Contributors: Ed Hall, Joseph Harari

 Species: Feline   |   Classification: Techniques

Introduction Requirements Preparation Procedure Aftercare Outcomes Further Reading

Introduction

  • Access to abdominal (also potentially thoracic and pelvic) cavity.

Uses

  • 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).

Alternative Techniques

Decision Taking

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.

Requirements

Materials Required

Minimum equipment

Ideal equipment

  • Self-restraining retractor, pediatric size (Balfour or Gossett) Surgical instruments: self-retaining retractors - Balfour abdominal . Laparotomy sponges (radio-opaque).

Preparation

Dietary Preparation

  • 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.

Site Preparation

  • Place patient in dorsal recumbency.

Site

  • Midline, ventral abdomen.

Preparation

  • 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.

Restraint

Procedure

Approach

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.

Exit

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.

Aftercare

Immediate

Analgesia

Outcomes

Further Reading

Publications

Refereed papers