TUGAS MATA KULIAH

ILMU BEDAH KHUSUS

TEKNIK OPERASI DAN INDIKASI LAPAROTOMY

HALAMAN JUDUL

KELAS: B

I Gede Hendra Prasetya Wicaksana 1409005005

I Putu Werdikta Jayantika 1409005008

A. A. Gede Oka Wijaya 1409005026

I Made Adistanaya 1409005071

Luh Putu Pradnya Swari 1409005083

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

TAHUN 2017
 RINGKASAN

Laparoctomy (celiostomy) adalah pembedahan membuka dinding

abdomen melalui insisi ventral abdomen atau flank (dinding perut
samping). Insisi pada ventral abdomen dapat dilakukan melalui linea
alba (midline/garis median), paramedian kiri dan kanan atau insisi
transversal pada dinding abdomen. Pada hewan besar operasi dapat
dilakukan pada bagian flank kanan atau kiri dengan posisi hewan
berdiri, sedangkan pada hean kecil, dapat dilakukan insisi pada ventral
midline dengan posisi hewan dorsal recumbency.

Kata kunci : Laparoctomy, abdomen, linea alba, paramedian, ventral

midline

SUMMARY

Laparoctomy (celiostomy) is a surgical of the abdominal wall through

ventral abdominal or flank incisions (side abdominal wall). Incisions
to the ventral abdomen may be performed through the alba line
(midline / median line), left and right paramedian or transversal
incision of the abdominal wall. In large animal surgery can be done on
the right or left flank with the position of the animal standing, while in
small hean, can be incised in the ventral midline with the position of
animals dorsal recumbency.

Key words: Laparoctomy, abdomen, linea alba, paramedian, ventral

midline

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 KATA PENGANTAR

Puji syukur penulis panjatkan kepada Tuhan Yang Maha Esa karena atas
berkat rahmat-Nya penulis dapat menyelesaikan tugas paper Ilmu Bedah Khusus
Veteriner yang berjudul Teknik Operasi dan indikasi Laparotomy.

Segala kritik dan saran sangat penulis harapkan demi kebaikan dari tugas ini.
Terimakasih kepada dosen pengampu yang memberikan materi pada saat perkuliahan
dan praktikum, teman kelompok yang sudah banyak membantu dalam proses
pengerjaan paper ini. Dan tak lupa penulis mengucapkan banyak terima kasih kepada
semua pihak yang telah membantu penulis.

Denpasar, 26 September 2017

Penulis

iii
 DAFTAR ISI
HALAMAN JUDUL ................................................................................................. i
RINGKASAN .......................................................................................................... ii
KATA PENGANTAR ............................................................................................. iii
DAFTAR ISI........................................................................................................... iv
DAFTAR GAMBAR ............................................................................................... v
DAFTAR LAMPIRAN ........................................................................................... vi
BAB I PENDAHULUAN......................................................................................... 1
1.1 Latar Belakang ..................................................................................... 1
BAB II TUJUAN DAN MANFAAT TULISAN ....................................................... 2
2.1 Tujuan Tulisan .................................................................................... 2
2.2 Manfaat Tulisan .................................................................................. 2
BAB III TINJAUAN PUSTAKA ............................................................................. 3
3.1 Definisi Laparostomy ........................................................................ 3
3.2 Lokasi Operasi .................................................................................. 3
3.3 Teknik Operasi .................................................................................. 4
BAB IV PEMBAHASAN ........................................................................................ 6
4.1 Managemet Pre-Operasi Laparostomy ................................................. 6
4.2 Janis dan Teknik Operasi Laparotomy................................................. 8
4.2.1 Laparotomy Flank .................................................................. 8
4.2.2 Laparotomy Medianus/Midline ............................................ 12
4.2.3 Laparotomi Paramedianus .................................................... 16
4.2.4 Insisi Paracostal ................................................................... 19
4.2.5 Perawatan Post Operasi ........................................................ 20
BAB V SIMPULAN DAN SARAN ....................................................................... 21
5.1 Simpulan ........................................................................................... 21
5.2 Saran ................................................................................................. 21
DAFTAR PUSTAKA............................................................................................. 22
LAMPIRAN ........................................................................................................... 23

iv
 DAFTAR GAMBAR

Gambar 1 ........................................................................................................ 4
Gambar 2 ........................................................................................................ 9
Gambar 3 ........................................................................................................ 10
Gambar 4 ........................................................................................................ 10
Gambar 5 ........................................................................................................ 11
Gambar 6 ........................................................................................................ 12
Gambar 7 ........................................................................................................ 14
Gambar 8 ........................................................................................................ 15
Gambar 9 ........................................................................................................ 17
Gambar 10 ...................................................................................................... 18
Gambar 11 ...................................................................................................... 18
Gambar 12 ...................................................................................................... 20

v
 DAFTAR LAMPIRAN

1. Exploratory Laparotomy in the Dog & Cat

2. Paramedian Abdominal Approach: Technique
3. Surgical Treatment of Displaced Abomasum in Cattle Using Ljubljana
Method

vi
 BAB I
PENDAHULUAN
1.1 Latar Belakang

Abdomen adalah istilah yang digunakan untuk menyebut bagian dari tubuh
yang berada di antara thorax atau dada dan pelvis di hewan mamalia dan vertebrata
lainnya. Bagian yang ditutupi atau dilingkupi oleh abdomen disebut cavum
abdominalis atau rongga perut yang didalam nya terdapat berbagai organ vital yang
bisa saja mengalami trauma sehingga memerlukan tindakan pembedahan atau operasi
yang di lakukan pada daerah abdomen.

Pembedahan atau operasi merupakan suatu tindakan pengobatan yang

menggunakan cara invasif dengan membuka dan menampilkan bagian tubuh yang
akan ditangani. Pembukaan bagian tubuh ini umumnya dilakukan dengan membuat
sayatan. Setelah bagian yang akan ditangani ditampilkan, selanjutnya dilakukan
perbaikan yang diakhiri dengan penutupan dan penjahitan luka

Bedah Abdomen atau Laparotomy merupakan salah satu jenis tindakan operasi
bedah mayor pada bagian abdomen yang dilakukan ketika terjadi masalah kesehatan
yang sangat berat pada aera abdomen misalnya trauma dan gangguan interna lainnya
seperti seksio caesaria, ovariohysterectomy, hysterectomy, enterectomy, cystotomy,
gastrotomy, spleenectomy, nephrotomy, nephrectomy,untuk tujuan diagnostic,dan
enanganan neoplasma.

Teknik operasi yang dilakukan dengan pembuatan insisi pada dinding

abdomen hingga cavitas abdomen, dimana insisi berbedabeda tergantung pada hewan
besar/kecil,jantan/betina dan gangguan penyakitnya, sehingga sangat penting untuk
mengetahuan teknik laparoctomy sehingga penanganan dapat berjalan dengan
sukses.

2.2 Rumusan Masalah

1. Apa yang dimaksud dengan Laparotomy ?
2. Bagaimana indikasi operasi laparostomy?
3. Bagaimana management preoperasi laparostomy ?
4. Apa saja jenis teknik operasi laparostomy?
5. Bagaimana penangan pasca operasi laparostomy?

1
 BAB II
TUJUAN DAN MANFAAT TULISAN

2.1 Tujuan Tulisan

1. Untuk memahami apa yang dimaksud dengan laparostomy. .

2. Untuk mengetahui indikasi operasi laparostomy
3. Untuk memahami management preoperasi laparostomy
4. Untuk mengetahui Apa saja jenis teknik operasi dan prosedur laparostomy
5. Untuk mengetahui prosedur penangan pasca operasi laparostomy

2.2 Manfaat Tulisan

Penulis berharap melalui paper yang kami yang buat berjudul Teknik
Operasi dan Indikasi Laparotomy dapat memberikan informasi dan
pengetahuan kepada pembaca, sehingga pembaca dapat mengetahui definisi
dan bagaimana teknik operasi Laparostomy yang baik dan benar

2
 BAB III
TINJAUAN PUSTAKA

3.1 Definisi Laparostomy

Laparoctomy (celiostomy) adalah pembedahan membuka dinding abdomen

melalui insisi ventral abdomen atau flank (dinding perut samping). Laparostomy
dilakukan untuk pembedahan didalam rongga abdomen seperti seksio cesaria,
ovarioheterctomy, hysterectomy, enterotomy, enterectomy, cystrotomy, gastrotomy,
dan untuk tujuan diagnostik

Insisi pada ventral abdomen dapat dilakukan melalui linea alba (midline/garis
median), paramedian kiri dan kanan atau insisi transversal pada dinding abdomen.
Insisi pada garis median dapat dilakukan pada garis tengah abdomen dan linea
alba,sehingga tidak terjadi pendarahan karena tidak ada pembuluh darah atau syaraf
yang terinsisi. (Sudisma et al.,2016 )

Insisi padamedian merupakan insisi merupakan irisan longitudinal disamping

garis median kira-kira 1 cm sejajar dengan garis median dapat diperluas/
diperpanjang sesuai dengan tujuan operasi. Insisi paramedian beresiko terjadinya
pendarahan.

