, in large animals. The
present paper reports cervical oesophageal
obstruction caused by fresh potato and its
surgical management in a non-descript milch
cow.
CASE HISTORY AND OBSERVATION
A non-descript free ranging cow aged about 5
years was presented with the history of
copious salivation, respiratory distress,
dysphagia along with slight abdominal
distention for the past three days. The case was
handled already at the local treatment centre
with some medicinal therapy with no marked
improvement. On clinical examination, there
was copious salivation (Fig.1) and the
respiratory rate, heart rate and rectal
temperature were slightly elevated.

Cite this article: Bhattacharya, S., Monsang, S.W., Lalzawmliana, V., Baishya, M.P., William, J.B.,
Oesophagotomy for Management of Foreign Body Obstruction in a Non-Descript Cow, Int. J. Pure App.
Biosci. 7(3): 346-349 (2019). doi: http://dx.doi.org/10.18782/2320-7051.7316

Copyright © May-June, 2019; IJPAB 346

Bhattacharya et al Int. J. Pure App. Biosci. 7 (3): 346-349 (2019)
Rumination was absent and a high pitched
ping sound was recorded on auscultation along
with moderate level of dehydration. On
palpation of the neck along the jugular furrow,
a hard mass approximately the size of a small
tennis ball was felt at the mid cervical region.
Surgical intervention was decided since the
attempt to dislodge the foreign body with
gentle massage and probang has failed.
TREATMENT AND DISCUSSIONS
A day before the surgery, the animal was fully
rehydrated with dextrose and normal saline
solutions to maintain the normal balance of
fluid and advised for removal of any feed and
water within 8 hours of surgery. Under mild
sedation with xylazine (@ 0.1mg/Kg BW,
IM), the cow was restrained in right lateral
recumbent position and the surgical site was
prepared aseptically under standard protocol.
2% lignocaine HCl was infiltrated just cranial
to the site of obstruction to produce adequate
local analgesia. A scalpel skin incision was
made over the swelling on the left side of the
neck along the dorsal aspect of the jugular
furrow. The fascia and the attached muscles
were bluntly separated to identify and expose
the oesophagus between the sterno-cephalicus
muscle and trachea. Thereafter, a 4-6
longitudinal incision was given on the
oesophagus just cranial to the site of
obstruction to remove the obstructed mass
carefully by gentle squeezing with thumb and
index fingers [Fig. 2(a) & (b)]. The mucosal
layer suffered from mild pressure necrosis
which was removed and freshened.
Subsequently, the mucosal layer was sutured
in simple continuous pattern using chromic
catgut no 2-0 and the submucosal and
muscularis layers were sutured together
separately in similar pattern (Fig.3). The skin
was sutured in a simple interrupted pattern
using a non-absorbable suture (Fig.4).
Postoperatively, systemic antibiotic and anti-
inflammatory drugs were administered strictly
for five days along with fluid therapy.
Copyright © May-June, 2019; IJPAB
ISSN: 2320 – 7051
Subsequently, it was advised to start feeding
with soft diet (gruel rice food) for about 10
days and changed the diet slowly to roughage
and green grass. The skin suture was removed
on the 14th day of post surgery although there
was a slight unhealed tissue at the periphery of
the wound (Fig.5). The animal made an
uneventful recovery and with no complications
during two months of observation.
In clinical practice, foreign body
oesophageal obstruction in bovines requires
immediate intervention, as blockade of the
oesophagus may inhibit eructation process and
cause severe bloat and respiratory problems. In
cattle, about 80% of oesophageal obstruction
occurs in the cervical region was reported due
to their peculiar feeding habits as compared to
other animals4,14. Oesophageal obstruction in
cattle can be diagnosed based on clinical signs,
radiography or by passing a probang and
skilled palpation, or passing flexible
endoscope8. Prompt surgical interventions and
corrective manipulations in due time are
important contributing factors for successful
outcomes6. Oesophageal obstruction due to
mango16, tarpaulin cloth13, tricho-
1
phytobezoar , has been corrected surgically
without any complication. In the present case,
we have successfully retrieved a fresh potato
as the causative agent for obstruction. The
prognosis is considered good if the
oesophageal obstructions are treated within 24
to 36 hr from the onset of clinical signs; and
worsens if they are not identified within 36 to
48 hr due to secondary ruminal tympany,
inflammation and necrosis of the oesophageal
mucosa10. In our present case, mild ruminal
tympany and superficial necrosis of the
mucosa was observed which was successfully
treated. The risk of post-operative
complications associated with an
oesophagotomy such as incisional dehiscence
and fistula formation was reported11, but in
present case, no such complications were seen
throughout the observation period.
347
Bhattacharya et al Int. J. Pure App. Biosci. 7 (3): 346-349 (2019) ISSN: 2320 – 7051

Fig. 1 Fig. 2(a) Fig. 2(b)

Fig. 1: Copious frothy salivation

Fig. 2 (a): Exposure of the foreign body (potato) in the mid cervical oesophagus.
Fig. 2 (b): Retrieved foreign body (potato) after oesophagotomy.

Fig. 3 Fig. 4 Fig. 5

Fig. 3: Closure of the submucosa and muscularis layer after oesophagotomy with non-absorbable suture
material (vicryl-1).
Fig. 4: External skin closure in horizontal mattress pattern using black braided silk.
Fig. 5: Suture removal after 14th day post surgery with maximum healing.

