Laparotomy: flank

• Access to abdomen Laparotomy: midline (infrequently in the USA).

• Treatment of various lesions, eg kidney stones, gastric foreign bodies.
• Investigation if other options unavailable or inconclusive.
• Gastrotomy tube placement Gastrostomy: percutaneous tube 1 (endoscopic).
• Gastric decompression Stomach: gastric dilatation / volvulus (GDV) syndrome.
• Ovariohysterectomy Ovariohysterectomy.
• Adrenal surgery (primarily in the USA).
• Kidney biopsy.

Advantages

• Muscle splitting approach may reduce risk of dehiscence if tissue healing poor.
• Good unilateral access to organs placed dorsally in the abdomen.

Disadvantages

• Limited access to restricted areas.

• Midline Laparotomy: midline.
• Paracostal.
• Paramedian.

Criteria for choosing test

• Midline laparotomy is usually preferred technique since it allows a full assessment of abdominal organs.

Minimum equipment

• Standard kit Surgical instruments.

Ideal equipment

• Self-restraining retractor (Balfour or Gossett).

• Starvation 12 hours before general anesthesia to avoid reflex esophagitis.

• Flank.

• General anesthesia General anesthesia: overview.
• Occasionally performed under sedation and infiltration with local anesthetic.

Standard method

• Laparotomy Laparotomy: midline

Step 1 - Skin incision

• Skin incision

Step 1 - Muscle incision

• Open each muscle layer by blunt dissection in direction of fibers.

Step 1 - Closure

• Close muscle in layers using monofilament nylon, polypropylene, polyglactin, polydioxanone or chromic catgut using a simple continuous pattern.
  Suturing peritoneum may increase risk of adhesions.

Step 2 - Skin closure

• Routine skin closure Wound closure: primary.

Refereed papers

• Recent references from PubMed and VetMedResource.