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TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

TEKNIK OPERASI COLOPEXY

Disusun Oleh :

Kelompok IV B

Tisa Tetrania 1609511053

Irene Cristina Br Sembiring 1609511061

Kartika Dewi Kusumawardhani 1609511063

Laras Ayu Nadira 1609511064

Widia Insani 1609511083

Luh Gede Setyawati 1609511090

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

TAHUN 2019

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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 Colopexy”.

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, 22 Oktober 2019

Penulis

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DAFTAR ISI

COVER ........................................................................................................... i
KATA PENGANTAR ................................................................................... ii
DAFTAR ISI ................................................................................................. iii
DAFTAR GAMBAR .................................................................................... iv
DAFTAR LAMPIRAN ................................................................................. v
BAB I PENDAHULUAN
1.1 Latar Belakang .......................................................................................... 1
1.2 Rumusan Masalah ..................................................................................... 1
BAB II TUJUAN DAN MANFAAT
2.1 Tujuan Penulisan ...................................................................................... 2
2.2 Manfaat Penulisan .................................................................................... 2
BAB III TINJAUAN PUSTAKA
3.1 Definisi Colopexy ..................................................................................... 3
3.2 Tujuan Colopexy ...................................................................................... 3
BAB IV PEMBAHASAN
4.1 Anastesi .................................................................................................... 4
4.2 Pre-Operasi ............................................................................................... 5
4.3 Teknik Operasi Colopexy ......................................................................... 6
4.4 Pasca Operasi ............................................................................................ 8
4.5 Komplikasi Pasca Operasi ........................................................................ 9
BAB V. SIMPULAN
5.1 Simpulan ................................................................................................. 10
DAFTAR PUSTAKA ................................................................................... 11
LAMPIRAN ................................................................................................. 12

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DAFTAR GAMBAR
Gambar 1. Insisi longitudinal melalui lapisan serosa pada kolon ...................6
Gambar 2. Insisi longitudinal pada peritoneum...............................................7
Gambar 3. Penautan kolon dan peritoneum dengan jahitan............................8

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DAFTAR LAMPIRAN
Lampiran 1. Colopexy as a Treatment for Recurrent Rectal Prolapse in a Dog
Lampiran 2. Comparison of Laparoscopic-Assisted and Open Colopexy in Dogs
Lampiran 3. Surgical Management of Recurrent Rectal Prolapse in a Domestic Kitten
(Felis catus)

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BAB I
PENDAHULUAN
1.1. Latar Belakang
Gangguan pada sistem pencernaan hewan merupakan salah satu hal yang
penting untuk diperhatikan karena berkaitan dengan pertumbuhan serta
perkembangan hewan. Gangguan pada sistem pencernaan yang dapat terjadi salah
satunya ialah prolapsus rektum. Prolapsus rektum adalah tonjolan keluar jaringan
rektum melalui anus. Penyebab kejadian ini adalah proses pengejanan kuat yang
terjadi saat proses defekasi pada diare kronis, proses partus terutama pada kasus
distokia juga dapat menyebabkan prolaps rektum, penyebab lainnya adalah sembelit ,
urolithiasis, obstruksi anus serta obstruksi vesica urinaria.

Penanganan pada kasus prolapsus rektum dapat berupa reposisi manipulative


yaitu secara manual, colopexy hingga amputasi rektal. Colopexy merupakan salah
satu pilihan yang efektif pada kasus prolapsus rektum kronis untuk mencegah rektum
tidak kembali prolaps. Colopexy merupakan tindakan operasi untuk melekatkan
secara permanen kolon descenden dengan dinding abdomen untuk mencegah prolaps
rektum.

1.2. Rumusan Masalah


1. Apa yang dimaksud dengan operasi colopexy?
2. Apa tujuan dilakukannya operasi colopexy?
3. Apa premedikasi dan anestesi operasi colopexy?
4. Bagaimana pre-operasi colopexy?
5. Bagaimana teknik operasi colopexy?
6. Bagaimana perawatan pasca operasi colopexy?
7. Apa komplikasi yang bisa timbul akibat operasi colopexy?

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BAB II

TUJUAN DAN MANFAAT PENULISAN

2.1. Tujuan Penulisan


1. Memahami definisi operasi colopexy.
2. Memahami tujuan operasi colopexy.
3. Memahami premedikasi dan anestesi operasi colopexy
4. Memahami pre-operasi colopexy.
5. Memahami teknik operasi colopexy.
6. Memahami perawatan pasca operasi colopexy.
7. Memahami komplikasi yang bisa timbul akibat operasi colopexy.

2.2 Manfaat Penulisan


Penulis berharap paper yang dibuat dapat memberikan informasi dan
pengetahuan kepada pembaca. Sehingga pembaca dapat mengetahui bagaimana
operasi colopexy yang baik dan benar.

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BAB III
TINJAUAN PUSTAKA
3.1. Definisi Colopexy
Colopexy adalah prosedur bedah umum untuk (adesi) secara permanen antara
permukaan serosa dari colon descendens dan lateral dinding abdomen yang
menembus peritoneum dan m. transversus abdominis untuk mencegah pergerakan
dari colon dan rectum. Beberapa kasus yang berakibat pada kejadian prolapsus rektal
adalah distokia, urolithiasis, neoplasma intestinal, hernia perineal, konstipasi dan
pasca operasi anus atau perineal.

3.2. Tujuan Colopexy


Colopexy paling sering digunakan untuk mengatasi prolap rektum berulang.
Indikasi operasi ini ditujukan untuk mencegah timbulnya prolapsus rektal (usus
keluar / menggantung melalui anus) berulang (Fossum, 2002). Prolapsus rektum
merupakan protrusion atau keluarnya satu atau lebih lapisan rektum melalui anal
orifisium. Pada hewan kecil, seperti anjing dan kucing, prolapsus rektum sering
terjadi karena adanya gangguan pada sistem digesti, seperti diare, tenesmus,
gangguan prostat dan saluran urinaria bagian bawah yang terjadi secara terus-
menerus. Tingkat prevalensi tertinggi terjadinya prolapsus rektum pada hewan
biasanya pada hewan yang berumur muda, yang ditandai dengan adanya diare berat.

Prolapsus rektum pada hewan dapat disembuhkan dengan melakukan tindakan


pembedahan. Tindakan pembedahan yang dilakukan adalah dengan melakukan
amputasi atau reposisi pada rektum. Amputasi rektum dilakukan apabila prolapsus
yang terjadi sudah menjadi nekrosis. Sedangkan reposisi rektum dapat dilakukan
apabila prolapsus rektum yang terjadi belum berat dan bagian mukosa hanya
mengalami sedikit kerusakan. Namun untuk mencegah terjadinya prolapsus rektum
biasanya dilakukan operasi colopexy.