CONCLUSION 2. Hari Krishna, N. V. V., Sreenu, M. and

The present report illustrates the successful
surgical management of cervical oesophageal
obstruction by a fresh potato under sedation
and local analgesia.
REFERENCES
1. Gangwar, A. K., Devi, K. S., Singh, A. K.,
Yadav, N., Katiyar, N., Kale, S. S., Patel,
G. and Singh, H., Surgical Management of
Choke by a Tricho-Phytobezoar in a
Crossbred Cow. J. Vet. Adv., 3(3): 135-
138 (2013).
Copyright © May-June, 2019; IJPAB
Bose, V. S. C., An unusual case of
oesophageal obstruction in a female
buffalo. Buffalo Bulletin, 30(1): 4-5
(2011).
3. Haven, M. L., Bovine oesophageal
surgery. Vet. Clin. North Am. Food Anim.
Pract., 6: 359- 369 (1990).
4. Holfmeyr, C. F. B., Obstruction of
oesophagus by tarpaulin cloth in a buffalo
calf. Indian Vet. J., 78: 243-244 (1974).
5. Madhava Rao, T., Bharti, S. and
Raghavender, K. B. P., Oesophageal
348
Bhattacharya et al Int. J. Pure App. Biosci. 7 (3): 346-349 (2019)
obstruction in a buffalo. A case report.
Intas Polivet, 10: 1-3 (2009).
6. Meagher, D. M. and Mayhew, I. G., The
surgical treatment of upper oesophageal
obstruction in the bovine. Can. Vet. J., 19:
128-132 (1978).
7. Misk, N. A., Ahmed, F. A. and Semieka,
M. A., A clinical study in esophageal
obstruction in cattle and buffaloes. Egypt
Vet Med Assoc. 64: 83–94 (2004).
8. Patel, J. H. and Brace, D. M., Oesophageal
obstruction due to trichobezoar in a cow.
Canadian Vet. J., 36: 774-775 (1995).
9. Prakash, S., Jevakumar, K., Kumaresan,
A., Selvaraju, M., Ravikumar, K. and
Sivaraman, S., Management of Cervical
Choke Due to Beetroot – A Review of two
cases. Shanlax International Journal of
Veterinary Science. 1(3): 37-38 (2014).
10. Ravikumar, S. B., Arunkumar. P. and
Madhusudan, A., Oesophageal obstruction
in a buffalo - a case report. Intas Polivet,
4: 48-49 (2003).
Copyright © May-June, 2019; IJPAB
ISSN: 2320 – 7051
11. Ruben, J. M., Surgical removal of a
foreign body from the bovine oesophagus.
Vet. Rec. 100: 220 (1997).
12. Salunke, V. M., Ali, M. S., Bhokre, A. P.
and Panchbhai, V. S., Oesophagotomy in
standing position. An easy approach to
successful treatment of oesophageal
obstruction in buffalo. A report of 18
cases. IntasPolivet, 4: 366-367 (2003).
13. Sreenu, M. and Suresh kumar, R. V.,
Obstruction of oesophagus by tarpaulin
cloth in a buffalo calf. Indian Vet. J., 78:
243-244 (2001).
14. Smith, B. P., Large Animal Internal
Medicine. 4th ed. St. Louis, MO, USA:
Mosby; pp. 804–805 (2008).
15. Tyagi, R. P. S. and Singh, J., Ruminant
Surgery. Ist Edn. CBS Publishers and
Distributers, New Delhi, India. 1999. Pp-
192.
16. Veena, P., Ravikumar, A. and
Ramakrishna, O., Oesophageal obstruction
by a mango in a heifer. Indian Vet. J., 77:
794 (2000).
349
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/38031190

Esophagectomy and substitution of the thoracic esophagus in dogs

Article  in  Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia · September 2009
DOI: 10.1590/S0102-86502009000500004 · Source: PubMed

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 4 – ORIGINAL ARTICLE
Alimentary Tract

Esophagectomy and substitution of the thoracic esophagus in dogs1

Esofagectomia e substituição do esôfago torácico em cães

Carlos Eduardo Meirelles dos SantosI, Sheila Canevese RahalII, Débora Cristina DamascenoIII, Rogério Saad HossneIV

I
Master, Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine of Botucatu, UNESP, Sao Paulo, Brazil.
II
PhD, Chairman Full Professor, Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine of Botucatu, UNESP, Sao Paulo,
Brazil.
III
PhD, Department of Gynecology and Obstetrics, School of Medicine of Botucatu, UNESP, Sao Paulo, Brazil.
IV
PhD, Assistant Professor, Department of Surgery, School of Medicine of Botucatu, UNESP, Sao Paulo, Brazil.