Insisi Transversal dinding abdomen dilakukan dengan memotong serabut-

serabut otot abdomen, disini akan terjadi pendarahan karena terpotongnya serabut-
serabut otot dan pembuluh darah. Pemilihan daerah insisi dinding abdomen diatas
dilakukan sesuai dengan tujuan operasi.

Anestesi yang digunakan adalah anestesi umum atau anestesi regional

(epidural, paravertebral). Pada hean besar dapat dilakukan dengan anestesi local
infiltrasi

3.2 Lokasi Operasi

Pada hewan besar operasi dapat dilakuak pada bagian flank kanan atau kiri
dengan posisi hewan berdiri, sedangkan pada hean kecil, dapat dilakukan insisi pada
ventral midline dengan posisi hewan dorsal recumbency. Dalam banyak hal operasi

3
dilakukan diantara tu;ang rusuk terakhir dengan bagian externa dari pada sudut ilium.
(Sudisma et al.,2016 )

3.3 Teknik Operasi

Pada hewan besar, dilakukan pada daerah flank (dinding perut samping).
Tempat operasi diberkan anestesi local secara infiltrasi pada bagian kulit dan otot-
ototnya. Diberikan pula premedikasi dengan golongan sedative secara intravena.
Insisi diusahakan searah dengan serabut otot. Scapel yang telah dipakai untuk insisi
kulit hendaknya tidak dipakai lagi untuk insisi jaringan yang lebih dalam.

Setelah kulit, pada hewan besar akan terinsisi muskulus abdominalis externa
dan interna kemudian obliqus abdominalis,serta muskulus transversus abdominalis.

Pada hewan kecil, dapat dilakukan insisi pada ventral abdomen melalui linea
alba (midline/garis tengah median),paramedian kiri dan kanan atau insisi transversal
pada dinding abdomen. Stelah kulit tensisi melalui ventral abdominal dan setelah
kulit akan terinsisi linea alba.

Gambar 1. Teknik insisi pada ventral abdomen (midline)

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 Setelah operasi selesai,peritoneum dijahit (continuous dengan catgut 2.0
atau 3.0). Kemudian dilanjutkan penjahitan fascia,otot-otot dan kulit. Untuk
kulit,dijahit dengan benang non adsorable silk, linen, unblikal tape atau yang
lain dengan metoda jahitan matras atau simple interrupted. Bekas insisi pada
kulit dapat ditutup dengan flexible collodion dan benang jahit pada kulit dapat
diambil setelah 10-14 hari. (Sudisma et al.,2016 )

5
 BAB IV
PEMBAHASAN

Laparoctomy (celiostomy) adalah pembedahan membuka dinding abdomen

melalui insisi ventral abdomen atau flank (dinding perut samping). Dimana indikasi
dari tindakan operasi Laparostomy yaitu :
1. Pembedahan di dalam rongga abdomen seperti seksio caesaria,
ovariohysterectomy, hysterectomy, enterectomy, cystotomy, gastrotomy,
spleenectomy, nephrotomy, nephrectomy,
2. Untuk tujuan diagnostic penyakit, dan
3. Penanganan neoplasma.

4.1 Managemet Pre-Operasi Laparostomy

Sebelum melakukan tindakan operasi, terlebih dahulu dilakukan persiapan

operasi. Adapun persiapan yang dilakukan adalah persiapan alat, bahan, obat,
persiapan ruangan operasi, persiapan hewan kasus dan operator.

a. Persiapan Alat, Bahan, dan Obat

Sterilisasi alat dengan menggunakan autoclave selama 15 menit, kecuali

gunting dan jarum disterilkan dengan dengan menggunakan alkohol 70%.
Tujuan dilakukan sterilisasi alat adalah untuk menghindari kontaminasi dari
alat pada luka operasi yang dapat menghambat kesembuhan luka.

b. Persiapan Ruang Operasi

Ruang operasi dibersihkan menggunakan desinfektan. Sedangkan meja

operasi didesinfeksi dengan menggunakan alkohol 70%. Penerangan ruang
operasi sangat penting untuk menunjang operasi, oleh karena itu sebelum
diadakanya operasi persiapan lampu operasi harus mendapatkan penerangan
yang cukup agar daerah/situs operasi dapat terlihat jelas.

c. Persiapan Hewan

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Pemeriksaan fisik awal wajib untuk dilakukan sebelum operasi dilakukan.
Pemeriksaan fisik meliputi: signalement, berat badan, umur, pulsus, frekuensi
nafas, suhu tubuh, dan pemeriksaan sistem tubuh lainnya (digestivus,
respirasi, sirkulasi, saraf, reproduksi), perubahan anggota gerak, dan
perubahan kulit, yang dicatat dalam ambulator atau kertas pemeriksaan
hewan.Sebelum dilakukan operasi, hewan dipuasakan selama 12 jam agar
hewan tidak muntah pada saat teranastesi.

Anestesi dengan diinjeksi menggunakan atropin sulfat secara

subkutan. Setelah 10 menit, hewan dapat di anestesi sesuai dengan jenis
hewan. Pada anjing dianastesi dengan kombinasi xylasin dan ketamin secara
intramuscular.

Sedangkan pada hewan besar dapat diberikan tranquilizer hingga

sedasi (chlorpromazine atau xylazine HCl) dan blokade syaraf di daerah para
ventralis atau paralumbar atau infiltrasi linear.

Selanjutnya lakukan pembersihan daerah operasi, rambut disekitar

tempat pembedahan dicukur. Bagian yang dicukur dibersihkan dengan
alkohol 70% dan desinfeksi dengan yodium tinctur 3% atau Betadine.

Pada hewan besar, operasi dapat dilakukan pada bagian flank kanan
atau kiri dengan posisi hewan berdiri. Sedangkan pada hewan kecil, dapat
dilakukan insisi pada ventral midline dengan posisi hewan dorsal
recumbency. Dalam banyak hal operasi dilakukan diantara tulang rusuk
terakhir dengan bagian externa dari pada sudut ilium. Selanjutnya, lakukan
pemasangan infus pada vena saphena dengan menggunakan NaCl.
Penyuntikan Vitamin K yang dilakukan secara intravena melalui infus.

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4.2 Janis dan Teknik Operasi Laparotomy

4.2.1 Laparotomy Flank

Terdapat dua macam laparotomy flank, yaitu laparotomi flank kanan dan kiri.
Laparotomi flank kanan sering dilakukan untuk melihat (organ rumen dan operasi
Caesar). Laparotomi flank kiri sering digunakan untuk melihat ( organ hati, kolon,
dan abomasum yang begerak ke kanan). Yang umumnya dilakukan pada hewan
besar, seperti domba, kambing, dan sapi

Teknik Operasi
Flank Kanan

Daerah insisi fossa paralumbar pada flank kanan . Lapisan yang diinsisi
adalah kulit, musculus obliquus abdominis internus, musculus abdominis
transverses dan peritoneum.
Posisi penyayatan dilakukan secara vertical ditengah fossa paralumbal, 3-5
cm ventral prosessus transversus. Untuk pemeriksaan rumen, maka
penyayatan dilakukan lebih ke cranial 20-25 cm dari ventral prosessus
transversus.
Sedangkan untuk pemeriksaan uterus, penyayatan dilakukan 10 cm cranial
prosesus transversus dengan panjang sekitar 30-40 cm dan umum dilakukan
pada sapi besar.

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 Gambar 2 Sayatan modified grid

Sayatan laparotomy flank kanan selalu ditutup dengan 4 jahitan terpisah.