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BAB IV
PEMBAHASAN
4.1 Anastesi
Obat-obatan anastetika yang diberikan pada hewan akan
membuat hewan tersebut tidak peka terhadap rasa sakit sehingga hewan menjadi
tenang, dengan demikian pembedahan lebih aman dan lancar. Beberapa obat
anastetik ada yang mampu menghilangkan rasa nyeri, sehingga masih dibutuhkan
obat – obat yang mempunyai kemampuan analgesik. Hal penting yang perlu
dipertimbangkan dalam suatu anastesi antara lain : nama obat (kandungan obat),
indikasi obat, sifat – sifat obat, efek samping obat, mekanisme kerja obat,
cara pemberian (peroral, perenteral atau perinhalasi), kondisi umum hewan,
spesies hewan dan umur hewan, tujuan anastesi. Tujuan umum pemberian anastesi :
1. Mengurangi atau menghilangkan rasa nyeri dengan meminimalkan kerusakan
beberapa organ tubuh terutama pada pasien dengan kondisi khusus, seperti :
pada pasien tua, bayi atau penderita komplikasi.
2. Membuat hewan tidak terlalu banyak bergerak bila dibutuhkan relaksasi
muskulus (mengendalikan hewan).

Premedikasi yang digunakan Atropin sulfat 0,025 % dengan dosis 0,04


mg/kg BB yang diberikan secara sub kutan. Adapun Atropin Sulfat dapat mengurangi
aksi dari vagus serta akan meningkatkan tekanan darah setelah pemberian. Dalam
pemberian pemberian harus hati-hati agar depresi pada pusat respirasi tidak terjadi.
Anestesi umum diberikan setelah 15 menit pemberian premedikasi. Anestesi umum
yang digunakan adalah kombinasi antara Ketamin HCl 10 % dengan dosis 15
mg/kg BB dan Xylasin 2 % dengan dosis 2 mg/kg BB yang diberikan secara
intramuskuler dapat diberikan kepada anjing dan kucing juga dapat diberikan untuk
domba dan babi. Sedangkan untuk reptile dan beberapa spesies unggas digunakan
kombinasi ketamine dengan diazepam. Pada semua hewan, pemberian ketamin
sebagai anestesi tunggal bukanlah pilihan yang terbaik karena obat ini tidak
merelaksasi muskulus dan terkadang tonus sedikit meningkat. Selain itu premedikasi

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yang lain juga adapat diberikan seperti ceftriaxone (25 mg/kg intravenously),
pentazocine (1 mg/kg intravenously), and diazepam (0.5 mg/kg intravenously).
Anestesi Thiopental Sodium juga dapat diberikan secara intravena.

4.2 Pre-Operasi
Adapun sebelum melakukan operasi Colopexy dibutuhkan beberapa persiapan
preoperasi, meliputi:

1. Persiapan Alat, Bahan, dan Obat


Sebelum melakukan operasi, alat-alat yang digunakan seperti blade
dan scalpel, arteri clamp, gunting, jarum ujung segitiga, pinset chirurgis, dan
alat bedah lainnya harus berada dalam keadaan steril agar tidak terjadi
kontaminasi yang dapat menghambat proses kesembuhan luka. Bahan-bahan
yang digunakan dalam hal ini antara lain tampon, kain kassa, benang Chromic
Catgut, Silk untuk menutup kulit bagian luar, alkohol 70% povidone iodine,
premedikasi menggunakan Atropine Sulfat, anestesi menggunakan Ketamine
dan Acepromacin, antibiotik menggunakan Betamox, analgesik menggunakan
Tolfedin, dan cairan NS.
2. Persiapan Ruang Operasi
Ruangan dan tempat operasi dibersihkan. Ruang operasi dan meja
operasi didesinfeksi menggunakan desinfektan. Kemudian difumigasi dengan
formalin 10% dan KMnO4 1% lalu dibiarkan selama 15 menit.
3. Persiapan Operator dan Co-operator
Persiapan Operator dan Co-operator harus memenuhi SOP untuk
tujuan sterilitas prosedur pelaksanaan operasi. Sebelum melakukan operasi,
keduanya harus dalam keadaan yang steril dengan memakai pakaian khusus
ataupun jas lab, gloves steril yang disemprotkan dengan alkohol 70% terlebih
dahulu, dan juga masker. Keduanya juga harus melepaskan aksesoris yang
dapat mengganggu jalannya operasi. Cuci tangan hingga mencapai siku
dengan menggunakan air bersih mengalir dan sabun, setelah itu dapat dicuci
kembali dengan alkohol 70%. Kondisi operator maupun co-operator harus

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dalam keadaan yang sehat fisik agar pelaksanaan operasi berjalan lancar.
Keadaan tersebut dipertahankan sampai operasi selesai.
4. Persiapan Hewan yang akan dioperasi
Persiapan hewan sebelum operasi, hewan harus dipuasakan makan
minimal 8 jam dan tidak diberi air minum selama 12 jam sebelum operasi
untuk menghindari dampak dari pemberian anestesi, mengosongkan lambung,
serta mengosongkan isi dari vesica urinaria/kantung kemih. Dilakukan
pemeriksaan terhadap fisik hewan berupa inspeksi ada atau tidaknya
keabnormalan bagian tubuh, pengukuran berat badan, pulsus, temperature,
penentuan umur dengan melihat gigi yang telah tanggal, dan lainnya.
Premedikasi diberikan 30 menit sebelum operasi dan setelahnya kurang lebih
10 menit diberikan anesthesia. Setelah pasien teranestesi, hewan diposisikan
rebah dorsal di atas meja operasi sehingga terlihat bagian ventral abdomen,
dan fiksasi keempat kaki untuk mempertahankan posisi. Lalu dilakukan
pencukuran rambut pada bagian yang akan dilakukan pembedahan (site
operasi) yang selanjutnya didesinfeksi dengan menggunakan povidone iodine
agar tidak terjadi kontaminasi. Bagian tubuh hewan ditutup kain drape yang
telah difiksasi dengan towel clamp, kecuali pada bagian yang akan dioperasi
dengan tujuan untuk meminimalisirkan kontaminasi selama operasi
berlangsung dan memfokuskan operator pada bagian yang akan dioperasi.