ABSTRACT
Purpose: To evaluate a technique to remove the thoracic esophagus without thoracotomy and two methods for thoracic esophageal
replacement in dogs. Methods: 27 ex-vivo dogs were divided into three groups in order to evaluate: G1 – total thoracic esophagectomy
by the everting stripping method; G2 – total thoracic esophagectomy and esophageal substitution using the whole stomach; G3 – total
thoracic esophagectomy and esophageal substitution using fundus rotation gastroplasty. After esophageal resection in G1, the integrity
of the intrathoracic route was evaluated by endoscopy and tested with 1% methylene blue solution. Results: Visceral pleural rupture
was observed in all animals. However, this intrathoracic route made it possible to bring both esophagus substitutes (G2 and G3) to be
anastomosed to the cut end of the cervical esophagus. Conclusions: Thoracic esophageal substitution using the whole stomach
showed less anastomotic tension and was less technically demanding than the fundus rotation gastroplasty method. The ex-vivo
results support further studies to validate the techniques in clinical cases.
Key words: Surgery. Esophagectomy. Esophagus. Endoscopy. Dogs.

RESUMO
Objetivo: Avaliar, em cadáveres de cães, uma técnica para remoção do esôfago torácico sem toracotomia e dois métodos de substituição
do esôfago torácico. Métodos: Foram utilizados 27 cadáveres de cães. Estes foram aleatoriamente divididos em três grupos de nove
animais, em que se estudou: G1 – esofagectomia torácica total pelo método de invaginação retrógrada; G2 – esofagectomia torácica
total com substituição esofágica pelo estômago inteiro; G3 – esofagectomia torácica total com substituição esofágica por um gastrotubo
confeccionado de acordo com a técnica de Büchler de gastroplastia por rotação do fundo. Após a ressecção esofágica no grupo 1, a
integridade da rota intratorácica foi avaliada por endoscopia e solução de azul de metileno a 1%. Resultados: A ruptura da pleura
visceral ocorreu em todos os animais, especialmente no terço caudal. Entretanto, a rota transtorácica mediastinal permitiu a elevação
de ambos os substitutos esofágicos (G2 e G3) para a realização da anastomose com a extremidade caudal do esôfago cervical.
Conclusões: A substituição por estômago inteiro apresentou menor tensão na anastomose, maior facilidade e rapidez comparada à técnica
de gastroplastia por rotação do fundo. Os resultados em cadáveres suportam a realização de estudos clínicos para validação da técnica.
Descritores: Cirurgia. Esofagectomia. Esôfago. Endoscopia. Cães.
1
Research performed at Experimental Laboratory of Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine of Botucatu,
State University (UNESP), Sao Paulo, Brazil.

Introduction advantages and disadvantages5. These organs are mobilized to be

Esophageal diseases have sometimes been considered a
therapeutic challenge in dogs. If major areas of the esophagus have
been compromised complex surgical procedures to repair, to
remove or to substitute the compromised area are required1,2,3.
Esophagectomy that consists of a complete or partial
resection of the esophagus is usually used in human medicine4.
Total thoracic esophagectomy is performed, in general, using the
transthoracic route, transhiatal approach without thoracotomy
or by thoracoscopy. The removed esophagus is replaced using
the stomach, colon, or small bowel, and each procedure has
anastomosed to the cut end of the cervical esophagus using several
routes.
The ideal esophageal substitute should conform in size
and in function to the original structure especially regarding
peristaltic activity; it should not occupy too much space in the
thorax; and the patient should be able to swallow normally and
experience no reflux symptoms4. Additionally, in pediatric patients
the esophageal substitute should be able to withstand without
deterioration during temporal evolution4.
In dogs, thoracic esophageal replacement by small
intestine or colon is hampered by limited mobility of the vascular