Peritoneum, fascia transversalis dan otot transversus dijahit bersama
menggunakan pola jahitan simple continuous (gambar 3a).
Otot obliqus interna dijahit dengan 2 atau 3 jahitan simple interrupted
(gambar 3b).

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 Gambar 3 (a) penjahitan peritoneum, fascia transversalis dan otot
transversus; (b) penjahitan otot obliqus

Otot obliqus externa juga ditutup dengan pola jahitan simple interrupted,
jumlah jahitan tergantung dari arah sayatan otot: pada sayatan true grid
cukup dengan 2 atau 3 jahitan, sedangkan pada sayatan modified grid
dibutuhkan lebih banyak jahitan (gambar 4).
Kemudian kulit ditutup dengan pola jahitan simple interrupted

Gambar 4. Jahitan untuk sayatan modified grid

.

10
Flank Kiri

Lakukan insisi kulit secara vertical pada prosesus transversus (gambar 2a).
Otot obliqus externa dan interna akan tertranseksi (gambar 2b). Pembuluh
darah bisa dijepit dengan melakukan ligasi atau pemberian hemostats.
Kemudian otot transversus diinsisi secara vertical dengan hati-hati

Gambar 5. (a) kulit diinsisi vertikal; (b) transeksi otot obliqus externa dan interna.

Fascia transversalis dan peritoneum diangkat dan ditarik dengan thumb

forceps, lalu disayat dengan scalpel (gambar 6a - usahakan untuk tidak
menyayat viscera di bawahnya). Sayatan kemudian diperluas pada bagian
dorsal dan ventral dengan menggunakan gunting (gambar 6b).

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 Gambar 6. (a) penyayatan fascia; (b) perluasan sayatan dorsal dan ventral.

Tiap sayatan yang dilakukan pada lapisan yang terpisah dari dinding
abdomen lebih pendek dari sayatan sebelumnya.
Sayatan ditutup dengan 3 atau 4 kali jahitan. Peritoneum dan fascia
transversalis ditutup bersama dengan otot transversus menggunakan pola
jahitan simple continuous. Otot-otot obliqus ditutup bersama menggunakan
pola jahitan simple interrupted. Jika laparotomy dilakukan di bagian bawah
flank, subcutisnya bisa dijahit dengan pola simple continuous menggunakan
benang jahit yang absorbable.
Kemudian kulit ditutup dengan pola jahitan simple interrupted menggunakan
benang jahit yang non-absorbable.

4.2.2 Laparotomy Medianus/Midline

Laparotomy medianus adalah insisi pada ventral abdomen yang dilakukan

melalui linea alba (midline atau garis median), pada median kiri dan kanan atau insisi
tranversal pada dinding abdomen. Insisi pada garis median tepat dilakukan pada garis
tengah abdomen dan linea alba, sehingga kemungkinan terjadi perdarahan sangat
kecil karena tidak ada pembuluh darah atau syaraf yang terinsisi. Penyayatan ini
umumnya dilakukan pada hewan kecil. Lapisan yang disayat adalah kulit, musculus
rectus abdominis internus dan eksternus, serta peritoneum.

Insisi Dan Penutupan (Jahitan Penutup) Garis Tengah Abdomen Pada

Hewan Betina

1. Hewan dipersiapkan untuk prosedur pembedahan dan diletakkan pada posisi

rebah dorsal. Dibuat insisi (irisan/sayatan) pada kulit dan jaringan subkutan.
2. Hemorrhagea (perdarahan) dikontrol dengan menggunakan arteri klem kecil
(mosquito forceps). Tepi insisi dikuakkan dengan cara membuka pinset yang
dipegang dengan tangan kiri. Dengan skalpel insisi dilanjutkan sampai
mencapai linea alba. Bila linea alba telah terlihat dilakukan insisi pendek
bersama dengan peritoneum sampai rongga abdomen.

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3. Pinset (grooved director) diselipkan ke dalam insisi pendek tadi dan secara
hati-hati pinset dibuka dan diangkat ke atas untuk mengakat garis insisi.
Selanjutnya insisi diperpanjang dengan melakukan irisan di antara pinset
(hati-hati terhadap struktur organ di bawahnya).
4. Pinset diarahkan ke arah yang berlawanan dan insisi dengan skalpel
diteruskan ke arah cranial sampai panjang yang diinginkan.
5. Dinding abdomen ditutup dengan jahitan terputus pada peritoneum
bersama dengan linea alba.
6. Untuk memperkuat jahitan utama ini, diberikan jahitan penguat pada m.
Rectus abdominis bagian ventral dengan jahitan mattress ataumenerus
(Continuous pattern).
7. Pada hewan gemuk, jaringan subkutan dijahit dengan pola jahitan mattress
vertical inverting, dan kulit ditutup dengan pola jahitan sederhana
terputus (simple interrupted).
8. Pada anjing jantan, setelah peritoneum dan fascia ditutup seperti yang
dijelaskan di atas, penis dikembalikan pada posisi normal dan difiksasikan
dengan jahitan benang catgut (absorbable) pada jaringan ikat dan fascia guna
menghilangkan dead-space, kemudian kulit dijahit dengan benang
nonabsorable.

Catatan : Terdapat beberapa tehnik pembukaan dan penutupan insisi garis

tengah abdomen. Metode yang dijelaskan di atas dianjurkan karena
kecepatan dan ketepatan pelaksanaannya.

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Gambar 7. teknik insisi dan penutupan jahitan garis tengah abdomen pada
hewan betina

A. Insisi Garis Tengah Kaudal (Caudal Midline Incision) Pada Hewan

Jantan
Indikasi : untuk prosedur pembedahan abdomen bagian belakang
Teknik Operasi
1. Hewan dipersiapkan untuk prosedur pembedahan, dan diletakkan pada posisi
rebah dorsal (dorsal recumbency).
2. Insisi kulit dimulai dari umbilicus dan ketika sampai di depan preputium
berbelok ke arah lateral, dan dilanjutkan ke kaudal sampai tepi pelvis.
(Gambar 8. 1).

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 Gambar 8. Teknik insisi dan penutupan midline abdominal pada hewan
betina

3. Vena epigastrica recurrent superficialis diligasi (diikat) rangkap dan dipotong

dekat ujung preputium (Gambar 8.2 dan 8.3).
4. Jaringan ikat di bawah penis dipreparasi dengan menggunakan skalpel sampai
dapat disingkapkan ke arah lateral sehingga linea alba terlihat.
5. Rongga abdomen dibuka dengan melakukan insisi peritoneum sepanjang
garis linea alba. Pertama-tama dibuat insisi secara hati-hati sepanjang kira-
kira 1 cm di linea alba sampai peritoneum. Pinset diselipkan di dalam insisi
tadi yang bertindak sebagai penguak (retractor ) dan penuntun (director)
selanjutnya insisi diperpanjang dengan menggunakan skalpel atau gunting.

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 Dapat pula jari (grooved director) diselipkan di dalam insisi untuk menguak
dan menuntun skalpel serta melindungi struktur organ di bawahnya (Gambar
8. 4.)
6. Penutupan dinding abdomen dengan pola jahitan sederhana terputus (simple
interrupted suture pattern) memakai benang cat gut (absorbable) nomor 0
atau 00 pada peritoneum dan fascia diikuti dengan jahitan penguat yang
ditempatkan di m. Rectus abdominis di bagian ventral
7. Penis dikembalikan pada posisi normal dan difiksasi dengan fascia memakai
cat gut, hindarilah terjadinya dead-space. Insisi kulit kemudian ditutup
dengan cara yang biasanya (semestinya).

4.2.3 Laparotomi Paramedianus

Laparotomy paramedianus merupakan irisan longitudinal disamping garis

median kira-kira 1 cm sejajar dengan garis median dapat diperluas atau diperpanjang
sesuai dengan tujuan operasi. Insisi paramedian berisiko terjadinya perdarahan. Insisi
transversal dinding abdomen dilakukan dengan memotong serabut-serabut otot
abdomen, disini akan terjadi perdarahan karena terpotongnya serabut-serabut otot
dan pembuluh darah. Lapisan kulit yang disayat adalah kulit, musculus rektus
abdominis internus dan eksternus, musculus rektus transversus dan peritoneum.