4.3 Teknik Operasi Colopexy


Setelah teranestesi, hewan dibaringkan dengan posisi rebah dorsal. Bagian
ventral abdomen (dari xiphoid sampai pubis dan kedua lipatan inguinal) dicukur,
disiapkan secara aseptik, dan dipasangi kain penutup operasi (Kumar et all, 2012).
Insisi dilakukan pada garis median abdomen dari umbilicus sampai 8-10 cm ke arah
caudal umbilicus. Kolon descenden ditentukan lokasinya dan di angkat ke permukaan
(ke arah cranial). Dilakukan insisi longitudinal sepanjang 3-4 cm pada batas
antimesenter dari dinding kolon descenden (Gambar 1). Hanya lapisan serosa dan
muskuler yang diinsisi tanpa penetrasi ke lapisan mukosa. Insisi sejenis dilakukan

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pada dinding kiri abdomen 2.5 cm dari linea alba melalui peritoneum dan dibawah
otot (Gambar 2). Masing-masing ujung dari insisi kolon dan dinding abdomen
ditautkan dengan jahitan pola sederhana menerus menggunakan benang polyglycolic
acid 2-0 (Gambar 3) (Zhang et all, 2012). Jahitan dilakukan hanya pada lapisan
seromuskuler dan submukosa sebagai usaha untuk menghindari penetrasi ke lumen
dari colon (Kumar, 2012). Ketelitian diperlukan saat menempatkan jahitan colopexy
hanya ke submukosa dan menghindari penetrasi ke lumen kolon untuk mencegah
kontaminasi pada situs colopexy (Popovitch et all, 1994). Setelah operasi selesai,
bagian muskulus pada abdomen dijahit dengan pola sederhana menerus menggunakan
benang plain catgut 3-0. Jaringan subkutan dijahit dengan pola sederhana menerus
menggunakan benang plain catgut 3-0 dan kulit dijahit dengan benang non-
absorbable menggunakan pola sederhana terputus.

Gambar 1. Insisi longitudinal melalui lapisan serosa pada kolon


Sumber : Nemeth T, 2013

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Gambar 2. Insisi longitudinal pada peritoneum
Sumber : Nemeth T, 2013

Gambar 3. Penautan kolon dan peritoneum dengan jahitan


Sumber : Nemeth T, 2013

4.4 Pasca Operasi


Kucing akan diberi obat pereda nyeri dan antibiotik selama beberapa hari
pertama setelah operasi untuk mengurangi rasa sakit dan pembengkakan yang terkait
dengan pembedahan dan mencegah infeksi yang terkait dengan pembedahan. Kucing

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harus tetap diam selama 10 hari pertama setelah operasi saat jahitannya sembuh, dan
lokasi sayatan kulit perlu diperiksa setiap hari untuk melihat tanda-tanda infeksi
(pembengkakan, kemerahan, keputihan). Dokter hewan Anda akan mengangkat
jahitan dan memeriksa sayatan setelah 10 hari. Setelah kucing Anda pulih dari
operasi, tidak perlu ada perawatan lebih lanjut.

Ceftriaxone ditambah tazobactum disarankan untuk 5 hari pascaoperasi


sementara 5% DNS (250 ml dua kali setiap hari) dan analgesik diberikan selama 3
hari. Istirahat diet ketat disarankan untuk 4 hari lagi diikuti dengan pemberian susu
dan bubur dari hari ke-4 seterusnya dan kemudian secara bertahap mengubah pola
makan menjadi makanan normal. Selain itu, pemberian oral pencahar (Cremaffin
plus) dimulai setelah 4 hari pasca operasi dan dilanjutkan selama 10 hari untuk
memungkinkan lewatnya feses dengan mudah dan mencegah ketegangan saat buang
air besar. Ganti kulit secara teratur luka dilakukan dengan menggunakan larutan
povidone iodine 5% dua kali sehari selama 7 hari (Monsang, dkk. 2014).

Analgesia pasca operasi diberikan oleh meloxicam (0,2 mg / kg


intramuskuler, sekali sehari) selama tiga hari. Ceftriaxone (10 mg / kg intramuskuler,
dua kali sehari) diberikan selama lima hari. Pembalut antiseptik dari garis jahitan
dilakukan dengan solusi povidone iodine selama 10 hari. Kulit jahitan dihilangkan
pada 10 pasca operasi hari (Kumar v, dkk. 2012).

4.5 Komplikasi Pasca Operasi


Beberapa penelitian menunjukkan bahwa colopexy laparoskopi dapat
membawa risiko lebih tinggi terjadinya kebocoran usus besar. Perdarahan dan
peradangan adalah komplikasi yang mungkin terjadi dari prosedur ini. Dalam
kebanyakan kasus, komplikasi minimal atau tidak sama sekali dari operasi colopexy,
dimana usus anjing akan kembali ke fungsi aslinya.

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BAB V
SIMPULAN
5.1 Simpulan
Colopexy merupakan tindakan operasi penempelan kolon terhadap dinding
abdomen dalam upaya mengatasi terjadinya prolapsus pada rektum. Colopexy
dilakukan untuk menciptakan perlekatan permanen antara serosa kolon dan dinding
perut yang bertujuan untuk mencegah pergerakan caudal kolon dan rektum.

Premedikasi yang digunakan Atropin sulfat 0,025 % dengan dosis 0,04


mg/kg BB yang diberikan secara sub kutan. Anestesi umum diberikan setelah 15
menit pemberian premedikasi. Anestesi umum yang digunakan adalah
kombinasi antara Ketamin HCl 10 % dengan dosis 15 mg/kg BB dan Xylasin 2 %
dengan dosis 2 mg/kg BB yang diberikan secara intramuskuler. Adapun sebelum
melakukan operasi Colopexy dibutuhkan beberapa persiapan preoperasi, meliputi:
persiapan alat bahan dan obat, persiapan ruang operasi, persiapan operator dan co-
operator dan persiapan hewan yang akan dioperasi.

Teknik operasi Colopexy yaitu insisi longitudinal melalui lapisan serosa pada
kolon, insisi longitudinal pada peritoneum, dan penautan kolon dan peritoneum
dengan jahitan. Perawatan pasca operasi hewan diberi obat pereda nyeri dan
antibiotik selama beberapa hari, hewan harus tetap diam selama 10 hari pertama
setelah operasi, dan lokasi sayatan kulit perlu diperiksa setiap hari untuk melihat
tanda-tanda infeksi (pembengkakan, kemerahan, keputihan). Perdarahan dan
peradangan adalah komplikasi yang mungkin terjadi dari operasi Colopexy.