353 - Acta Cirúrgica Brasileira - Vol. 24 (5) 2009


pedicle 2 . In addition the use of free colon autograft with
microvascular anastomosis has shown unsatisfactory results in
experimental studies6. In this way, substitutes for the esophagus
created from the stomach may be a better alternative.
The use of the whole stomach or gastric tubes as
substitutes for the esophagus are common procedures in human
patients7, but there are few clinical reports of their use in small
animals1. The present study evaluated a technique to remove the
thoracic esophagus without thoracotomy and two methods for
thoracic esophageal replacement in dogs, ex vivo, aiming at the
treatment of diseases associated with this species.
Methods
This study followed the guidelines for the care and use of
laboratory animals and was approved by the Ethics Committee of
our Veterinary School.
Twenty-seven dogs that had died or been euthanatized
due to reasons unrelated to this study were used; 12 males and 15
females, weighing 2-20 kg (median 6 kg), and aged 2 months to 10
years old (median 3 years and 2 months). The time between death
and accomplishment of the experiment did not exceed 24 hours.
FIGURE 1 – Illustration of the gastric vessels and the ligatures of their tributaries: (RG) Right gastric artery. (LG) Left gastric artery.
(SG) Short gastric arteries. (RGE) Right gastroepiploic artery. (LGE) Left gastroepiploic artery
Esophagectomy and substitution of the thoracic esophagus in dogs
The dogs were randomly divided into three groups of nine
animals each in order to evaluate: G1 – total thoracic esophagectomy
by the inverting stripping method; G2 – total thoracic
esophagectomy and esophageal substitution using the whole
stomach; G3 – total thoracic esophagectomy and esophageal
substitution using fundus rotation gastroplasty.
Surgical procedures
GROUP 1
Each dog was positioned in dorsal recumbency. The
ventral neck, thorax and abdomen were clipped, prepared, and
draped. A semi-rigid latex was orally placed into the lumen of the
stomach. The surgical procedure consisted of three main steps:
1. The abdomen was opened via midline incision
extending from the xiphoid to the caudal to the umbilicus. The
right gastric branches, right and left gastroepiploic branches were
ligated, but the vascular arcades were preserved. The short gastric
vessels and the left gastric vessels were ligated (Figure 1) and
the liver were retracted to expose the esophageal hiatus. The
gastroesophageal junction area was bluntly isolated.
Acta Cirúrgica Brasileira - Vol. 24 (5) 2009 - 354
Santos CEM et al
2. A ventral midline skin incision was made from the
middle third of the neck to the manubrium. To expose the caudal
cervical esophagus, the trachea and right carotid sheath were
retracted to the right.
3. The orogastric tube was pulled out through the
mouth so that two atraumatic clamps could be placed in the
gastroesophageal junction. An incision was made between the
clamps, and the cranial clamp was removed (Figure 2). The tube
was pulled caudally to protrude through the abdominal cavity,
FIGURE 2 – Points of incision of the esophagus (arrows) (cervical
esophagus and gastroesophageal junction)
355 - Acta Cirúrgica Brasileira - Vol. 24 (5) 2009
maintaining its proximal tip at the level of thoracic entrance. The
cervical esophagus was transected obliquely about 2cm from the
thoracic entrance (Figure 2). The caudal edge of the esophagus
incision was held to the tube’s proximal tip using four equidistant
simple interrupted sutures (Figure 3). The tube protruding from
the abdominal cavity was pulled gently and caudally, allowing the
esophagus inverting stripping. The esophagus was pulled through
the thorax in the direction of the abdominal cavity (Figure 3). The distal
esophagus remained attached to the diaphragm, and it was occluded.
FIGURE 3 – The edge of the esophagus incision was held to the tube’s
proximal tip using four equidistant simple interrupted sutures (arrow A).
The tube protruding from the abdominal cavity was pulled gently and
caudally (arrow B), allowing the esophagus inverting stripping
 Esophagectomy and substitution of the thoracic esophagus in dogs

4. The integrity of the intrathoracic route was evaluated
by videoendoscopy. The endoscopy was advanced to the heart base
level since after this point the visceral pleura could be injured. 1%
methylene blue solution was used to test for leaks. For this, the
operating table was elevated at 15 degrees and a cranial portion of
the sternum was removed for better observation.
GROUP 2
The dogs were positioned and prepared as previously
described for Group 1. The vessels and branches were isolated and
ligated as previously described for Group 1, for mobilization of
the greater and lesser curvature of the stomach. Heineke-Mikulicz
pyloroplasty was performed. The gastroesophageal junction was
divided, and the cut edge of the stomach was closed in two layers
with the first using a continuous suture and the second layer using
a continuous inverting seromuscular suture.
Total thoracic esophagectomy by the inverting stripping
method was performed as in Group 1. However, a second tube was
sutured together with the orogastric tube and the edge of the
esophagus, one inside the other (Figure 4). The orogastric tube
was removed during esophagectomy. The most distal part of the
second tube was sutured to the fundus region of the stomach using
four simple interrupted seromuscular sutures.
The stomach was pulled through the thorax in the
direction of the cervical region by pulling the proximal tip of
the second tube (Figure 5). After tube removal, a stomach stoma
was made and anastomosed to the cut end of the cervical
esophagus. Three equidistantly suture stitches were initially
placed. Additional full-thickness simple continuous pattern
sutures were then placed between the stitches until completely
closed.
The mobilized stomach wall was anchored to
diaphragmatic hiatus with two simple interrupted sutures to
prevent subsequent herniation. The celiotomy incision was closed
in a routine manner.
The esophagus and mobilized stomach were evaluated
using videoendoscopy.

FIGURE 4 – Esophagus removal by traction of the main tube and maintenance of the accessory
tube in the thoracic course

FIGURE 5 - (a) Accessory tube with one of its extremities in the cervical region and another sutured to
the stomach. (b) Traction of the accessory tube and exteriorization of the stomach in the cervical region

Acta Cirúrgica Brasileira - Vol. 24 (5) 2009 - 356

Santos CEM et al

GROUP 3

The gastric vessel ligatures, piloroplasty,

exposure and cut of the cervical esophagus were
similar to those described in Group 2.
Gastroplasty was performed beginning by
a horizontal cut of the lesser curvature distally to
the gastric stoma. The cut was extended following
the greater curvature toward the fundus-corpus
region 3 cm from the pyloric antrus and redirected
toward the lesser curvature to a point 1-2 cm
distally to the starting point. The gastric tube with
2 to 3 cm in diameter was built by the fundus, and
most of the gastric corpus and antrus formed the
neostomach (Figure 6). The edges of the
neoesophagus and neostomach were double-layer
apposed.
Total thoracic esophagectomy by the
inverting stripping method was performed as
described in Group 2, and the most distal part of
the second tube was sutured externally to the
neoformed gastric tube stoma. The neoformed
gastric tube was pulled through the thorax in
the direction of the cervical region by pulling
the proximal tip of the tube orally. The other
procedures were performed as described in
Group 2.

