Contributors: Kyle Mathews
Species: Canine | Classification: Techniques
- Access to abdominal (also potentially thoracic and pelvic) cavity.
- Treatment of various lesions (almost all abdominal organs can be exposed optimally).
- Investigation when other options are unavailable or inconclusive.
- Access to pelvic organs: extension via pubic symphysiotomy.
- Access to thoracic organs: extension via sternotomy or diaphragmatic incision.
- Allows full assessment of entire abdomen.
- Fast and usually avascular approach.
- Can improve access to craniodorsal abdomen with paracostal extension (rarely indicated).
- Flank: left or right flank Laparotomy: flank.
Criteria for choosing test
- Always briefly discuss specific surgical risks before surgery with the owner.
- Clear advice on possible adverse sequelae is more effective before surgery and if given in writing.
- Standard kit Surgical instruments.
- Starvation 12 hours before to avoid reflux esophagitis.
- General anesthetic General anesthesia: overview.
- Consider epidural analgesia.
Step 1 -
- Dorsal recumbency.
Step 2 -
- Midline incision through skin and subcutis .
Count sponges before cutting - sponges with radiopaque markers are preferred.
Step 3 -
- Identify linea alba, which appears as trough between 2 rectus muscles, with minimum of blunt dissection/undermining .
- In male, if access to caudal abdominal or intrapelvic structures is required:
- Caudal incision paramedian around penis, prepuce.
- Cut subcutaneous preputial muscles.
- Reflect penis, prepuce laterally.
- Ligate branches of external pudendal vessels.
Step 4 -
- Raise linea alba, penetrate with stab incision .
Use guarded scalpel blade..
- Using scissors, or scalpel with Brodie director, extend cranial and caudal as required, incising linea and underlying peritoneum .
- Avoid underlying viscera by continuing to elevate linea alba and/or placing finger or grooved director within abdomen under line of incision.
- Ligate/cauterize small vessels.
If using retractor protect exposed tissues with saline soaked swabs..
- Extend with sternotomy or pubic symphysiotomy if necessary, or with paracostal incision.
Step 1 -
- Close body wall in single layer .
Inclusion of peritoneum increases incidence of adhesions..
- Include only external rectus sheath .
Step 2 -
- Simple continuous suture of monofilament nylon, polypropylene, polyglactin or polydioxanone is rapid and secure.
Use simple interrupted technique if chromic catgut used..
- Use taper cut needle.
- Variable size suture material:
- 3/0 small dogs.
- 2/0 small - medium dogs.
- 0 medium - large dogs.
Step 3 -
- Simple continuous suture, with fine absorbable material, in subcutis.
Step 4 -
- Always Analgesia: overview.
- Recent references from PubMed and VetMedResource.
- Rosin E & Richardson S (1987) Effect of fascial closure technique on strength of healing abdominal incisions in the dog. A biomechanical study. Vet Surg 16 (4), 269-272 PubMed.
- Rosin E (1985) Single layer, simple continuous suture pattern for closure of abdominal incisions. JAAHA 21 (6), 751-756 VetMedResource.
- Crowe D T Jr. (1978) Closure of abdominal incisions using a continuous polypropylene suture - clinical experience in 550 dogs and cats. Vet Surg 7 (3), 74-77 Wiley Online Library.