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DAFTAR PUSTAKA

Fossum,T.W. 2002. Small Animal Surgery 2nd Edition. CV Mosby Comp.


Philadelphia
Kumar V., Ahmad R.A., Amarpal. 2012. Colopexy As A Treatment For Recurrent
Rectalprolapse In A Dog. Indian Journal Of Canine Practice, 138-140.
Monsang SW., Singh J., Madhu DN., Amarpal., Pawde M., Kinjavdekar P. Surgical
Management Of Recurrent Prolapse In Dosmetic Kitten (Felis Catus) A
Case Report. Department OfTVCC (Surgery), C. V. Sc. And A.H., R.K.
Nagar-799008 Tripura (W), India. Division Of Surgery, IVRI, Izatnagar,
Bareilly-243122 (U.P.), India.
Nemeth T. 2013. Surgery Of The Large Intestine. Veterinarium Facultas Scientiarum.
Popovitch C.A., Holt D., Bright R. 1994. Colopexy As A Treatment For Rectal
Prolapse In Dogs And Cats: A Retrospective Study Of 14 Cases. Vet Surg,
23, 115-118.
Vineet Kumar , Raja Aijaz Ahmad And Amarpal. 2012. Colopexy As A Treatment
For Recurrent Rectal Prolapse In A Dog. Indian Journal Of Canine Practice :
Volume 4 Issue 2.
Zhang S., Zhang J., Zhang N., Shi J., Wang A. 2012. Comparison Of Laparoscopic-
Assisted And Open Colopexy In Dogs. Bull Vet Inst Pulawy 56, 415-417.

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COLOPEXY AS A TREATMENT FOR RECURRENT RECTAL
PROLAPSE IN A DOG

Vineet Kumar1, Raja Aijaz Ahmad1 and Amarpal2


1
PhD scholar, 2Senior Scientist, Division of Surgery, Indian Veterinary Research Institute,
Izatnagar- 243122, Uttar Pradesh, India

Colopexy was evaluated as a treatment for recurrent rectal prolapse in a male German shepherd dog.
Simple suture colopexy technique used to treat the condition failed 6 weeks after the initial treatment. This was
followed by incisional colopexy technique which prevented recurrence during the three month follow-up period. It
may be concluded that incisional colopexy technique is effective in preventing recurrent rectal prolapse.
Keywords: Colopexy, dog, rectal prolapse

Introduction Veterinary Polyclinics, Indian Veterinary


Rectal prolapse is usually a Research Institute, Izatnagar, Uttar Pradesh,
consequence of underlying disorders that India, with a 15 days history of recurrent rectal
produce severe or persistent straining. It may prolapse (Fig. 1). The prolapse would recur
be associated with intestinal diseases that cause frequently and was managed by the referring
diarrhoea and tenesmus, anorectal diseases that veterinarian with reduction of the prolapse and
produce constipation and dyschezia, or lower anal purse string sutures on four occasions.
urinary tract diseases that cause stranguria and
dysuria (Papovitch et al., 1994; Gilley et al., Surgical Treatment
2003). Rectal prolapse occurs most commonly The dog was fasted for 24 hours and
in young, parasitized dogs and cats. Recurrent water was withheld for 12 hours prior to
prolapse that is unresponsive to reduction and surgery. Premedication was done with atropine
placement of a purse string suture may require sulphate (0.04 mg/kg intramuscularly),
colopexy (Gilley et al., 2003). The present ceftriaxone (25 mg/kg intravenously),
study reports a case of recurrent rectal prolapse pentazocine (1 mg/kg intravenously), and
in which simple suture technique failed to diazepam (0.5 mg/kg intravenously)
correct the prolapse while incisional technique approximately 30 minutes prior to surgery.
produced successful result. Anaesthesia was induced and maintained by
intravenous thiopental sodium. The dog was
History and Clinical findings positioned in dorsal recumbency, and the
A 6-month-old intact male German ventral abdomen was prepared for aseptic
shepherd cross-bred dog, weighing 8 kg was surgery. Left sided caudal paramedian ventral
presented to the Surgery Unit of the Referral celiotomy was performed

Fig 1: Rectal prolapse in a male crossbred GSD pup Fig 2: Intraoperative image showing attachment
of descending colon to the left abdominal wall

Indian Journal of Canine Practice 138 Volume 4 Issue 2, December, 2012


Fig 3: Intraoperative image showing longitudinal Fig 4: Intraoperative image showing attachment
incision through serosal layer of descending colon of incised serosal fold to the left abdominal wall

The descending colon was then sutured dressing of the suture line was performed with
to the left abdominal wall (Fig. 2) povidone iodine solution for 10 days. Skin
approximately half the distance between the sutures were removed on the 10th postoperative
linea alba and the sublumbar muscles by use of day.
2 longitudinal rows of 6 simple interrupted
sutures per row with 2-0 polyglactin 910 Discussion
(Ethicon). Sutures were placed 5 to 10 mm After first colopexy recurrence of
apart in a ventral to dorsal direction through the prolapsed was recorded six weeks later, which
transverse abdominal muscle and in a may be attributable to the absence of formation
transverse direction through the colon. of adequate adhesions between the colon and
Beginning dorsally, rows were kept the abdominal wall. However, after second
approximately 5 mm apart with the first row of colopexy no recurrence was reported and
sutures placed along the antimesenteric border. animal showed complete recovery. Colopexy is
Sutures were placed through the seromuscular a preferred surgical technique for treating
and submucosal layers only in an effort to recurrent rectal prolapsed that fail to respond to
avoid entering the lumen of the colon. Initially multiple attempts at purse-string suture.
the animal showed recovery but prolapsed Intestinal functions are not adversely affected
recurred after a period of six weeks. After the by this technique (Popovitch et al, 1994).
recurrence, the animal was prepared for the Following colopexy permanent fibrous
surgery again and anaesthetised using the same adhesions occur and reduction of the prolapsed
anaesthetic protocol as used earlier for first mass is maintained (Mattieson, 1985).
surgery. Caudal paramedian ventral celiotomy Although both simple suture technique (Simon
was performed at the same site and colon was et al., 2009; Amarpal et al., 2010) and
exteriorised. A longitudinal incision was made incisional technique colopexy are reported to
on serosal layer of the descending colon (Fig. be effective in preventing recurrent rectal
3). Serosal flaps were then sutured to the left prolapsed (Mattieson, 1985; Popovitch et al.,
abdominal wall using 2-0 nylon suture, similar 1994), however, in the present case simple
to aforementioned technique (Fig. 4). After suture technique was not effective but
completion of the colopexy, light caudal incisional technique prevented recurrence
traction was applied to the colon to evaluate the possibly due to formation of firm adhesions
integrity of the attachment. The colon was between the colon and the abdominal wall.
firmly attached to the body wall, with no caudal
movement during gentle traction. References
Amarpal, Singh, J., Saxena, A. C., Kinjavdekar,
Post-operative Care and Outcome P. and Madhu, D. N. 2010. Colopexy for
Postoperative analgesia was provided the treatment of recurrent complete
by meloxicam (0.2 mg/kg intramuscularly, rectal prolapse in a male pug dog. Intas
once daily) for three days. Ceftriaxone (10 Polivet 11: 355-357.
mg/kg intramuscularly, twice daily) was Gilley, R. S., Caywood, D. D., Lulich, J. P. and
administered for five days. The antiseptic Bowersox, T.S. 2003. Treatment with a