C o r re l a t i o n b e t w e e n a n a t o m i c a l
proportions and anastomotic tension

Because of the need to compare the

interferences of the anatomical measures in the
result of the surgical techniques in different sized
animals, it was necessary to have the individuals’
made uniform through the calculation of their
anatomical proportions. The anatomical proportions
were calculated for G2 and G3 dogs: between the
distance from the larynx to the pubis and from the
larynx to the xiphoid (proportion I); between the
esophageal substitute length and the distance of
the hiatus to the gastroesophageal anastomosis FIGURE 6 – Illustration of the steps for construction of a gastric tube according to
(proportion II); between the distance from the the fundus rotation gastroplasty technique
larynx to the xiphoid and the esophageal substitute
length (proportion III); between the distance from
the gastroesophageal anastomosis to the larynx
and the distance from the larynx to the pubis Results
(proportion IV); between the distance that the
esophageal substitute transcended the cut end of GROUP 1
the cervical esophagus and the distance from the
larynx to the pubis (proportion V). Esophagectomy by the inverting stripping method showed to be
easily performed in all animals since the esophagus was released by slight
Statistical analysis traction of the tube. According to endoscopic evaluation, small hemorrhage
points were observed in the medial (n=3) and caudal (n=1) thirds of the pleural
Pearson correlations were used when cavity. Pleural rupture was verified in three animals. The application of 1%
comparing Proportion V with the other Proportions. methylene blue aqueous solution showed pleural rupture in all animals, which
In order to compare Proportions V of Groups 2 was more frequent in the left caudal portion near the diaphragm (Table1).
and 3, the Wilcoxon nonparametric test for two The speed with which the solution filled the thoracic cavity was proportional to
independent samples was used. the extension and the number of ruptures.

357 - Acta Cirúrgica Brasileira - Vol. 24 (5) 2009

 Esophagectomy and substitution of the thoracic esophagus in dogs

TABLE 1 - Evaluation of the channel formed after thoracic esophagectomy by the inverting stripping method
as shown by endoscopic examination and methylene blue solution
Pleural rupture Pleural rupture Third of the Other
Dog
(endoscopic (methylene channel affected endoscopic
(number)
visualization) blue) by the rupture findings

1 P P RCr, LCr, LCa

2 A P LCa SP

3 A P LCa

4 P P RM

5 A P LM MHp

6 A P LCa SP/ MHp/ CaHp

7 A P LCa MHp

8 P P LCa , RCa

9 A P LCa

P, present. A, absent. RCr, right cranial. LCr, left cranial. LCa, left caudal. RM, right medial. LM, left
medial. RCa, right caudal. SP, slim pleura in the rupture locality. MHp, medial hemorrhagic point. CaHp,
caudal hemorrhagic point

GROUP 2

In one dog, the length of the short gastric vessels was
reduced, and the spleen was closely connected to the stomach. Seven
dogs showed direct extramural communication between the right
and left gastroepiploic arteries, and in two dogs such communication
was indirect. Removal of the thoracic esophagus by the inverting
stripping method was problematic in one dog showing an anatomic
curve proximally to the cardia, which prevented the tube from
reaching the stomach. Hence, the esophagogastric junction was
sectioned without passing the tube, and the accessory tube was
inversely pulled by endoscopic procedures. The esophageal
substitute reached the anastomotic region in all animals. The edge
of the suspended stomach exceeded the anastomotic region with
an average of 2.62% of the animals’ measure (Table 2).
Proportions II and III interfered with anastomotic tension
(Table 2), and there was no anastomotic tension for Proportion II
greater than 1.05 or Proportion III greater than 0.79. According to
the endoscopic evaluation, the region of the esophagogastric
anastomosis was closed during the first visualization, but it was
easily opened with a touch by a gastroscope in all animals. No
openings, leaks or lacerations were detected in the anastomotic
region. The esophageal channel consisting of the whole stomach
showed to be continuous and without obstructions (Figure 7).
The organ’s lumen was always greater than the esophageal lumen,
with longitudinal folds towards the stomach’s positioning.

TABLE 2 - Means of the anatomical proportionalities of dogs in groups 2 and 3

Proportion Proportion Proportion Proportion Proportion

I II * III* IV V (%)

G2 1.87 1.15* 0.85* 0.08 +2,62

G3 1.87 1.12* 0.83* 0.08 -0.46a / -7.05 b**

* p<0.05 (statistical comparison between Proportion V and the other Proportions). (a) neostomach inside
the thoracic cavity. (b) neostomach inside the abdominal cavity. **p<0.05 (statistical analysis between
groups 2 and 3); (+) opening of the gastric tube surpasses the esophageal section; (-) opening of the
gastric tube does not reach the esophageal section