Target organ dari laparotomy paramedianus anterior kanan adalah

diaphragma, hati, empedu, ginjal kanan, dan ovarium kanan. Laparotomy
paramedianus anterior kiri adalah gastrium, pancreas, limpa, ginjal, dan ovarium kiri.
Laparotomy paramedianus posterior kanan adalah uterus, vesica urinaria (anjing
jantan) dan prostat. Sedangkan untuk laparotomy paramedianus posterior kiri adalah
uterus, vesica urinaria (anjing jantan) dan prostat.

Kelebihan laparotomy paramedianus adalah kesembuhannya relatif cepat dan

tidak mudah terjadinya hernia. Sedangkan kerugiannya adalah sering terjadi
perdarahan dan agak sulit dilakukan jika ingin digunakan untuk operasi pada organ
berpasangan.

Teknik Operasi

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 Posisikan anjing pada rebah dorsal dan lakukan insisi pada kulit sekitar 1 cm
sejajar dengan linea alba dari cranial preputium hingga kira-kira 3-4 cm di
cranial tulang pubis. Hindari pembuluh epigastrium superficialis caudal yang
letaknya longitudinal dan sejajar dengan putting.
Lakukan sayatan pada jaringan subcutan dan lakukan ligasi atau
elektrocoagulat cabang pembuluh epigastrium. Begitu fascia rektus terlihat,
temukan tepi lateral dari otot rektus (yang tampak seperti garis antara fascia
putih dari otot rektus dan otot obliqus abdominal externa yang tampak lebih
kemerahan.

Gambar 9. Insisi paramedian abdominal

Buat sayatan dalam sejajar linea pada fascia rektus externa, kira-kira 2/3 lebar
otot rektus dari linea. Buka fascia rektus sejajar dengan linea dan buat sayatan
pada fascia (memotong 2 bagian terpisah dari fascia) dengan gunting Mayo
sepanjang sayatan sebelumnya (tanpa menyayat otot dibawahnya).
Lanjutkan dengan membuat bukaan ke rongga peritoneal dengan mosquito
forceps. Pegang 2 mosquito forceps (satu di tiap tangan) dan letakkan ujung
forceps pada sayatan, lalu tarik/lebarkan forceps ke arah serabut otot. Ini akan
langsung membuka rongga abdomen tanpa memotong jaringan otot, sehingga
akan mengurangi trauma jaringan dan perdarahan. Jika ada pembuluh
epigastrium yang tidak sengaja terpotong, lakukan ligasi terhadap pembuluh
yang mengalami perdarahan tersebut dengan jahitan chromic catgut.
Lalu singkirkan semua alat yang menempel pada peritoneal, kemudian
tempatkan spons laparotomy di sepanjang tepi rektus, dan masukkan retraktor

17
 abdominal (Balfour retractor) untuk membantu mengisolasi area yang
bermasalah.

Gambar 10. Retractor Balfour

Untuk menutup sayatan, singkirkan semua instrumen dari abdomen. Tidak

perlu menutup lapisan peritoneal atau otot. Lakukan jahitan fascia rektus
externa dengan pola simple interrupted atau simple continuous.

Gambar 11. Paramedian abdominal closure

18
4.2.4 Insisi Paracostal

Indikasi : pembedahan pada ren, lien, discus intervertebralis lumbalis dsb.

Tehnik Operasi :

1. Hewan dipersiapkan untuk prosedur pembedahan dengan diletakkan pada

posisi rebah lateral kanan atau kiri (Gambar 12.1 dan 12.1a.). Di bagian
caudal tulang rusuk (Costae) terakhir dibuat insisi kulit sepanjang kira-kira 2-
3 cm mulai dari loin (m. Psoas) sampai hampir di bagian garis tengah
abdomen.
2. Jaringan lemak dan subkutan dipotong dengan gunting dan dipreparasi
(preparir) ke bawah sampai m. Obliqus abdominis externa (Gambar 12.2.).
Perhatikan perpaduan antara serabut otot dan aponeurosa tepat di bawah
pertengahan insisi.
3. Aponeurosa m obliqus abdominis externa diinsisi dengan skalpel atau gunting
dan diperpanjang dengan gunting (Gambar 12.3.).
4. Musculus obliqus abdominis interna diinsisi dengan cara yang sama
(Gambar 12.4.).
5. Musculus transversus abdominis dan peritoneum diinsisi dengan skalpel dan
diperpanjang dengan gunting (Gambar 12.5.).
6. Bagian pinggir m. Transversus dan peritoneum dikuakkan dengan allis
forceps (forceps jaringan) (Gambar 12.6.).
Catatan :
Insisi paracostal ditutup dengan dijahit lapis demi lapis. Lapisan
paling dalam (peritoneum dan m. Transversus abdominis) dijahit dengan pola
jahitan sederhana terputus menggunakan benang catgut 00, demikian pula
dengan jahitan lapis ke 2 pada bagian tepi m. Obliqus abdominis interna.
Jahitan lapis ke-3 pada m. Obliqus abdominis externa dengan cara yang sama,
dan jahitan ke-4 adalah pada kulit dengan pola jahitan sederhana terputus atau
matress menggunakan absorbable nomor 00.

19
 Gambar 12. Teknik insisi paracostal

4.2.5 Perawatan Post Operasi

Selama post operasi dilakukan pemantauan kondisi hewan seperti temperatur,

dan frekuensi nafas, nafsu makan, urinasi, defekasi serta kondisi luka. Dilakukan
pemasangan infuse pada kucing, dikarenakan selama operasi kucing mengalami
dehidrasi dan perdarahan.

Bekas insisi pada kulit dapat ditutup dengan flexible collodion dan benang
jahit pada kulit dapat diambil setelah 10-14 hari. Pemberian Antibiotik dan
membatasi geraknya.

20
 BAB V
SIMPULAN DAN SARAN

5.1 Simpulan

Laparoctomy (celiostomy) adalah pembedahan membuka dinding abdomen

melalui insisi ventral abdomen atau flank (dinding perut samping). Laparostomy
dilakukan untuk pembedahan didalam rongga abdomen seperti seksio cesaria,
ovarioheterctomy, hysterectomy, enterotomy, enterectomy, cystrotomy, gastrotomy,
dan untuk tujuan diagnostik

5.2 Saran

Diperlukan latihan yang baik, dan memperhatikan tahapan-tahapan operasi

laparoctomy. Ketika melakukan tindakan operasi harus memperhatikan kerja yang
aseptis, dan sterilisasi alat. Dan perawatan pasca operasi untuk mendapatkan hasil
yang optimal dan mencegah terjadinya infeksi.

21
 DAFTAR PUSTAKA

Daniel D. 2008. Paramedian Abdominal Approach: Technique. Abstracts European

Veterinary Conference Voorjaarsdagen. Colorado State University. USA

Firth, E.G. et al. 1985. Atlas of Large Animal Surgery. London: Williams & Wilkins.

Hernndez, C., Restrepo, R. 2005. Adenocarcinoma in the Jejunum of a Dog: A Case

Report. Colombia: Revista.

Hickman, J., Houlton, J., Edwards, B. 1995. An Atlas of Veterinary Surgery Third
Edition. London: Blackwell Science Ltd.

Joze Staric et al. 2010. Surgical Treatment of Displaced Abomasum in Cattle Using
Ljubljana Method. Harran University. Turkey

Lysimachos G. P, Eleni B. 2015. Exploratory Laparotomy in the Dog & Cat.

Aristotle University of Thessaloniki. Greece

Shin, S.T., Jang, S.K., Yang, H.S., Lee, O.K. 2008. Laparoscopy vs. laparotomy for
embryo transfer to produce transgenic goats (Capra hircus). Korea: J. Vet.
Sci.

Smeak, D.D. 2008. Paramedian Abdominal Approach: Technique. Colorado:

Colorado State University.

Stari, J., Biricik, H. S., Aksoy, G., Zadnik, T. 2010. Surgical Treatment of
Displaced Abomasum in Cattle Using Ljubljana Method. Turkey: ACTA
VET.

Tobias, K.M. 2010. Manual of Small Animal Soft Tissue Surgery. Iowa: Wiley-
Blackwell.

Sudisma, I.G.N., Jaya, A.A.G.W., Putra, I.G.Ag.P., Gorda, I.W. 2016. Buku Ajar
Ilmu Bedah Veteriner dan Teknik Operasi. Penerbit Universitas Udayana.
Denpasar.