Indian Journal of Canine Practice 139 Volume 4 Issue 2, December, 2012


combined cystopexy-colopexy for Surg. 23: 115-118.
dysuria and rectal prolapse after bilateral Simon, M. S., Shafiuzama, M., Sooryadas, S.,
perineal herniorrhaphy in a dog. J. Am. Arun Prasad, A. and Suresh Kumar, R.,
Vet. Med. Assoc. 222: 1717-1721. 2009. Management of recurrent rectal
Landon, B.P., Abraham, L.A., Charles, J.A. and prolapse in a pup by colopexy. Tamil
Edwards, G.A. 2007. Recurrent rectal Nadu J. Vet. Anim. Sci. 5: 275-277.
prolapse caused by colonic duplication Mattieson, D. T. and Sandra M. M. 1985.
in a dog. Aus. Vet. J. 85: 381–385. Diseases of the anus and rectum. In
Popovitch, C.A., Holt, D., Bright, R. 1994. Slatter (Ed) 3rd ed., Text Book of Small
Colopexy as a treatment for recurrent Animal Surgery. W. B. Saunders,
rectal prolapse in dogs and cats: A Philadelphia. p. 629.
retrospective study of 14 cases. Vet.

ΘΘΘΘΘ

Indian Journal of Canine Practice 140 Volume 4 Issue 2, December, 2012


Bull Vet Inst Pulawy 56, 415-417, 2012
DOI: 10.2478/v10213-012-0073-6

COMPARISON OF LAPAROSCOPIC-ASSISTED
AND OPEN COLOPEXY IN DOGS
SHIXIA ZHANG, JIANTAO ZHANG, NAN ZHANG, JIAO SHI, AND HONGBIN WANG

College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China


hbwang1940@yahoo.com.cn

Received : March 2, 2012 Accepted : July 24, 2012

Abstract
The objective of this study was to describe laparoscopic-assisted colopexy (LAC) technique, and compare the extent of the
surgical trauma after LAC and open colopexy (OC) by examing postoperative serum values of C-reactive protein (CRP) in dogs.
Twelve healthy mixed-breed dogs with body weight ranging from 15 to 25 kg were used. Two portal sites were used for LAC
procedures. OC was performed by laparotomy on linea alba. Colopexy was accomplished in all dogs without major intraoperative
and postoperative complications. A permanent adhesion between the colon and abdominal wall was observed. There were statistically
significant differences in serum CRP levels between LAC and OC immediately after the procedure and 1 d post operation. LAC had a
similar pexy effect to OC, but had fewer surgical trauma than OC in dogs.

Key words: dog, colopexy, laparoscopy, C-reactive protein.

Colopexy is a common surgical procedure to Material and Methods


provide a permanent adhesion between the colon and
Animals. Twelve healthy mixed-breed adult
abdominal wall. It has been used for treatment of the
dogs, aged 0.8 to 5 years, weighing 15 to 25 kg were
recurrent rectal prolapse and torsion of the descending
studied. The dogs were divided into two equal groups:
colon (10, 12).
LAC group and OC group.
Laparoscopic procedures are minimally
Surgical technique. All dogs were found to be
invasive surgical techniques that have excellent
healthy on the basis of physical examination and
outcomes, minimal incision, low complication rate,
complete blood count (CBC). Feed was withheld for 12
rapid postoperative recovery, lower pain scores, and
h, and water for 6 h before surgery to decrease risk of
improved patient convalescence, compared with open
damage to viscera during cannula placement. The dogs
surgical procedures. It obtained a rapid development in
were premedicated with atropine (0.04 mg/kg, b.w.) and
veterinary medicine (4, 5, 16). The disadvantage of
15 min later they received intramuscularly 1.5 mg/kg of
laparoscopy is the need for specialised equipment,
xylazine and 20 mg/kg of ketamine. The animals were
adequate training and longer surgical time. Therefore,
positioned in dorsal recumbency. The ventral abdomen
laparoscopic-assisted surgery is becoming increasingly
(from the xiphoid to the pubis and to each inguinal fold)
popular in the treatment of small animals, using
was shaved, aseptically prepared, and draped for
laparoscopic-assisted gastropexy (9, 14), cystopexy (13),
surgery.
and ovariohysterectomy (6), and placement of
Peripheral blood samples were obtained prior to
jejunostomy feeding tube (2, 7).
anesthesia, immediately after the procedure, and on days
Colopexy has been achieved through celiotomy
1, 3, 5, and 7 post operation for measurement of serum
(1, 8, 11) and laparoscopic-assisted technique in dogs
CRP levels by ELISA.
(13). However, complication developed as a result of
Surgical procedures were performed by the
leakage from needle holes in the colon in the case of
same surgeon and two assistant surgeons. The
laparoscopic-assisted colopexy (LAC) technique (13).
descending colon was sutured to the left ventral
There are no data comparing the surgical trauma after
abdominal wall approximately 2.5 cm lateral to the
laparoscopic-assisted and open colopexy (OC)
ventral midline.
techniques in dogs. Thus, the objective of the presented
LAC technique. A 10/11-mm trocar-cannula
study was to describe LAC technique, and compare the
unit for laparoscope (Olympus, Germany) was placed on
extent of surgical trauma after laparoscopic-assisted and
the midline, 1-2 cm caudal to the umbilicus. A second
OC by examining postoperative serum values of
10/11-mm trocar-cannula unit was placed approximately
C-reactive protein (CRP).
2.5 cm to the right of ventral midline for laparoscopic