Acta Cirúrgica Brasileira - Vol. 24 (5) 2009 - 358

Santos CEM et al
FIGURE 7 – Endoscopic evaluation of the esophagus replacement by the whole stomach:
lumen of the suspended stomach
GROUP 3
In one dog, the left artery and gastric vein were located
very close to the splenic vein and the caudal cava vein, and in
another the left gastric artery was adjacent to the gastric wall, which
required more careful dissection. In three animals, indirect extramural
communication between the right and left gastroepiploic arteries
was observed. In one dog, the rupture of the suture stitches applied
between the esophagus and the tube occurred when the esophagus
was removed, and further fixation was necessary. In all dogs, the
neostomach formed presented an appendix shape. Except for one
case in which gastric tube rupture occurred, the esophageal
substitute reached the distal cervical region of all animals;
however, that only took place when the neostomach was positioned
in the thoracic cavity. Five animals did not show tension in the
anastomotic region. The gastric tube extremity was away from the
anastomotic region with an average of 0.46% and 7.05% of the
animals’ measure when the neostomach was inside the thoracic
and abdominal cavities, respectively (Table 2). There was no
anastomotic tension for Proportion II greater than 1.13 or
Proportion III greater than 0.84 in the measurements taken with
the neostomach in the thoracic cavity. According to endoscopic
evaluation, the esophagogastric anastomotic region was closed
when firstly visualized, but it was later easily opened with a touch
by a gastroscope. No openings, leaks or lacerations were detected
in the anastomotic region. The course of the gastric tube was
continuous and regular, and showed a larger diameter than that of
359 - Acta Cirúrgica Brasileira - Vol. 24 (5) 2009
the cervical esophagus and a smaller diameter than the gastric
one. The “neostomach” had a larger diameter and, according to
retroflexion visualization, a type of sphincter was observed which
separated it from the gastric tube itself (Figure 8). In five dogs,
lateralization of the pylorus occurred, which made the passage of
the endoscope difficult (n=1) or impossible (n=4).
Discussion
The choice for the esophageal removal technique depends
on a number of factors such as type and location of the primary
lesion, safety and feasibility of the approach, patient condition, and
even the surgeon’s preference8. Esophagectomy by the inverting
stripping method as used in the present experiment was considered
to be a simple and effective procedure to remove the thoracic
esophagus in dogs, minimizing surgical time and the complications
associated with a thoracic approach. It was based on the technique
described by Ferreira9, who developed and successfully tested it
in 10 dogs, and further in human patients10.
Transhiatal resection has the advantages of avoiding
thoracotomy, reduced surgical trauma, and less pulmonary
complications5,11. The endoscopy performed after esophagectomy
in the dogs in Group 1 showed few and small areas of bleeding.
During evaluation 48 hours after esophagectomy without
thoracotomy in dogs, inexpressive hematoma, and no injury to
tissue and organs were observed by Ferreira9.

