Abdominal Surgery

Question 1

what is the difference between laparotomy and celiotomy

Answer 1

laparotomy: refers to flank incision into the abdominal cavity

celiotomy: refers to midline incision into the abdominal cavity

Question 2

when we refer to an “ex-lap”, we are technically referring to what procedure

Answer 2

celiotomy

Question 3

what do we can acute clinical signs referable to the abdominal cavity

Answer 3

acute abdomen

Question 4

exploration of the abdominal cavity can fall under what 3 categories? give an example of each

Answer 4

• diagnostic: liver biopsy
• therapeutic: GDV, tumor resection
• preventative: gastropexy, OHE

Question 5

for abdominal exploration, where should you clip

Answer 5

few cm cranial of the xiphoid to the level of the inguinal region

Question 6

T/F you should prepare and drape more than what you anticipate for an ex-lap

Answer 6

T

Question 7

what are the 4 general principles of surgery

Answer 7

1) asepsis
2) gentle tissue handling
3) hemostasis
4) maintain organ function

Question 8

what does it mean to count sponges “in and out”

Answer 8

count before and count after surgery

Question 9

T/F your sponges are no longer sterile once used so they should be discarded in a garbage off of the surgical table

Answer 9

F: discard in your large bowl to not throw off your count (but yes, they are no longer sterile)

Question 10

what should you do if you drop a sponge used during surgery

Answer 10

discard it under the table and remember to count it later

Question 11

what are the benefits of cutting through the linea alba

Answer 11

1) clean incision
2) less bleeding
3) clean, secure closure

Question 12

T/F in males, you have to cut off the linea alba at the level of the prepuce

Answer 12

F: your SKIN incision will be off midline but you still cut through the linea (just have to dissect to get there and make sure that you tack down)

Question 13

what length of incision is necessary to explore the abdominal cavity

Answer 13

xiphoid to the pubis

Question 14

what number blade should you use for a midline incision for a celiotomy? what would you use for the rest of the surgery

Answer 14

10 blade; 15 blade

Question 15

what is an important consideration when you make your initial incision and have to dissect around the rectus fascia to find the linea

Answer 15

this will create dead space and can lead to a seroma if you do not tack it down; limit the amount of dissection you do

Question 16

what blade do you want to use to incise the linea

Answer 16

15

Question 17

where would you ideally make your stab incision on the linea

Answer 17

caudally, to extend cranially

Question 18

what is an important step before extending your linea incision with mayo scissors

Answer 18

palpate for any adhesions along the body wall

Question 19

how does the incision differ if a male dog?

Answer 19

1) make an incision parallel and lateral to the prepuce
2) ligate the branches of the caudal superficial epigastric vein
3) undermine prepuce and reflect it away from the surgeon to expose the linea

Question 20

where is the linea easiest to locate

Answer 20

at level of umbilicus (widest)

Question 21

why do we make our stab incision at the umbilicus

Answer 21

this is where the linea is the easiest to identify

Question 22

where is the falciform ligament

Answer 22

cranial to the umbilicus

Question 23

what is the best way to deal with the falciform ligament

Answer 23

excise it completely from the abdomen

Question 24

what are the 4 steps for removing the falciform ligament

Answer 24

1) incise the attachments on either side of the linea
2) deal with any bleeders
3) clamp and ligate the attachment at the cranial end of the xyphoid
4) amputate distal to suture

Question 25

T/F it is necessary to remove the falciform ligament to improve visualization for caudal abdominal procedures

Answer 25

F; only cranial abdominal procedures

Question 26

what tool do we use to keep the abdomen open during a celiotomy

Answer 26

Balfour retractor

Question 27

what structures are strong and what are weak when it comes to closing the abdomen

Answer 27

strong: skin and fascia weak: muscle and fat

Question 28

what is the deal with the peritoneum when it comes to closing the abdomen

Answer 28

it heals fast BUT does not contribute to wound strength and can increase adhesions

Question 29

what is the layer of strength for closing the abdomen

Answer 29

rectus fascia (external rectus sheath)

Question 30

how long should your suture tags be for closing the linea

Answer 30

~ 0.5cm

Question 31

what are the advantages and disadvantages of simple interrupted for closing the linea

Answer 31

advantage: more secure when learning (novice surgeon) disadvantage: more foreign material, longer sx time, more suture (cost)

Question 32

what are the advantages and disadvantages of simple continuous to close the linea

Answer 32

advantages: fast, less foreign material, less material (cheaper) disadvantages: can be catastrophic if it comes undone, line breaks, or gets infected

Question 33

what should you NEVER use to close the linea

Answer 33

steel, cat gut or non-absorbable braided suture

Question 34

if you incised on the linea, you should take what kind of bites? what about if you incised lateral to the linea

Answer 34

on the linea: 4-10mm full-thickness bites off the linea: 5-10mm bites of external rectus fascia only

Question 35

T/F you should include subq or falciform in your bites as it will help heal

Answer 35

F

Question 36

how far apart should you space sutures when closing the linea

Answer 36

5-7mm

Question 37

what is the main cause of wound dehiscence

Answer 37

tissue weakness

Question 38

you should take _____ bites of the ___________ leaf of the fascia for every bite

Answer 38

large; external

Question 39

what size suture should you use for a simple interrupted closure on the linea in the following size dogs: 2-12 kg 12-30 kg >30 kg

Answer 39

2-12 kg -> 3-0 12-30 kg -> 2-0 >30 kg -> 0

Question 40

what size suture should you use for a simple continuous closure on the linea in the following size dogs: 2-12 kg 12-30 kg >30 kg

Answer 40

2-12 kg -> 2-0 12-30 kg -> 2-0 to 0 >30 kg -> 0

Question 41

what are good suture options for the linea

Answer 41

PDS II, biosyn, maxon

Question 42

what should you use to close subq and what type of suture

Answer 42

simple continuous; Monocryl

Question 43

how do you tack down to prevent a seroma

Answer 43

take a bite of fascia every 2-4 bites

Question 44

should you use absorbable or non-absorbable suture on the subq

Answer 44

absorbable

Question 45

T/F knots for subq sutures must be buried

Answer 45

T

Question 46

what are the 3 steps for a parapreputial closure

Answer 46

1) close SQ first using simple interrupted or cruciate sutures 2) re-oppose the preputial mm to re-align the prepuce using one mattress or cruciate suture 3) close the SQ in a straight line like for a female

Question 47

what is the #1 complication of parapreputial incisions

Answer 47

seromas due to excessive dead space

Question 48

how do we close the skin

Answer 48

1) staples (fast to place, longer to remove) 2) simple interrupted or cruciate (4-0 or 3-0)

Question 49

what surgeries do NOT warrant prophylactic antibiotics

Answer 49

<1.5-2h with no entry into a hollow viscus or contamination

Question 50

what does perioperative antibiotics mean

Answer 50

start giving within a half hour of cutting and stop once procedure is done or within 24h

Question 51

what should you check an incision for every day

Answer 51

redness, swelling, pain, discharge