Contributors: Ed Hall, Joseph Harari
Species: Feline | 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).
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.
- Food withheld 12 h before to avoid reflux esophagitis Esophagitis. (If possible, ie not emergency procedure). Water should not be withheld, especially if fluid volume a concern.
- Place patient in dorsal recumbency.
- Midline, ventral abdomen.
- Clip and prepare sufficient area to allow extension incision if required .
- Drape to allow minimal skin exposure lateral to incision .
- Standard aseptic skin preparation .
- Can tilt surgery table so that hind limbs/tail lower than head → will reduce abdominal pressure on abdomen.
- General anesthetic General anesthesia: overview.
Step 1 - Incision
- Midline incision through skin and subcutis.
Count sponges before cutting.
Step 2 - Identify linea alba
- Identify linea alba, which appears as trough between 2 rectus muscles, with minimum of blunt dissection/undermining.
Step 3 - Incise linea alba
- Raise linea alba, penetrate with stab incision .
Use guarded scalpel blade.
Step 4 - Extend incision
- Using scissors 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 sponges.
Step 5 - Further extension of incision
- Extend with sternotomy or pubic symphysiotomy if necessary, or with paracostal incision Laparotomy: paracostal.
Step 1 - Close body wall
- Count swabs before closure.
- Close body wall in single layer.
Inclusion of peritoneum not critical.
- Include external rectus sheath - most important layer for strength (versus internal rectus sheath).
Step 2 - Suture body wall
- Continuous suture of monofilament nylon, polypropylene, polygalactin or polydioxanone is rapid and secure.
Use simple interrupted technique if chromic catgut used.
- Use taper cut needle.
- Variable size suture material dependent on patient size.
Step 3 - Suture subcutis
- Simple continuous suture, with fine absorbable material, in subcutis .
Step 4 - Close skin
- 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.
- Essential Analgesia: overview.