FIGURE 8 – Fundus rotation gastroplasty: retroflexion image showing the limit between
the gastric tube and the “neostomach”
An important limitation of esophagectomy by the
inverting stripping method is type and extension of the lesion.
In cases of infiltrative tumors for example, a direct vision of
compromised structures is necessary12. Esophagectomy without
thoracotomy has been used in human patients especially in cases
of megaesophagus8,10,13 or corrosive injuries5. Since the mediastinal
pleura is delicate and directly adhered to the adventice, pleural
rupture was observed, by endoscopy and the methylene blue
solution test in all animals in Group 1 after esophagectomy.
Hence, mechanical ventilation during the procedure and a
drainage system postoperative are necessary in cases in vivo.
There are several controversies concerning thoracic
esophageal replacement using the stomach as a tube, semitube or
whole stomach7,14. Besides the factors related to the adequacy of
blood supply, in dogs, the capacity of emptying the esophageal
substitute in a quadrupedal position should be considered.
Various techniques for isoperistaltic or antiperistaltic
gastric tubes have been proposed 15,16,17,18,19 . In the present
experiment, fundus rotation gastroplasty was used, which,
according to the authors20 has advantages in human patients, such
as the increase in the length of the gastric tube, increase in blood
flow at the tip of the gastric tube, and increase in the gastric reservoir
since it requires resection of a small part of the gastric corpus.
The tributaries of the right gastric vessels are maintained
in the fundus rotation gastroplasty used in human patients20.
However, in dogs, some differences were observed. The ligature
of the left gastric artery and vein was necessary to allow anastomosis
Esophagectomy and substitution of the thoracic esophagus in dogs
of the esophageal substitute with the cervical esophagus. For the
same reason, the ligature of the branches of right gastric vessels
was caudal rather than that usually used in human patients20. In
addition, in 8 dogs in Group 3, the gastric tube length was
inadequate for tension-free anastomosis, and the neostomach
was positioned inside the thoracic cavity. These differences are
probably associated with the length of the canine thorax.
On the other hand, esophageal substitution using the whole
stomach required less suture procedures. In addition, according to
the correlation between anatomical proportions and anastomotic
tension, the whole stomach technique, contrarily to fundus
rotation gastroplasty, surpassed the anastomotic region, indicating
that the use of whole stomach probably induces less anastomotic
tension. The significant relation between the absence of tension
and Proportion III enables the surgeon to obtain a previous
prognosis of the anastomotic tension by observing the patient’s
measures. The use of the measures of proportionalities allowed the
comparison of animals of different sizes, common in the studied
specie, therefore although their absolute measures are different,
the proportion among their anatomical segments is similar.
The whole stomach occupied more space in the thorax
than did the gastric tube, suggesting that the adjacent organs may
be compressed by alimentary content. However, radiographic studies
in human patients showed that the mobilized stomach acquires a
tubular shape during the course of time, and food is propelled chiefly
by gravity13. This last observation may be a problem in dogs.
Bemelman and others7 use a tubulized stomach without pyloroplasty
Acta Cirúrgica Brasileira - Vol. 24 (5) 2009 - 360
Santos CEM et al
and not the whole stomach because the gastric remnant must be
small and with a low compliance to prevent delayed gastric
emptying. In the present study, the gastric tube was smaller than
the whole stomach, but gastric tube tension with pylorus deviance
in 5 dogs made the endoscope passage difficult, thus suggesting
that the same may occur to the passage of food content.
According to the results, it was possible to conclude that
total thoracic esophagectomy by the inverting stripping method
was an effective procedure to remove the thoracic esophagus, and
the whole esophageal substitution using the whole stomach or
fundus rotation gastroplasty can be used for thoracic esophageal
replacement. The ex-vivo results support further studies to validate
the techniques in clinical cases of dogs requiring substitution of
the intrathoracic esophagus.
References
1- Colgrove DJ. Transthoracic esophageal surgery for obstructive lesions
caused by Spirocerca lupi in dogs. J Am Vet Med Assoc.
1971;158(12):2073-6.
2- Parker NR, Caywood DD. Surgical diseases of the esophagus. Vet Clin
North Am Small Anim Pract. 1987;17:333-57.
3- Ranen E, Shamir MH, Sharar R, Johnston DE. Partial essophagectomy
with single layer closure for treatment of esophageal sarcomas in 6 dogs.
Vet Surg. 2004;33(4):428-34.
4- Spitz L, Kiely E, Pierro A. Gastric transposition in children-a 21-year
experience. J Pediatr Surg. 2004;39(3):276-81.
5- Gupta NM, Gupta R. Transhiatal esophageal resection for corrosive
injury. Ann Surg. 2004; 239(3):359-63.
6- Holmberg DL, Kuzma AB, Miller CW. Free bowel transfer for
esophageal reconstruction in the dog. Microsurgery. 1991;12:140-4.
7- Bemelman WA, Taat CW, Slors JF, van Lanschot JJ, Obertop H.
Delayed postoperative emptying after esophageal resection is dependent
on the size of the gastric substitute. J Am Coll Surg. 1995;180(4):461-4.
8- Pinotti HW, Pollara WM, Raia AA. Tratamento cirúrgico do megaesôfago
avançado pela esofagectomia subtotal por via cérvico-abdominal sem
toracotomia com abertura do diafragma. Rev Assoc Med Bras.
1980,26(10):339-42.
Correspondence:
Dra Sheila Canevese Rahal
Department of Veterinary Surgery and Anesthesiology
Distrito Rubião Jr, s/n
18618-000 Botucatu – SP Brazil
Phone/Fax: (55 14)3811-6054
sheilacr@fmvz.unesp.br
How to cite this article
Santos CEM, Rahal SC, Damasceno DC, Hossne RS. Esophagectomy and substitution of the thoracic esophagus in dogs. Acta Cir Bras.
[serial on the Internet] 2009 Sept-Oct;24(5). Available from URL: http://www.scielo.br/acb
*Color figures available from www.scielo.br/acb
361 - Acta Cirúrgica Brasileira - Vol. 24 (5) 2009
View publication stats
9- Ferreira EAB. Subtotal esophagectomy through cervico-abdominal
incision and its possible use in the surgical management of megaesophagus.
Rev Paul Med. 1973;82:133-4.
10- Ferreira EAB. Esophagogastroplasty and esophagocoloplasty through
the posterior mediastinum without thoracotomy: a preliminary note.
Rev Paul Med. 1974;82:142.
11- Gockel I, Sultanov FS, Domeyer M, Goenner U, Junginger T.
Developments in esophageal surgery for adenocarcinoma: a comparison
of two decades. BMC Cancer. 2007;7:114.
12- Gockel I, Heckhoff S, Messow CM, Kneist W, Junginger T. Transhiatal
and transthoracic resection in adenocarcinoma of the esophagus. Does the
operative approach have an influence on the long-term prognosis? Word J
Surg Oncol. 2005;3:1-11.
13- Pinotti HW, Cecconello I, Rocha JM, Zilberstein B. Resection for
achalasia of the esophagus. Hepatogastroenterology. 1991;38:470-3.
14- Di Benedetto V, Dessanti A. Experimental technique of esophageal
substitution: intrathoracic interposition of a pedunculated gastric tube (PGT)
preserving cardiac function. Preliminary results. Hepatogastroenterology.
1998;45:2202-5.
15- Swenson O, Magruder LT. Experimental esophagectomy. Surgery.
1944;6:954-63.
16- Yamagishi M, Ikeda N, Yonemoto T. An isoperistaltic gastric tube.
Arch Surg. 1970;100:689-92.
17- Akiyama H, Hiyama M, Hashimoto C. Resection and reconstruction
for carcinoma of the thoracic oesophagus. Br J Surg. 1976;63:206-9.
18- Yamato T, Hamanaka Y, Hirata S, Sakai K. Esophagoplasty with an
autogenous tubed gastric flap. Am J Surg. 1979;137:597-602.
19- Lazar G, Kaszaki J, Abraham S, Horvath G, Wolfard A, Szentpali K,
Paszt A, Balogh A, Boros M. Thoracic epidural anesthesia improves the
gastric microcirculation during experimental gastric tube formation.
Surgery. 2003;134(5):799-805.
20- Büchler MW, Baer HU, Seiler Ch, Schilling M. A technique for
gastrosplasty as a substitute for the esophagus: fundus rotation gastroplasty.
J Am Coll Surg. 1996;182:241-5.
Acknowledgement
To Research Support Center (GAP-UNESP) for their
valuable contribution in statistical analysis and English review.
Conflict of interest: none
Financial source: FAPESP (Process nº 06/00133-7)
Received: March 23, 2009
Review: May 19, 2009
Accepted: June 25, 2009
KELOMPOK B3
TERKNIK OPERASI
OESOPHAGOTOMY
DAN
OESOPHAGOSTOMY
 NAMA KELOMPOK

