Flashcards in Abdominal Surgery Deck (29)
What is a laparotomy?
Flank approach to the abdomen
What is a coeliotomy?
What is an exploratory laparotomy?
Exploration of the abdomen for diagnostic and therapeutic reasons
- Used when exact cause is not known
What is a laparoscopy?
The use of fibre-optic telescope to perform minimally invasive abdominal surgery
How could you approach a laparotomy?
1. Ventral Midline
7. Laparoscopic portals
Describe the ventral midline approach to a laparotomy...
- use the direction of the muscle fibres to guide
- Good suture holding
- Good visualisation in some species
- Holds the weight of the viscera which increases tension
- Fascia is slower to heal so needs secure strong closure
What tissues are passed through in a ventral midline laparotomy?
- Sub cut fat
- Linea alba ( incise in groove between rectus muscles)
- Falciform Ligament
What are the differences between bitch and dog ventral midline laparotomies?
Bitch can have a full xlap
- From xiphoid to pubis
Dog: need to skirt around the L/R side of the prepuce
- Cut preputialis muscle and reflect prepuce back
What might happen if you don't close the preputialis muscle after a dog xlap?
Can get urine deviation
What are the most common reasons for a midline laparotomy in companion animals?
1. Spey (ovariohysterectomy)
-- Caesarian section
2. Foreign obstruction
-- Small intestine
Describe the paramedian approach to a laparotomy...
- Parallel to the midline
-- through or next to the rectus abdominis muscle
- Less weight
- More vascular so good healing
- Use in cattle for approach over specific organs
- Incision through R. abdominis may be more painful
- Muscle not as strong as fascia
e.g. retained testicle
Describe the flank approach to a laparotomy...
- Grid approach: split muscles in the direction of fibres
- Modified grid: internal abdominal and transverse incised together
- Less weight of viscera
- Exposure of uy specific viscera is better
- Incision must be placed for optimal access
- Incision must be invisible for show cats etc.
What tissues are passed through with a flank incision?
- Sub cut fat
- Transverse abdominal m
- Omental fat
Describe the inguinal approach to a laparotomy...
Over the inguinal canal for reproductive organs or a reproductive hernia
Describe the paracostal approach to a laparotomy...
Approach parallel to the last rib
- To access the liver
Go through same tissue layers as for flank incision
Describe the vaginostomy approach to a laparotomy...
Through the vaginal wall
- No visualisation
- Haemorrhage is difficult to control
e.g. cattle ovariohysterectomy
Utilises the principle of triangulation
Site and length of incision is based on:
- Reason for surgery
- Facilities available
- Surgeon preference
What are some laparoscopic procedures?
- Liver biopsies etc.
In horses, cats and dogs where should an xlap be approached from?
In cattle where should an xlap be approached from?
How do you perform an xlap?
1. Start with the GIT
- Feel oesophagus entering through diaphragm
- Stomach, Duodenum, Jejunum, ileum, Caecum, Colon
- Also: liver, gallbladder and pancreas
2. Then the urogenital tract
- Kidneys and ovaries, ureters, bladder, urethra (prostates)
- Also: adrenals
3. Lymphoreticular system
- Lymph nodes of hepatic hilus, mesentery, ileocaecal valve, sublumber chain, spleen
4. Inspect vessels and diaphragmatic surface
What should you do if you must incise an organ?
- Prevent leakage
- Pack off with abdominal swabs
- Empty a segment by "milking it"
- Stay suture to hold organ up and out so it doesn't deflate and leak contents into the abdomen
- Use special drapes to prevent leakage
Describe Laparotomy closure...
- External rectus sheath is the most important (>90% strength)
- Closure must be strong and secure and last long enough
- Sub cut fat and skin must be closed separately
- Avoid dead space
How should Laparotomy closure sutures be placed?
- 5-10mm between sutures
- 4-10 mm from incision (first 3mm have too much inflammation
- Full thickness or external sheath only
What are some complications of laparotomies?
1. Wound infection
4. Wound breakdown
5. Non-retrieved swabs. instruments, drains
Describe peritonitis from laparotomy...
Septic or non-septic
- Septic: Bacteria from GIT, urinary, skin or surgeon (usually result of surgical error)
- Non-septic: Handling e.g. pancreas, chemicals, bile etc
How do you differentiate between septic and non-septic peritonitis?
- On the free fluid that accumulated in the abdomen
- Is there bacteria?
Describe wound breakdown from a laparotomy...
Infection, surgical error or failure of materials
Early breakdown - Eventration (eating own intestines)
Late breakdown - Usually leads to incisional hernia - abdominal contents herniate beneath healed skin
Partial Breakdown - e.g. skin suture breakdown but body wall intact vs. complete