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An Urban Experience
Use continuous suture patterns
Whereas using interrupted patterns for closure of entero- and enterectomy wounds is not wrong, it is slower and leaves more foreign body in the wounds.
When using a continuous pattern for enterectomy, the suture should be stop in at least one point 2 separate
to avoid creating a purse-string. Either a double- needled suture or 2 sutures (Figure 1) can be used. In
all cases, the sutures should be placed in a way that allows intraluminal control of the good apposition of the mesenteric portion intestinal edges, which means that the last portion to be sutured must be the antimesenteric border.
Figure 1: Intestinal anastomosis in 2 continuous patterns, using 2 single-needled sutures.
Preserve jejunal vessels when closing the mes- entery
When little tissue is present to close the mesentery without risking damaging the jejunal vessels, a horizontal mattress continuous suture can be used to place suture at a distance, in a vessel-free portion of the mesentery.
Omentalise without damaging the intestine
To omentalise the intestinal wound, the free extremity
of the greater omentum can be wrapped around the intestinal loop of interest and sutured on itself through a vessel-free portion of the mesentery, rather than sutured to the small intestine, to limit the trauma to the intestine.
Feed the gut
Never close an abdomen after intestinal surgery without considering whether a feeding tube should be placed. In most instances, an oesophagostomy tube will be most appropriate, and be placed after the abdomen is closed, but decisions must be made before closure, in case a gastrostomy, gastro-jejunostomy or jejunostomy tube would be preferable.
Use antibiotics wisely
In the absence of pre-existing perforation/rupture
or infection, entero- and enterectomies are clean- contaminated surgeries. As such, unless the amount of intestinal damage leads to a risk of bacterial translocation or if intraoperative contamination was signi cant and could not be addressed satisfactorily, only prophylactic antibiosis should be used (IV antibiotics given at induction and every 90 minutes throughout surgery, discontinued within 12 to 24 hours after surgery). Therapeutic antibiosis (prolongation of antibiotic administration beyond 24 hours postoperatively) should only be used
in case of strongly suspected or documented massive contamination or infection.

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