• Nelci Elisabeth Bolla 1709511034

• Putu Prema Candrayani 1709511052
• Berliani Susi Ester Natara 1709511058
• Martina Tiodora Sitohang 1709511063
• Agnes Merina Galis Afonso 1709511129
 Terminologi & Indikasi
• Oesophagotomy adalah tindakan operasi yg dilakukan dgn
mengincisi pada dinding esophagus untuk membuka lumen
esophagus
• Oesophagectomy adalah tindakan operasi dengan melakukan
reseksi parsial seluruh atau sebagian esophagus.
• Pd esophagostomy pembukaan lumen esophagus bertujuan
untuk memasukkan feeding tube atau selang untuk pemberia
n pakan secara langsung ke lambung.
• Indikasi terjadi bila obstruksi esophagus atau terdapat benda
asing, tumor, kanker, anoreksia, atresia esophagus, achalasia
atau cedera kaustik hewan yang mengalami trauma pd faring
(cedera faring) dan mucositis.
 Persiapan operasi

Persiapan hewan
dan operator

Persiapan ruangan,
alat, bahan, dan
obat

Premedikasi dan
anestesi
 Premedikasi dan Anestesi

• Premedikasi: acepromazine 0,02 mg/kg BB & bruphenorphine

0,02 mg/kg BB (IM) atau pada anjing yang akan diberi tindakan
esophagotomy diberikan diazepam 0.25 mg/kg BB & butorphanol
0.2 mg/kg BB (IV).
• Anestesi yang diberikan berupa anestesi umum yaitu dengan
ketamin dan xylazine atau dapat mengggunakan isofluran dengan
oksigen pada anjing yang akan dilakukan esophagotomy.
 Teknik Operasi
Teknik Operasi Oesophagotomy

• Operasi Oesophagotomy dapat dilakukan secara longitudinal atau

transversal tergantung dri tujuan dilakukannya esophagotomy tersebt
• Sebelum lakukan operasi hewan harus di persiapkan terlebih dahulu,
bulu di cukur dan kulit dipersiapkan secara aseptis.
• Setelah teranestesi hewan di baringakan pd posisi dorsal recumbency
(hewan kecil) dan dibaringkan ke sebelah kanan (hewan besar).
• Pada hewan kecil dilakukan irisan pada bagian tengah ventral leher
(ventral midline cervicalis) dari larynx ke sternum.
Lanjutan

• Muskulus strenohyoidus dan sternocleidomastoidus kiri dan kanan di

preparasi secara tumpul sehingga terlihat trachea.
• Esophagus terletak disebelah kiri dari pada trachea dan dengan
preparasi tumpul terlihat lebih jelas. Irisan pada esophagus dibuat
secara longitudinal dan benda asing (corpora aliena) dikeluarkan.
• Esophagus dijahit dgn 4-0 chromic catgut secara simple interrupted.
Kulit dijahit dngan benang non absorbable secara simple interrupted
.
Gambar Teknik Operasi pada Hewan Kecil
Gambar Esofagotomi untuk manajemen obstruksi benda
asing pd sapi

Gambar. 2 (a): benda asing (kentang) di servical esofagus.

Gambar. 2 (b): Pengambilan benda asing (kentang) setelah esofagotomi
• Gambar. 3: Penutupan lapisan submukosa & muskularis setelah
esofagotomi dengan jahitan non-absorbable(vicryl-1).
• Gbr. 4: Penutupan kulit luar dngan pola horizontal mattress meng
gunakan black braided silk.
• Gambar 5: Pengangkatan jahitan setelah hari ke-14 pasca operasi
dengan penyembuhan maksimal.
 Teknik Operasi Oesophagostomy

• Persiapan hewan memiliki kesamaan dengan prosedur pd esophagotomy.

• Hewan di baringkan secara lateral recumbency dan semua bulu yang
mengkontaminasi daerah insisi atau mengganggu daerah insisi dapat di
cukur.
• Untuk menentukan bagian yang di insisi dpt dimasukkan forceps kedalam
rongga mulut menuju esophagus.
• Insisi dilakukan untuk membuka kulit kemudian esophagus yang besar
sayatannya bergantung pada besaran tube yang akan dipasang.
• Tube dapat di fiksasi dengan menggunakan bantuan perban ataupun
plester agar tidak bergerak ataupun berpindah.
Gambar teknik operasi Oesophagostomy
 Pasca operasi
• OESOPHAGOTOMY
Hewan dipuasakan (4-6 hari)
Hewan diberi makanan secara parental melalui infus

• OESOPHAGOSTOMY
Pemantauan peletakan feeding tube dan perawatan luka pasca operasi.
Untuk mencegah infeksi diberikan antibiotic dan multivitamin untuk
menjaga kondisi tubuh.
Terima Kasih