22
LAMPIRAN

23
PROCEDURES PRO h SURGERY h PEER REVIEWED
Exploratory Laparotomy
in the Dog & Cat
Lysimachos G. Papazoglou,
DVM, PhD, MRCVS
Aristotle University of Thessaloniki
Thessaloniki, Greece
Eleni Basdani, DVM, PhD
Bessys Klinik
Zurich, Switzerland
Exploratory laparotomy is routinely per-
formed in small animal practice and is
indicated when organ dysfunction or
trauma involving the abdominal cavity
requires definitive diagnosis along with
surgical treatment and prognosis.1 Sur-
gical exploration provides information
through inspection, palpation, and/or
hollow organ luminal mucosa observa-
tion. Samples can be obtained for micro-
biologic and cytologic examination or
biopsy for histopathologic examination.
Abdominal exploration should be per-
formed in a timely manner to increase
the likelihood of successful diagnosis
and management without negatively
affecting the patient.
A ventral midline laparotomy of adequate
length from xiphoid to the pubis is the
standard approach to explore the entire
abdominal cavity in a systematic manner.
Every surgeon may develop his or her
own technique, but a suggested method
includes exploring the cranial quadrant
(diaphragm; liver, gallbladder, and bili-
1. Surgical bowl, 2. bulb syringe for irrigation, 3. laparotomy pads, 4. 4 x 4 gauze
sponges, 5. monopolar diathermy cable, 6. suction tube, 7. Poole suction tip, 8.
Babcock tissue forceps, 9. Allis tissue forceps, 10. No 15 and 10 scalpel blades, 11.
Bard Parker scalpel handle, 12. Backhaus towel clamps, 13. curved and straight
Metzenbaum scissors, 14. straight Mayo scissors, 15. Balfour retractors, 16.
Debakey tissue forceps, 17. Rat-tooth thumb forceps, 18. Mayo-Hegar needle
holders, 19. straight and curved Rochester-Carmalt hemostatic forceps, 20.
straight and curved mosquito hemostatic forceps.
ary tree; spleen and stomach; duode-
num and pancreas), caudal quadrant WHAT YOU WILL NEED
(jejunum, ileum, and colon; urinary
bladder; urethra and prostate or dN
 ecessary instrumentation
uterus), right paravertebral region by for performing an
retracting the mesoduodenum, and left exploratory laparotomy
paravertebral region by retracting the includes a well-equipped
mesocolon (kidneys, adrenal glands, general surgery pack.
Swabs and sponges
ureters, and ovaries).2
should be counted at the
A ventral midline laparotomy beginning and the end
of surgery.
of adequate length from
xiphoid to the pubis is the
standard approach to explore
the entire abdominal cavity in
a systematic manner.
October 2015 cliniciansbrief.com 15
PROCEDURES PRO h SURGERY h PEER REVIEWED

STEP-BY-STEP
EXPLORATORY LAPAROTOMY

STEP 1

1
Generously clip and prepare the surgical site, extend-
ing cranially to the xiphoid, caudally to the pubis, and
over 5 to 10 cm from the ventral midline on either side.
Express the bladder through the abdominal wall.

Author Insight:
Midline laparotomy incision should extend from
xiphoid to pubis.

STEP 2 STEP 3

2 3

ROSTRAL

Use a 4-corner draping technique: in male dogs, grasp

Inject preincisional block (2 mg/kg bupivacaine) along
the ventral midline from the beginning to the end of
the proposed incision in a fan-like fashion to infiltrate
subcutaneous and muscular tissues. This technique
provides postoperative analgesia for at least 24 hours.3,4
the prepuce with towel forceps and position laterally to
the midline to avoid urine spillage into the surgical site;
penis and prepuce can be covered by 1 of the lateral
drapes. Make a parapreputial skin incision, dividing the
preputial muscles and sealing external pudendal vessels
with elecrocautery following the incision to allow reflec-
tion of the prepuce and penis laterally to visualize the
linea alba. In female dogs and all cats, extend the ventral
midline incision from xiphoid to pubis.

16 cliniciansbrief.com October 2015

STEP 4 STEP 6

4 6

ROSTRAL

After skin incision, seal subcutaneous vessels via elec-
rocautery and undermine subcutaneous tissues from
attachment to the rectus sheath 1 cm laterally to visual-
ize the linea alba. Avoid excessive undermining to pre-
vent vascular compromise of the fascia and dead space
creation and subsequent seroma formation.
Insert thumb forceps with the tips placed caudally to
lift upward on the linea alba and make a cranial to cau-
dal incision. Extend the incision cranially by directing
thumb forceps with tips placed cranially.
STEP 7

STEP 5 7A
5

ROSTRAL

Make a stab incision to the linea alba with a scalpel and 7B

insert a finger into the incision to ensure entry to the
abdominal cavity and to confirm that there are no adhe-
sions between the abdominal wall and intra-abdominal
organs. A stab incision and letting air into the abdomi-
nal cavity also allows the abdominal organs to fall
dorsally, away from the ventral aspect of the abdominal
wall, making the subsequent extension of the midline
ROSTRAL
incision safer.

An alternative technique to enter the abdominal cavity

is to lift the linea alba with thumb forceps and make a
stab incision with the cutting edge of the scalpel blade
pointing upward (A). Use Mayo scissors to extend the
incision (B).

October 2015 cliniciansbrief.com 17

PROCEDURES PRO h SURGERY h PEER REVIEWED

STEP 8 STEP 10

8 10A

ROSTRAL

10B

When treating dogs, excise the falciform ligament

with elecrocautery or by placing a ligature at its
base to improve exposure to the cranial abdomen.
STEP 9
Use a systematic approach for abdominal explora-
tion. Abdominal organs should be inspected by
direct vision and palpation. Gently lift the right
lobe of the duodenum and mesoduodenum toward
the left side of the animal to allow exposure of the
right kidney, adrenal gland, ovary, and ureter (A).

9 Gently lift the colon and mesocolon toward the

right side of the animal to expose abdominal
organs of the left paravertebral fossa (B).

ROSTRAL

After the abdomen is entered, protect wound edges

with moistened laparotomy pads and place Balfour
retractors.

18 cliniciansbrief.com October 2015

STEP 11
11A
11B
Following abdominal exploration, lavage the
abdominal cavity using large volumes of warm
normal saline solution, which aids in removal of
contaminants and patient warming (A, B).2,5
Completely remove lavage fluid by suction before
closing the abdomen to avoid compromise of
defense mechanisms.2
STEP 12
12A
ROSTRAL
12B
The midline laparotomy incision is closed in 3 lay-
ers. The abdominal wall is closed using the exter-
nal leaf of the rectus abdominis muscle sheath in a
simple continuous or simple interrupted suture
pattern. Most surgeons favor a continuous
polydioxanone or polyglyconate suture pattern,
which provides a quick and secure closure.
Sutures should be placed 510 mm from the inci-
sion edge and spaced 510 mm apart, depending
on the size of the animal (A).6,7 Suture size
depends on the animals weight (animals <5 kg:
3/0; 520 kg: 2/0; 2040 kg: 0; and >45 kg: 1)(B).
Author Insight:
Closure of the linea alba must include the
external leaf of the rectus sheath.
October 2015 cliniciansbrief.com 19
PROCEDURES PRO h SURGERY h PEER REVIEWED

STEP 13 STEP 14
13A 14A

ROSTRAL

13B 14B
20 cliniciansbrief.com September 2015

For the second layer, subcutaneous closure is most commonly

ROSTRAL
Place 6 throws at the beginning and 7 at the
end of the continuous pattern (A).8,9 Sutures
should be placed tightly enough, depending
on the suture material used, to get the inci-
sion edges into apposition (B).
accomplished in a simple continuous pattern using 3/0 synthetic
absorbable monofilament suture to eliminate dead space and
decrease tension in the incision, allowing skin edges to be placed in
close apposition (A). Bury knots in the beginning and end of the
suture pattern (B). In male dogs, preputial muscle should be
apposed separately with a couple of simple interrupted sutures to
reposition the penis normally.

Author Insight:
Sutures should not be placed too tightly as this can
cause ischemic necrosis of the incision edges; however,
they must be tight enough to achieve adequate
apposition of the incision edges.

