Figure 3.5
3.5.4 Parker–Kerr Oversew
This continuous inverting pattern is used to “blind end” a tubular organ such as bowel or uterine stumps (Figure 3.6). To reduce contamination and aid in needle purchase, a large hemostatic clamp is first placed perpendicular to the long axis of the tubular organ. Any remaining organ tissue extending past the jaws of the clamp is removed. Starting at either the mesenteric or antimesenteric surface, a loose continuous Cushing suture pattern is placed catching 3–4 mm of bowel wall with each needle bite and running at least 3 mm from the edge of the clamp. Once the loose Cushing pattern is complete, the jaws of the clamp are partially opened releasing the incised bowel edges, while the suture end with the needle is slowly tensioned away from the side closest to the clamp hinge. The clamp is removed and the suture line is tensioned from both sides to completely invert the stump edges. The needle is then reversed and a Lembert pattern is placed and tied to the original free suture end to form a leak‐proof double inverted stump.
3.6 Special Supplementary Patterns: Purse‐String
This suture pattern is intended to close a hollow organ opening or body aperture, such as the anal opening, or around a tube entrance in viscera (Figure 3.7). It is often utilized around the anal opening to prevent fecal contamination during perineal surgery, and to create a seal around a feeding tube placed in hollow viscera, as in a gastrostomy tube procedure. As the suture is placed around the site, tension on the suture end will tighten the continuous pattern much like a purse being pulled together at its neck with a string. The suture pattern is begun with parallel 3–4 mm bites of tissue about 3–5 mm away from the opening or cut edge. Each successive bite is advanced no more than 2–3 mm from the exit site of the last purchase. This forms a circular pattern around the centrally located opening. At the end of the pattern, both beginning and ending suture strands are in close apposition to each other. The strands are pulled firmly to form a tight cuffed rim of tissue around the tube or orifice, preventing leakage.
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4 Feeding Tubes
Eric Monnet
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
Enteral feeding is an important component of the treatment of critically ill patients, and for the support of patients with anorexia related to chronic conditions. Different type of feeding tubes are available to the surgeons to support the patients according to their need and underlying conditions (Armstrong