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416

Babcock forceps (Optcla Medical Instrument Co., Ltd, (P<0.05) between LAC group (51.67±8.50 min) and OC
China). group (48.33±6.81 min). Total length of all skin
The anti-mesenteric section of descending incisions was 4-5 cm in LAC group and 8-10 cm in OC
colon was identified and grasped by laparoscopic group. Leakage from colon and infection did not occur
Babcock forceps. The Babcock forceps were removed clinically.
from the abdomen along with the cannula, exteriorising Postmortem, one month after the operation, a
the descending colon by laparoscopic guidance to focal fibrous secure adherence was observed between
prevent the torsion of the descending colon. The incision the descending colon and the abdominal wall in all dogs.
in the abdominal musculature was enlarged to a length No other abdominal abnormalities were found in both
of 3-4 cm. Two traction sutures of 2-0 polyglycolic acid groups. All adhesions were characterised by a thick band
suture were placed in the colon 3-4 cm apart. The serosa of well-organised fibrous connective tissue.
and muscular layers of the colon were incised between Haemorrhage and inflammation were detected. The
the traction sutures avoiding entering the lumen of the fibrous connective tissue was composed of collagen
colon. Each edge of the seromuscular colonic incision fibbers. No differences in the amount of collagenous
was sutured separately to the corresponding edge of the connective tissue could be observed histologically in
incision in the abdominal wall musculature in a simple both groups.
continuous fashion with 2-0 polyglycolic acid suture. Serum CRP levels increased significantly at
The abdominal muscles were closed in a continuous days 1 and 3 after operation in OC group and LAC
pattern, and the skin incision apposed in a simple group (P<0.05). There were statistically significant
interrupted pattern. differences in serum CRP levels between LAC group
OC technique. A ventral midline was and OC group immediately after the procedure and 1 d
performed from the level of the umbilicus to 8-10 cm post operation. (P<0.05).
caudal to the umbilicus. The descending colon was
located and exteriorised. A 3-4 cm longitudinal incision LAC
35
was made along the antimesenteric border of the *# OC
Serum CRP values (mg/L)

descending colon. Only the serosal and muscular layers 30


were incised without mucosal penetration. A similar 25
incision on the left abdominal wall 2.5 cm to the linea #
20 # #
alba through the peritoneum and underlying muscle was
15 *
made. Each edge of the colonic and abdominal wall
incisions was apposed in a simple continuous fashion 10
with 2-0 polyglycolic acid suture. Abdominal wall was 5
closed in two layers with 2-0 polyglycolic acid suture.
0
Postoperative care and monitoring. Systemic
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6
antibiotics (Ampicillin, 20 mg/kg, i.m., every 8 h) were
administered for 5 d. Subjective assessment of the dogs’ T ime
behaviour and appetite, together with the measurements
of temperature twice a day and CBC once a day were
performed 7 d after surgery. Water was offered 2 h and Fig. 1. Changes in C-reactive protein (CRP) in
feed 6 h after surgery. laparoscopic-assisted colopexy (LAC) and open
Postmortem and histological evaluation. A colopexy (OC) groups. Stage 1 - before surgery; Stage 2
month after operation, the dogs were euthanatised. The - immediately after the procedure; Stage 3 - 1 d post
adhesions and surrounding colon and abdominal wall operation; Stage 4 - 3 d post operation; Stage 5 - 5 d post
muscle was collected and placed into 10% neutral operation, Stage 6 - 7 d post operation. * P<0.05
buffered formalin for histological examination. compared to LAC, # P<0.05 compared to preoperative
Statistical analysis. Standard statistical serum levels.
methods were used for the analysis of all results. Data
are reported as mean ±SD. Statistical differences within
each group were determined by one-way ANOVA. Discussion
Paired-samples T Test was used to compare the two
groups. Significant level was established as P<0.05. LAC was performed in six healthy dogs,
Statistical analysis of data was performed with computer without major intraoperative or postoperative
software (SPSS, USA). complications. Thus LAC is an alternative technique to
colopexy. The laparoscope was inserted into abdomen to
view the descending colon. The identified descending
Results colon was easy to exteriorise from instrumental portal
All dogs recovered from the colopexy site. The incisional colopexy technique was used for
procedure without apparent surgical complications. LAC and OC groups. This technique had been certified
Mean surgical time was not significantly different to be a safe and effective pexy method (12, 13, 14). The