20 cliniciansbrief.com October 2015

STEP 15
15A
15B
Close skin using a simple continuous (A), Ford interlocking (B), or intradermal pattern with buried knots
(C), or use staples (D).
References
1. Boothe HW, Skater MR, Hobson HP, et al. Exploratory celiotomy in
200 nontraumatized dogs and cats. Vet Surg. 1992;21(6):452-457.
2. Boothe HW. Exploratory laparotomy in small animals. Compendium
Contin Educ Pract Vet. 1990;12:1057-1066.
3. Savvas I, Papazoglou LG, Kazakos G, et al. Incisional block with
bupivacaine for analgesia after celiotomy in dogs. JAAHA.
2008;44(2):60-66.
4. Campagnol D, Teixeira-Neto FJ, Monteiro ER, Restitutti F, Minto BW.
Effect of intraperitoneal or incisional bupivacaine on pain and the
analgesic requirement after ovariohysterectomy in dogs. Vet Anaesth
Analg.2012;39(4):426-430.
5. Nawrocki MA, MacLaughlin R, Hendrix PK. The effects of heated and
15C
ROSTRAL
15D
ROSTRAL
room-temperature abdominal lavage solutions on core body
temperature in dogs undergoing celiotomy. JAAHA. 2005;41(1):61-67.
6. Rosin E. Single layer simple continuous suture pattern for closure of
abdominal incisions. JAAHA. 1985;21(6):751-756.
7. Rosin E, Richardson S. Effect of fascial closure technique on strength
of healing abdominal incisions in the dog. A biomechanical study. Vet
Surg. 1987;16(4):269-272.
8. Muffy TM, Kow N, Iqbal I, Barber MD. Minimum number of throws
needed for knot security. J Surg Educ. 2011;68(2):130-133.
9. Marturello DM, McFadden MS, Bennett RA, Ragently GR, Horn G. Knot
security and tensile strength of suture materials. Vet Surg.
2014;43(1):73-79.
October 2015 cliniciansbrief.com 21

1 Scientific Proceedings: Companion Animals Programme
Paramedian Abdominal Approach: Technique
Daniel D. Smeak, DVM, Diplomate ACVS; Hospital Director, Colorado State University, USA,
Dan.Smeak@colostate.edu
Objectives of the Presentation
Present an alternate approach for limited access to the
caudal abdomen in male dogs.
General Key Points:
Technique Advantages
Easy, quick method to access the caudal abdomen in
male dogs. Allows continuation of exploration outside
abdominal cavity along inguinal region to scrotum, if
needed.
Technique Limitations
Only allows limited access to caudal abdomen. May
cause more hemorrhage in abdominal wall compared to
midline approach.
Key point: Surgeon must be certain that further explo-
ration of abdomen will not be required before attempting
this approach. Further access to abdominal cavity from
the paramedian approach will cause unnecessary tissue
dissection and bleeding.
Key Anatomy Points: Between the umbilicus and the
pubis, the external rectus sheath is comprised of fused
fascia of the external and internal abdominal oblique
muscles, and the transverses abdominis muscle. On
the lateral half of the external rectus fascia there are
2 separate fascial sheets (the fused fascial sheets of
the abdominal oblique muscles, and the fascial sheet
of the transversus abdominis muscle. In this area,
216 | Abstracts European Veterinary Conference Voorjaarsdagen 2008
Surgery
there is no internal rectus fascia deep to the rectus
abdominus muscle but there is a thin layer of peritoneum
present. The caudal superficial epigastric vessel runs
medial to the nipples as it runs forward to supply the
prepuce, superficial inguinal lymph node, and mammary
skin. The deep epigastric vessel runs about 1-2 cm lateral
to the linea alba just deep to the rectus abdominus
muscle. Smaller branches of this vessel course both
lateral and more superficial in the muscle.
Technique
Step 1
With the dog positioned in dorsal recumbency, place
a towel clamp on the prepuce (if a urethral catheter
is not expected to be used in the procedure) and clamp
it to the skin on one side of the body (the side opposite
the side of your intended abdominal approach). If you
expect that you will need access to the urethra, for
example, to flush urinary calculi from the urethra,
thoroughly irrigate the prepuce with antiseptic solution
and position the prepuce within your sterile field.
Step 2
Create a skin incision about 1 cm parallel and lateral
to the nipples from the level of the cranial aspect of
the prepuce to about 3-4 cm cranial to the pubic bone
(palpate this landmark under the skin). Avoid the caudal
superficial epigastric vessels, which run longitudinal and
parallel to nipples.
Surgery

Scientific Proceedings: Companion Animals Programme 1

Step 3
Incise through the subcutaneous tissue and ligate or
electrocoagulate small lateral branches of the epigastric
vessels. Once the rectus fascia is visible, locate the lateral
edge of the rectus muscle (this is seen as a line between
the whitish fascia of the rectus muscle and the more
reddish-appearing external abdominal oblique muscle.
Step 6
Bluntly break down any peritoneal attachments with
your fingers. The abdominal exposure is complete. Place
laparotomy sponges along the rectus edges, and insert
abdominal retractors (Balfour retractors work fine here)
to help isolate the problem area.
Cryptorchid testicle
excision through paramedian approach
Step 1
If the surgery aim is to remove an abdominal ectopic
testis, find the ductus deferens and follow this structure
to the testis.

Step 4
About 2/3 the width of the rectus muscle from the linea,
make a stab incision parallel to the linea in the external
rectus fascia. Undermine the rectus fascia parallel to
the linea and make an incision in the fascia (you will
cut through two separate layers of fascia) with Mayo
scissors the length of the original incison (do not incise
underlying muscle yet).
Alternately, the testicular artery can be used to locate
the testis. Remove the testis by separately ligating the
testicular vessels and ductus with absorbable suture
material or vascular occluding clips.

Step 5
At the same level as the rectus fascia incision, bluntly Perform routine castration for testicle in normal scrotal
create an opening into the peritoneal cavity with location
mosquito forceps. Grasp two mosquito forceps, one in
each hand, place the tips of the forceps in the wound,
and spread the forceps in the direction of the muscle
fibers. This will bluntly open the abdominal cavity
without cutting muscle tissue, which will reduce tissue
trauma and bleeding. If the deep epigastric vessels are
accidentally discupted, ligate the bleeding vessels with
chromic catgut sutures.

Abstracts European Veterinary Conference Voorjaarsdagen 2008 | 217

 Surgery

1 Scientific Proceedings: Companion Animals Programme

Step 2 in one layer with either a simple interrupted or simple

If the ductus is followed to the inguinal ring (this continuous pattern. Prolonged absorbable sutures are
means you did not detect that the testicle is outside recommended for closure.
the abdominal cavity), first gently pull on the ductus to
determine if the testis is in the ring- if it is not, bluntly
dissect external to the inguinal rings to find the spermatic
cord. Dissect along the cord until the testis is found. The
original skin incision is easily enlarged caudally to help
expose the area between the inguinal canal and scrotum
if the testicle is located in the subcutaneous tissue
caudal to the original incision area. Routinely ligate and
remove the ectopic testis.

Step 3
If the opposite testicle is intra-abdominal, this can
be reached through the same approach (follow step 1 Step 3
again) The subcutaneous tissue and skin are closed routinely.

Urinary calculi removal through paramedian approach

Step 1
Isolate the bladder with moist laparotomy sponges.
Place your stay sutures at the ends of the proposed
bladder incision site.

Step 2
Create the cystotomy.

Aftercare
Strict confinement after surgery is recommended for 2
weeks. Monitor the wound for any evidence of infection,
fluid accumulation, or breakdown. Fit an Elizabethan
collar on the patient if extra wound protection is neces-
sary.

Step 3
Run an appropriately-sized soft red rubber urinary
catheter normograde and retrograde up the urethral
orifice and cytotomy incision to remove residual calculi.
Complications
Just like for the standard midline approach to the
abdomen in dogs, bruising or seroma formation occa-
sionally occurs due to ineffective subcutaneous dead-
space closure or poor hemostasis.

Step 4
Close the cystotomy routinely.

Closure of the Approach

Step 1
Perform a sponge count and remove all pads and
instruments from the abdomen. There is no need to close
the peritoneal layer or muscle.

