What is Gastrotomy?
Gastrotomy is a surgical procedure in which an incision is made into the stomach wall in order to gain access to the stomach itself. It is most commonly performed to access a foreign body lodged in the stomach that cannot be removed by other means such as endoscopy. The latter may be the case because the object is sharp or embedded deep in the stomach wall and perforation is a risk.
Gastrotomy is carried out infrequently in cats because they are fairly fastidious about what they swallow, therefore the need for foreign body removal is less in the cat than dogs. Gastrotomy itself is regularly performed in first opinion practice.
Gastrotomy Procedure in Cats
Prior to the procedure the cat is given pain relief, antibiotics, and intravenous fluids. The cat is given a general anesthetic, positioned on their back, and the fur clipped from the belly. Under aseptic conditions the surgeon makes a long incision starting just below the rib cage.
The stomach is then located, packed around with sterile swabs so as to isolate it. The surgeon anchors the stomach with stay sutures and then makes an incision through the full thickness of the wall. The stomach lumen is explored so as to remove any offending items. The stomach is then closed in two layers, and the abdomen closed in three layers.
Efficacy of Gastrotomy in Cats
Gastrotomy is major surgery, not least because it involves opening into the abdomen. However, the procedure itself is relatively straightforward, and no special equipment is required other than that found in most first opinion vet practices.
Gastrotomy provides temporary access to the stomach lumen, with the intention of the stomach healing fully afterwards.
Alternatives to gastrotomy include endoscopy. However, endoscopes capable of removing foreign bodies are especially expensive and mainly the preserve of specialist referral centers. Also, not all foreign bodies are amenable to endoscopic removal. Sharp objects would scratch or lacerate the esophagus on the way back up therefore not advisable, making gastrotomy the procedure of preference.
Gastrotomy Recovery in Cats
The stomach wall takes 10 to 14 days to heal, and in the initial few days, there is a risk of wound breakdown. Therefore, coarse and difficult to digest foods are best avoided during this period. The first meal post-operative should be bland and easy to digest, and the cat closely monitored for vomiting. This bland diet should be given for around five to seven days.
When the cat is eating, not vomiting, and showing no signs of complications, they are able to be discharged and go home. Typically they will need a postoperative check two to three days after surgery, and then the sutures removed 10 to 14 days later.
Cost of Gastrotomy in Cats
The total package including anesthetic, laparotomy, and gastrotomy is likely to cost from $800 upwards. It is also likely there will be additional fees for the investigation, such as radiography ($130 upwards) or ultrasound of the abdomen ($40 to $180 upwards, depending on the experience of the operator.)
Cat Gastrotomy Considerations
Many cases that need a gastrotomy were sick prior to surgery. To make the procedure as safe as possible, it is therefore important to stabilize them first, by correcting any electrolyte imbalances and dehydration. When this is done, the risks associated with gastrotomy are low.
One possible complication is wound breakdown and leakage of the stomach contents into the abdomen. This causes serious infection and a condition called peritonitis. This requires emergency corrective surgery to wash out the abdomen and repair the hole in the stomach wall.
However, with an uneventful gastrotomy, once fully healed the stomach is 'as good as new' and there are no permanent effects.
Gastrotomy Prevention in Cats
Cats are by nature fastidious eaters and so the risk of them indiscriminately scavenging is much lower than for dogs. That said, what kitten can resist playing with a needle and thread, and cats love to play pawsy with tinsel on the Christmas tree. Anything that sparkles or wriggles is attractive to a cat and key to preventing the need for gastrotomy is to keep this in mind.
Keep sewing baskets and mending well out of the cat's reach. Be careful about festive decorations and always tidy up children's toys or small objects that would be hazardous if swallowed.