Unauthenticated
Download Date | 10/21/19 11:49 AM
417

descending incision was the same length as the skin laparoscopic ovariohysterectomy and
incision. In the direct view, the seromuscular colonic ovariohysterectomy in dogs. Vet Surg 2004, 33, 62-69.
incisions apposed to the abdominal wall musculature 5. Dupré G., Fiorbianco V., Skalicky M., Gültiken N., Ay
could be done easily. Histological characteristics of both S.S., Findik M.: Laparoscopic ovariectomy in dogs:
comparison between single portal and two-portal access.
LAC and OC adhesions suggest that adhesions related to
Vet Surg 2009, 38, 818-824.
colon fixation method rather than surgical method. LAC
6. Gower S., Mayhew P.: Canine laparoscopic and
formed the secure adherence and produced a similar laparoscopic-assisted ovariohysterectomy and
pexy effect with OC. ovariectomy. Compend Contin Educ Vet 2008, 30,
Canine CRP has a molecular weight of 100 kD, 430-440.
which consists of 5 subunits of 20 kD each. It is one of 7. Hewitt S.A., Brisson B.A., Sinclair M.D., Foster R.A.,
the acute-phase proteins that increase as a result of Swayne S.L.: Evaluation of laparoscopic-assisted
inflammatory response to infection or tissue damage. placement of jejunostomy feeding tubes in dogs. J Am
The changes in serum CRP levels are more useful than Vet Med Assoc 2004, 225, 65-71.
the WBC count for assessing the severity of 8. Landon B.P., Abraham L.A., Charles J.A., Edwards G.A.:
inflammation (3, 15). In this study, serum CRP increased Recurrent rectal prolapse caused by colonic duplication
in a dog. Aus Vet J 2007, 85, 381-385.
rapidly after surgery. Time of maximum peak of its
9. Mayhew P.D., Brown D.C.: Prospective evaluation of
concentration was 1 d after surgery and this increase was
two intracorporeally sutured prophylactic laparoscopic
significant compared with CRP concentration before the gastropexy techniques compared with
anaesthesia. Our results were in accordance with those laparoscopic-assisted gastropexy in dogs. Vet Surg 2009,
of a previous study, which also concerned the trauma 38, 738-746.
after surgery (3). The increase in serum CRP subjected 10. Milner H.R., Newington A.N.: Longitudinal colonic
to surgery was generally related to the intensity of the torsion as a cause of tenesmus in an adult Irish Water
surgical trauma in the dog (15). There were statistically Spaniel. N Z Vet J 2004, 52, 40-43.
significant differences in serum CRP levels between 11. Niles J.D., Williams J.M.: Perineal hernia with bladder
LAC group and OC group immediately after the retroflexion in a female cocker spaniel. J Small Anim
procedure and 1 d post operation. This suggests that Pract 2008, 40, 92-94.
12. Popovitch C.A., Holt D., Bright R.: Colopexy as a
LAC produces result in a lesser trauma than OC.
treatment for rectal prolapse in dogs and cats: a
Therefore, LAC is a good alternative technique for
retrospective study of 14 cases. Vet Surg 1994, 23,
colopexy in dogs. 115-118.
13. Rawling C.A., Howerth E.W., Mahaffey M.B., Foutz
T.L., Bement S., Canalis C.: Laparoscopic-assisted
References cystopexy in dogs. Am J Vet Res 2002, 63, 1226-1231.
14. Rawlings C.A., Foutz T.L., Mahaffey M.B., Howerth
1. Brissot H.N., Dupre G.P., Bouvy B.M.: Use of E.W., Bement S., Canalis C.: A Rapid and strong
laparotomy in a staged approach for resolution of laparoscopic-assisted gastropexy in dogs. Am J Vet Res
bilateral or complicated perineal hernia in 41 dogs. Vet 2001, 62, 871–875.
Surg 2004, 33, 412-421. 15. Yamamoto S., Shida T., Miyaji S., Santsuka H., Fujise H.,
2. Chandler J.C., Kudnig S.T., Monnet E.: Use of Mukawa K., Furukawa E., Nagae T., Naiki M.: Changes
laparoscopic-assisted jejunostomy for fecal diversion in in serum C-reactive protein levels in dogs with various
the management of a rectocutaneous fistula in a dog. J disorders and surgical trauma. Vet Res Commun 1993,
Am Vet Med Assoc 2005, 226, 746-751. 17, 85-93.
3. Conner J.G., Eckersall P.D., Ferguson J., Douglas T.A.: 16. Zhang J.T., Wang H.B., Liu Y.F., Sun Y.G., Shao J.T., Shi
Acute phase response in the dog following surgical J.: Laparoscopic splenectomy in goats. Vet Surg 2009, 38,
trauma. Res Vet Sci 1988, 45, 107-110. 406-410.
4. Davidson E.B., Moll H.D., Payton M.E.: Comparison of

Unauthenticated
Download Date | 10/21/19 11:49 AM
Journal of
Advanced Veterinary Research
Volume 4, Issue 3 (2014) 142-144 Case Report
Surgical Management of Recurrent Rectal Prolapse in a Domestic Kitten
(Felis catus) – Case report
Shongsir Warson Monsang1*, Jasmeet Singh2, Doddhadasarahalli Nanjappa Madhu2, Amarpal2, Abhijit
Motiram Pawde2, Prakash Kinjavdekar2

1
Department of TVCC (Surgery), C. V. Sc. and A.H., R.K. Nagar-799008 Tripura (W), India
2
Division of Surgery, IVRI, Izatnagar, Bareilly-243122 (U.P.), India

Accepted 04 July 2014

Abstract

A case of recurrent rectal prolapse in a domestic 3 months old kitten was presented to the Referral Veterinary Polyclinic,
Indian Veterinary Research Institute, Izatnagar, with the complaint of protruded tubular pink mass through the anus along
with mild signs of mucosal necrosis since last 5 days. Reduction and retention of the prolapsed mass by conventional purse-
string suture technique was attempted earlier on 2 occasions by the attending veterinarian with no good results. Hence, the
case was referred for second opinion and treatment. Surgical reduction was done under ketamine-xylazine anesthesia and
the animal recovered uneventfully in 7 days.

Keywords: kitten; Rectal prolapse; Recurrent

Introduction Case history and Clinical Examination

Rectal prolapse is a double layer evagination of the A three months old domestic female cat of non-de-
rectum through the anal canal which may be either script breed, weighing about 1.5 kg was presented
partial or incomplete in nature. In kittens, it is most to the Referral Veterinary Polyclinic, Indian Veteri-
commonly associated with severe endoparasitism, nary Research Institute, Izatnagar, with the com-
enteritis, and associated tenesmus (Fossum, 2002). plaint of tubular pink mass along with mild signs
In older queens, rectal prolapse occur secondary to of mucosal necrosis protruding through the anus
dystocia, while it has been reported secondary to since last 5 days (Fig. 1). Reduction and retention
urethral obstruction in tom cats. The initial treat- of the prolapsed mass by conventional purse-string
ment is usually directed at the conservative man- suture technique was attempted earlier on 2 occa-
agement, and surgical intervention is required in sions by the attending veterinarian with no success-
recurring or long-standing cases (Johnston, 1985). ful results. Therefore, it was referred for the second
In clinical cases where chances of recurrence are opinion and subsequent treatment.
very high, prophylactic colopexy as the modality On record, urination was normal with abnormal
of choice should be considered (Sherding, 1996). episodes of inappetence and absence of defecation
This paper describes a rare case of recurrent rectal for the past days. Clinical examination revealed
prolapse and its successful surgical management in subnormal temperature (36.8 0C), tachycardia (190
a kitten. beats per minute) and tachypnea (36 breaths per
minute). The abdomen was markedly distended
*Corresponding author: Shongsir Warson Monsang
with an arched back appearance. Ultrasonography
E-mail address: warsonmonsang@gmail.com revealed negative for any signs of intussusception.

