Q&A on gastrointestinal surgery: Suture technique, blood flow, and leak prevention tips

For many general practitioners (GPs), gastrointestinal surgery can feel daunting, but according to Galina Hayes, PhD, DVSc, DACVECC, DACVS, it doesn't have to be. A soft tissue surgeon and associate professor of small-animal surgery at Cornell University College of Veterinary Medicine, Hayes has spent more than a decade teaching veterinary surgery and believes that bowel surgery is well within the reach of GPs who approach it with the right fundamentals.

In this Q&A, she breaks down the physiologic principles behind intestinal healing, the suture techniques she recommends, the most common errors surgeons make—often out of the very anxiety they're trying to prevent—and how to navigate the unexpected when already at the table.

Editor’s note: This dvm360 Q&A has been edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

dvm360: To start, can you introduce yourself?

Hayes: My name is Galina Hayes. I'm a specialty soft-tissue surgeon at Cornell University in Ithaca, New York. I've been teaching veterinary surgery for the past 12 or [14] years. I'm also boarded in emergency and critical care, which I find really helpful for the preoperative and postoperative management of our trickier patients. Before I became a specialist, I worked in [emergency department] practice, and before that, in small animal and mixed practice—so a fairly diverse career.

dvm360: What are the key physiologic factors that most influence how the intestine heals after surgery?

Hayes: The big one is blood flow—perfusion to the intestine. As surgeons, we can optimize healing through really careful handling of the bowel margins when we're suturing, whether for an enterotomy or an anastomosis. The goal is to minimize congestion and inflammation and keep blood flow brisk and healthy to those wound edges. Controlling suture tension is part of that—you don't want to inadvertently compromise blood flow with overly tight sutures. Good apposition is what we're after.

But blood flow at the wound edges is only part of the picture. It's also dependent on the systemic health of the patient. Ideally, they're well hydrated and fluid resuscitated before surgery. We're controlling anesthetic depth to keep blood pressure in an optimal range. All of those things working in concert help us get the outcomes we're after.

dvm360: Are there specific suture patterns or techniques you recommend for improving healing at the anastomosis site?

Hayes: There are really 2 patterns used commonly in intestinal resection and anastomosis: a simple interrupted pattern and a simple continuous pattern. With the simple continuous pattern, you have anchor knots placed at 180-degree intervals around the bowel, and it can be a little more difficult to control placement and tension without an assistant. For anyone working solo or whose assistant may be less experienced, I'd recommend the simple interrupted pattern. It's more manageable if you're not performing these procedures on a regular basis.

dvm360: What are some of the most common errors veterinarians make during intestinal surgery, and how can they be prevented?

Hayes: I think the most understandable error comes from fear of leakage, either at the enterotomy or anastomosis site. We know the risk window for leakage peaks at 3 to 5 days post closure, so intuitively, surgeons worry that something they do clinically might predispose to that. The natural instinct is to place sutures very tightly, very close together, and to reach for a heavier gauge suture material, all in an attempt to achieve a really secure closure.

While that might seem logical, we have to remember that this isn't a mechanical system; it's a biological one. Healing relies heavily on blood flow. By placing lots of tight, closely spaced sutures, we inadvertently compromise that flow. In many cases, the anxiety to prevent a leak is precisely what leads surgeons to make the errors that cause one.

The correction is straightforward: Keep sutures at a tension that is purely appositional—no more than that. Use a light suture material, 4-0 monofilament, with a taper-point needle. Keep spacing generous, around 4 mm apart. That helps you avoid what I'd call suture toxicity, which is a very real phenomenon.

dvm360: When surgeons encounter anatomic variations or unexpected findings intraoperatively, what are the most important adaptations to keep in mind?

Hayes: One of the key ones involves foreign bodies, which tend to lodge at the first U-bend they meet, right where the duodenum curves into the jejunum. There's a ligament at that location, the duodenocolic ligament, and it's really important to remember to release it fully when dealing with a foreign body lodged there. That's what allows you to exteriorize that segment of intestine and work on it with proper visualization. If you're dealing with a foreign body or a perforation in the proximal duodenum—particularly if it's close to the common bile duct—there are additional modifications to consider.

dvm360: What are the top takeaways you hope attendees walked away with from your session at the 2025 New York Vet Show?

Hayes: I really want to help people feel more confident in bowel surgery. It can be very rewarding, and the skills are not highly technical. There's no advanced or specialty equipment required. These are procedures that are genuinely within reach of [GPs]—they should feel confident, empowered, and comfortable approaching them.

When I think about improving access to care for as many patients as possible, I would love to see more GPs feeling equipped to take these cases on. That would be lifesaving for many animals. I'm hopeful that some of what I'll share will resonate and give people that extra bit of empowerment—the sense that, if you can do a spay [or] a pyometra, you can do [gastrointestinal] surgery. There's not as much difference as people might think.

dvm360: Is there anything we didn't cover that you think is worth highlighting?

Hayes: A few equipment points—nothing dramatic, but worth mentioning. Before you enter the bowel, and again after you've closed it, create a separate drape zone to keep any potential contamination walled off from the rest of the abdominal cavity. Having suction available can also speed things up considerably if you're performing these regularly.

Beyond the technical side, enjoy these surgeries. You never know what you're going to find. We've removed plastic animal figures, corn cobs, belt buckles, a small green metal tractor—you never know what dogs are going to swallow.