Step 2
Close the external rectus fascia (both fascial sheets)

218 | Abstracts European Veterinary Conference Voorjaarsdagen 2008

 ACTA VET. BRNO 2010, 79: 469473; doi:10.2754/avb201079030469

Surgical Treatment of Displaced Abomasum in Cattle Using Ljubljana Method

Joe Stari1, Halil Selcuk Biricik2, Gurbuz Aksoy3, Toma Zadnik1
1
Clinic for Ruminants, Veterinary Faculty, University of Ljubljana, Slovenia
2
Department of Surgery, 3Department of Internal Medicine, Faculty of Veterinary Medicine,
Harran University, Turkey

Received April 5, 2009

Accepted May 13, 2010

Abstract
Displacement of the abomasum (DA) is an increasingly common disease in dairy cattle in
intensive production. This study presents surgical treatment of DA using Ljubljana method in
years 2005 and 2006. Slovenian Black and White dairy cows (n = 30) with left DA in 19 cows,
right DA in four cows, anterior DA in two cows and abomasal volvulus in five cows were used.
The surgical treatment was successful in 28 cows, 2 had to be euthanized due to complications
associated with left DA and abomasal volvulus. One month after the surgery all 28 cows were
productive. Omentopexy using Ljubljana method can be used as a clinical procedure as well as
procedure performed in ambulatory practice.
Displacement, surgery, percutaneous, abdomen, omentopexy

In the last decade, displacement of the abomasum (DA) has been one of the most common
surgical interventions in dairy cattle. It occurs due to gas accumulation in the abomasum,
which pulls the organ from its physiological position on the abdominal floor either between
the left abdominal wall and rumen or between the right abdominal wall and intestines.
Distended abomasum can also change its normal position in the cranial direction. In such
case, displaced abomasum is trapped between the reticulum and diaphragm. This type of
displacement is called anterior DA (Zadnik et al. 2001; Zadnik 2003a). The incidence
of left abomasal displacement on lactation varies between 0.5 and 2.2%; in certain
circumstances it may be even 5% or more (Steiner 2006). Left DA is much more common
(8596% of DA) than right DA, accounting for 415% of cases (Constable et al. 1992).
In a study conducted in Slovenia, anterior abomasal displacement accounted for 12.4% of
cases (Zadnik 2003a).
Majority of cases develop within the first month after calving and other cases develop
during last months of pregnancy or in other physiological periods. Beside known
predisposing factors such as negative energy balance, hypocalcaemia, retained foetal
membranes, uterine infections, dystocia, cow breed, and others, physiologically more
transverse and cranial position of the abomasum during the last 3 months of gestation
(Wittek et al. 2005) and increasing depth of abdomen (Wittek et al. 2007) increase the
risk of displacement in dairy cattle.
In rare cases, abomasum spontaneously returns to its physiological position on the
abdominal floor. In majority of cases, treatment of the affected animal is necessary.
Decision upon the type of treatment is dependent on various factors including availability
of equipment, clinical status of the animal, costs of procedure, clinicians skills and
preferences, value of the animal, owners wishes, etc. Abomasal displacements can be
corrected by surgical or nonsurgical techniques. Nonsurgical techniques include rolling the
cow to flip the abomasum back in place, or securing the abomasum to the body wall with
a percutaneous blind tack or a toggle pin fixation. Rolling is not an effective long-term
treatment because most cows will have a recurrence. Left DA can be corrected surgically
using right flank omentopexy, right paramedian abomasopexy, left flank abomasopexy,
Address for correspondence:
Joe Stari, DVM, MSc Phone: 00386 1 4779 217
University of Ljubljana, Veterinary Faculty e-mail: joze.staric@vf.uni-lj.si
Gerbieva 60, 1000 Ljubljana, Slovenia http://www.vfu.cz/acta-vet/actavet.htm
470

one-step standing or dorsally recumbent cow laparoscopic abomasopexy or two-step

laparoscopic abomasopexy. Right DA and abomasal volvulus are corrected surgically using
right paralumbar fossa omentopexy or right paramedian abomasopexy. Current scientific
findings favour laparoscopy-assisted correction of uncomplicated left DA over other surgical
procedures due to lesser invasiveness, quicker completion of surgery, less complications,
quicker return to productivity and minor or no need of antibacterial treatment (Rohn et al.
2004; Seeger et al. 2006; Steiner 2006; Roy et al. 2008).
At the Clinic for Ruminants, Veterinary Faculty of Ljubljana we generally advise surgical
correction in the right paralumbar fossa based on more than 30-year-long experience with
DA. Right paralumbar fossa laparotomy gives excellent opportunity for evaluation of
almost the whole abdomen with organs, very good orientation and possibility of favourable
omentopexy position. Based on obtained information about clinical status, surgical and
clinicopathological findings, we are able to institute post-surgical medical treatment,
focused also on other pathological findings obtained at surgery and to give a firm prognosis
about recovery of the affected cow (Zadnik et al. 2001; Zadnik 2003b).
The study describes Ljubljana method of surgical correction of all types of displacements
of the abomasum or abomasal volvulus.
Materials and Methods
Animals
A total of 30 Slovenian Black and White dairy cows were included in this study. All the cows were within
4 weeks after calving, except one cow that was 140 days in milk. Cows were affected with left displacement
of abomasum (19), right DA (4), anterior DA (2) and abomasal volvulus (5).Cows were surgically treated by
Ljubljana method at the Clinic for Ruminants, Veterinary Faculty of Ljubljana in the years 2005 and 2006.
Diagnosis
The diagnosis was based on findings obtained by signalment and history of the disease and clinical examination.
The diagnosis was confirmed surgically. Clinic-pathological profile was examined to better assess the health
status of affected cows and further assist them with specific treatments (supplementation of fluids, minerals,
glucose, etc.) to facilitate faster return to full production.
Anaesthesia
Local anaesthesia with 2% procaine (procaine powder with sterile distilled water) was prepared. Proximal
paralumbar block (last thoracic T 13 and first two lumbar L 1 and L 2 spinal nerves) and inverted L block a few
cm cranial from surgical incision was performed. Twelve ml of 2% procaine were injected at each location of
dorsal and ventral branch of spinal nerves. Additional 60 ml was infiltrated subcutaneously in inverted L block.
Sedation was not used.
Ljubljana method percutaneous omentopexy using Bhner tape (silk ribbon)
Standing laparotomy was performed in right paralumbar fossa. Vertical or slightly oblique cranio-caudal
surgical incision started little less than a hand-width beneath transverse processes of lumbar vertebrae and
continued until the most caudal part of the costal arch where it ended about 4 to 5 cm caudal from it. M. obliqus
abdominis externus and internus were incised, although internus could be also separated bluntly in the direction
of muscle fibres. For entering the abdomen, rat-tooth tissue forceps were used to tent fascia and peritoneum, and
blunt Mayo scissors for cutting a hole big enough for passing a finger that helped as a guide for extending the
incision with scissors dorsally and ventrally. When the abdomen was entered, the suction of air into abdominal
cavity could be heard. For haemostasis Pean haemostats and 4 4 s were used. The surgical incision should
be long enough to permit passing a hand up to a shoulder. During the abdomen exploration, the quantity and
quality of abdominal fluid was evaluated followed by examination of the kidneys, caecum, uterus, small and
large intestines, rumen, and displaced abomasum. Then the abomasum was deflated at its most dorsal part at an
acute angle with a 2 mm diameter needle attached to sterile rubber tubing until there was no palpable gas left in it.
Palpation of the cranial part of the abdomen was followed by evaluation of liver fattiness, gall bladder, omasum
and reticulum. Thick omentum close to pylorus was then grabbed and the abomasum pulled to the right side in
case of left DA. In right DA or abomasal volvulus, the abomasum was deflated after excluding the possibility
of volvulus, perforating ulcer or establishing the direction of volvulus followed by retorsion and before any
exploration of the abdomen. Identification of pylorus was the next step. The landmark was thick omentum, which
was followed cranio-ventrally until pylorus was reached. Pylorus (Plate II, Fig. 1) could be identified due to its
unique characteristics: pale bluish pink colour, distinctive difference from omentum majus and its meaty structure
on palpation. For omentopexy silk ribbon (1 cm wide and 50 cm long), originally used for Bhner closure of vulva
in cows, was used and placed with Gerlach needle (Plate II, Fig. 2). Omentopexy suture was positioned about 5
 471

to 10 cm caudal from pylorus through the thick omentum with Gerlach needle. Than each loose end of a suture
was passed through the abdominal wall using Gerlach needle about 5 cm beneath the ventral end of the surgical
incision (Plate III, Fig. 3). To enable penetration of the needle through the skin, small stab incision was made
over the protruding Gerlach needle. The same was repeated with the other loose end of the omentopexy suture.
Position of the abomasum was rechecked and both ends of the suture tightened (not too tight in order to prevent
ischemia of the omentum). The suture was supported with rolled sterile 4 4, which was put under the knot.
Surgical incision was closed with three layers. Peritoneum, fascia and transversus muscle were sutured together
with simple continuous pattern with chromic catgut. M. obliqus internus if bluntly separated was apositioned with
about 3 simple interrupted sutures and m. obliqus externus was sutured with simple continuous pattern, both with
chromic catgut. Skin was closed with supramid (Ford interlocking suture and most ventral 2 sutures were simple
interrupted). Skin sutures and omentopexy sutures were removed about 10 days after the surgery.

