Laparotomy: midline

• 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.

Advantages

• 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.
• Paracostal.
• Paramedian.

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.

Minimum equipment

• Standard kit Surgical instruments.

Ideal equipment

• Self-restraining retractor (Balfour  or Gossett).

• Starvation 12 hours before to avoid reflux esophagitis.

• Clip and prepare (clip, scrub) sufficient area to allow extension incision if required .
• Drape to allow minimal skin exposure lateral to incision  .

• 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 -

• Routine skin closure:
• Close subcutaneous layer .
• Simple interrupted or cruciate.
• Appose skin edges  .
• Should be possible to lift knot easily, ie not too tight.
• Alternative: subcuticular buried pattern.

Analgesia

• Always Analgesia: overview.

Refereed papers

• 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.