Results
reduced appetite or off feed, reduced milk production, not chewing cud and reduced
faecal output of more dry or pasty faeces were recorded in all cows. Other predisposing
factors for abomasum displacement like obesity, milk fever, retained placenta etc. were
found. Concurrent diseases were often present (Table 1). Ketosis that did not respond
favourably to treatment was very common.

Table 1. Information on concurrent diseases in treated cows using Ljubljana method at the hospital and their
follow up status after 1 month
Type of abomasal pathology
LDA ADA RDA AV
In hospital Number of cows 19 2 4 5
Average days in milk 14.1* 14.5 12 20.2
No other problems 4 0 0 3
Metritis 8 0 1 1
Mastitis 0 0 0 0
Ketosis 13 2 4 2
Euthanized after surgery 1 0 0 1
1 month follow-up No problems 13 2 4 2
Lower than expected productivity 5 0 0 2
Surgical site infections 0 0 0 0
Euthanized 0 0 0 0
*One cow had LDA 140 days in milk and was not included in this calculation
LDA - Left displacement of abomasum, RDA - Right displacement of abomasum, ADA - Anterior displacement
of abomasum, AV - Abomasal volvulus

Clinical examination usually revealed typical ping effect on simultaneous percussion

and auscultation positioned either in the right or left costal region of abdomen that
could extend to paralumbar fossa, depressed ruminal motor activity, often mild
jaundice, deep paralumbar fossa, positive succussion test over sight of abomasal
displacement (splashing sounds), sound of gas bubbles emerging through accumulated
fluid in the abomasum on auscultation, high or slightly elevated arterial pulse and
often enophtalmus (especially if diagnosed late in the course of the disease). Clinico-
pathological findings indicative of abomasal displacement included hypokalaemia,
hypochloridaemia, hyperbilirubinaemia, mild hypocalcaemia, elevated beta-hydroxy
butyrate. Higher activities of aspartame amino transferase, lactate dehydrogenase,
gamma glutamyl transferase and glutamate dehydrogenase were frequently observed.
Stress leucogram and hyperglycaemia were also present in many cases. Especially
in long-lasting and AV cases, haemoconcentration was often observed. Clinical signs
were usually more pronounced in abomasal volvulus (AV) cases, where also signs of
dehydration were usually more evident.
472

The surgical correction was successful in 28 cows, 2 had to be euthanized, one due to bad
clinical status after abomasum displacement and perforating ulcer correction and the other
due to n. vagus indigestion following AV correction. No relapses occurred within a month
after the surgery. All 28 cows were productive one month after the surgery.
Discussion
Since the first cow was treated for DA at the Clinic for Ruminants, Veterinary Faculty of
Ljubljana in 1969 (Skuek et al. 1970), the frequency of the disease has increased rapidly
(Zadnik et al. 2001). Based on recent data collected by Veterinary Administration of the
Republic of Slovenia, current incidence rate of DA is about 2% of dairy cows in lactation.
Displaced abomasum is also the most frequent diagnosis in dairy cows admitted at the
Clinic for Ruminants.
Clinical and clinic-pathological findings in studied cows with abomasal displacement
were in accordance with findings of other studies (Zadnik et al. 2001; Zadnik 2003b).
Experience with DA and AV shows that the clinical treatment using Ljubljana method
is successful. Based on our experience, percutaneous omentopexy using Ljubljana method
does not produce permanent adhesion of the omentum to the abdominal wall. When
omentopexy suture is removed about 714 days after the surgery, abomasum can be free
again and can move in the abdominal cavity. We assume that in the period of up to 14 days
after the surgery, the rumen improves to disable abomasal movement. Affected cows also
stabilize metabolically which is necessary for the healthy tonus and motorical function
of the abomasum. Even though abomasum may be free when the omentopexy suture is
released, re-displacements are very rare, and none was observed in cows included in this
study. We did not perform follow-up ultrasound or laparoscopic examination to exclude
formation of permanent adhesions after Ljubljana method surgical correction of DA. Our
assumption is based on few documented cases of cows (n = 15) which had DA again in
consecutive lactations. A small round adhesion of about 0.5 cm diameter and a few cm
length of the omentum to the abdominal wall was observed only once in these cows. Even
in a cow that was surgically treated for LDA in the second, third and fourth lactation, there
were no adhesions found at the surgery.
The possibility of re-displacement is a disadvantage of this method compared to methods
that produce a permanent adhesion. This is the reason why some owners of cows with
DA prefer permanent fixation. However, we are of the opinion that enabling normal
physiological movement of the abomasum during pregnancy is beneficial for cows.
Permanent omentopexy can cause stretching of the omentum in late pregnancy when the
abomasum moves physiologically more cranial and transverse than in non-pregnant cows
(Wittek et al. 2005). The situation can be more aggravated in cows with abomasopexy.
This can potentially cause discomfort and complications when these cows are in late
pregnancy. Another potential disadvantage of surgical correction of DA using Ljubljana
method compared to other surgical methods that do not produce percutaneous pexy is
the possibility of infection through percutaneous omentopexy suture. Omentopexy suture
presents a potential route of entry for bacteria into the abdominal cavity. This could be a
problem especially if cows are kept in unsanitary conditions after surgery. At the Clinic
for Ruminants in Ljubljana, cows are hospitalized for about 3 to 7 days after surgery and
receive antibiotic treatment. If omentopexy suture is soiled it needs to be cleaned and
disinfected (we usually use povidon iodide or oxytetracycline spray). Occasionally some
pus comes out of the suture site after the suture is removed, but infection usually resolves
spontaneously without complication. To reduce the possibility of abdominal contamination
and infection, the suture should be disinfected with povidon iodide and then pulled lightly
before cutting one side of it and pulling it out. In case of fluid accumulation in the abdominal
cavity, omentopexy suture draining peritoneal fluid was observed.
 473

Surgical treatment of DA using Ljubljana method is financially acceptable and useful

for all types of DA and AV. Bhner tape is not expensive, and except the Gerlach needle
there are no other special surgical instruments needed. Because only one percutaneous
omentopexy suture is placed, the surgery can be completed faster than in laparotomy
techniques where pexy is carried out by suturing. The surgery can be performed also in the
field. Many ambulatory cattle practitioners in Slovenia successfully perform it on farms.
In conclusion, we recommend omentopexy using Ljubljana method as an alternative
to laparoscopy-guided surgery and other laparotomy techniques, as a clinical procedure
as well as procedure performed in ambulatory practice. The surgery can be used in all
types of DA and AV; it is rapidly performed in standing animal; it does not need expensive
equipment; it can be performed with minimal personnel; it has low recurrence rate, and is
not expensive. It can also be used in cows in late pregnancy.
Acknowledgment
The authors thank Joica Jeek PhD, DVM and edo Bursa, veterinary technician, for their help in cow treatment
and Marija Nemec MSc, DVM for performing haematology and biochemistry analyses.

References
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abomasal displacement in cattle. Am J Vet Res 53: 1184-1191
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Vet Med Series A 51: 300-305
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 Plate II
Stari J. et al.: Surgical ... pp. 469-473

Fig. 1. Appearence of pylorus during operation

Fig. 2. Bhner tape and Gerlach needle

 Plate III

Fig. 3. End of suture is passed through the abdominal wall using Gerlach needle about 5 cm
beneath the ventral end of the surgical incision