ISSN: 2090-6277/2090-6269, www.advetresearch.com


Shongsir Warson Monsang et al. /Journal of Advanced Veterinary Research 4 (3) (2014) 142-144

Based on the history, clinical findings and ultra- (Fig. 2). The abdominal cavity was explored and
sonographic findings, the case was confirmed as gentle traction was placed on the descending colon
rectal prolapse. Hence, laparotomy was done and in cranial direction for reduction of the prolapsed
surgical correction was resorted immediately. rectum. Colopexy was performed by placing 4 sim-
ple interrupted sutures in the antimesentric border
Surgical Procedure into the seromuscular wall of the descending colon
and transverse abdominal muscle with Vicryl No.
1 (Fig. 3 and 4). The abdominal muscular layer was
Supportive therapy consisting of 200 ml DNS so-
closed layer by layer using Catgut No.1 (Fig. 5) fol-
lution IV (5% DNS – Baxter India Pvt. Ltd., Gur-
lowed by skin suture application in horizontal mat-
goan) followed by broad spectrum antibiotics
tress pattern using braided silk (Fig. 6).
ceftriaxone and tazobactum combination at 25 mg/
Postoperative ceftriaxone plus tazobactum was
kg IV (Intacef Tazo) along with vitamin B com-
advised for 5 days while 5% DNS (250 ml twice
plex injection 0.5 ml IM (Tribivet), was carried daily) and analgesic was administered for 3 days.
out for patient stabilization before the surgery. Strict dietary rest was advised for another 4 days
Premedication with diazepam at 0.5 mg/kg followed by feeding of milk and gruel from 4th day
body wt. IV (Calmpose) was done followed 10 onwards and then gradually changing the diet to
minutes later by pentazocine at 0.5 mg/ kg IV normal food. Additionally, oral administration of
(Fortwin). The animal was induced with ketamine laxative (Cremaffin plus) was started after 4 days
at 7.5 mg / kg body wt. IV (Ketmin) and main- post-operatively and continued for 10 days to allow
tained with keta-diazepam (1:1) throughout the easy passage of faeces and prevent any straining
procedure. In dorso-ventral recumbency, a ventral during defecation. Regular dressing of the skin
midline incision of 2 inches length was given in the wound was done using 5 % povidone iodine solu-
caudal abdominal area to expose abdominal organs tion twice daily for 7 days.

143
Shongsir Warson Monsang et al. /Journal of Advanced Veterinary Research 4 (3) (2014) 142-144

Results and Discussion should be managed either by mucosal resection or


complete resection and anastomosis. Colopexy
The animal recovered uneventfully from anaesthe- does not affect intestinal function adversely
sia and showed progressive signs of improvement (Popovitch et al. 1994). Moreover, there is forma-
under the umbrella of therapy given in the post op- tion of permanent fibrous adhesion after colopexy
erative period. The skin sutures were removed 10th which maintains reduction of the prolapsed mass
day post operatively and the animal made an un- (Mattieson and Maretta, 1985).
eventful recovery.
Prolapse of rectum has been found to arise as a Conclusion
consequence of disorders such as diarrhoea, tenes-
mus, lower urinary tract and prostatic diseases that It can thus be concluded that recurrence of rectal
produce persistent straining and incidence is re- prolapse can be easily prevented by colopexy.
ported to be higher in young, unthrifty parasitized However, the underlying cause of tenesmus should
animals with severe diarrhoea (Sherding, 1996). be diagnosed and resolved as soon as possible.
The incomplete rectal prolapse arises due to the This technique is very simple and can be consid-
backward gliding of sub-mucosa and mucous ered as viable option in companion animals where
membrane on the muscular coat to form a circular purse string technique proves to be ineffective and
protrusion while a completely prolapsed mass is the risks of suture line dehiscence or rectal stricture
generally larger and more cylindrical in shape be- after amputation are high. Therefore, colopexy
cause it involves eversion of other visceral organs should be considered with priority in the manage-
(O’ Connor, 1985). ment of recurrent rectal prolapse.
Management of rectal prolapse depends on the
degree of tissue viability and number of recur- References
rences. Clinical cases presented at the first occur-
rence along with signs of viable rectal mucosa can Fossum, T.W., 2002. Small Animal Surgery. 2nd Edn. Mosby
be effectively treated by manual reduction followed Publication. Missouri. pp. 372-375.
Johnston, D.E., 1985. Surgical diseases- rectum and anus. In:
by application of purse string suture. If the rectal Text Book of Small Animal Surgery. Slatter, D., (Ed).
prolapse is viable but not digitally reducible or 2nd Edn. W. B. Saunders, Philedelphia, pp 770-794.
there is a history of multiple recurrences, then Mattieson, D.T., Maretta S.M., 198). Diseases of the anus and
colopexy can be considered as better option than rectum. In: Text Book of Small Animal Surgery. Slat-
any other surgical technique (Cynthia, 2005). ter, D., (Ed). 2nd Edn. W. B. Saunders, Philedelphia,
pp 629.
In prolonged as well as recurrent cases, repeated Cynthia M.K., 2005. Merck Veterinary Manual. Ninth Edi-
eversion of protruded mass causes loss of tone of tion, Merck and Co., INC. White house Station, N.J.,
anal sphincter, loosening of rectal mucosal mem- U.S.A. pp.151-152.
brane and loosening of attachment of peri-rectal tis- Niebauer, G.. 1993. Rectoanal diseases. In: Current Tech-
sue which can further aggravate the condition niques in Small Animal Surgery. Bojrab, M. J, (Ed).
4th Edn. Lea and Febiger, Philedelphia. pp. 271-284.
(Venugopalan, 1999). Various treatment modalities O’Connor, J.J., 1985. Dollar’s Veterinary Surgery. 9th Edn.
have been proposed which include both surgical as CBS Publishers and Distributors, New Delhi. pp. 699-
well as non-surgical methods. In cases of prolapsed 707.
mass of longer duration with clinically visible signs Popovitch. C.A., Holt, D., Bright, R., 1994. Colopexy as a
of mucosal necrosis, amputation of prolapsed rectal treatment for rectal prolapse in dogs and cats: A ret-
rospective study of 14 cases. Vet Surg. 23.115
stump can be performed (Fosum, 2002). Since Sherding, RG., 1996. Diseases of colon, rectum and anus. In:
there were only mild signs of mucosal necrosis and Hand Book of Small Animal Gastroenterology. Tams,
hence amputation was not carried out in the present T. R., (Ed). W. B. Saunders, Philedelphia. pp. 362-
clinical case. 363.
The surgical outcome of present clinical case go Venugopalan, A., 1999. Essentials of Veterinary Surgery. 7th
Edn. IBH Publishing Co., New Delhi. p 321.
in favour with the findings of Johnston (1985) who
reported colopexy to be rewarding in preventing
the recurrence of prolapse of the rectum. In con-
trast to this, Niebauer (1993) stated that prolapse
of longer duration with poorly viable rectal mucosa
144

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Teknik Operasi Colopexy
Kelompok 4 :
Tisa Tetrania 1609511053
Irene Cristina Br Sembiring 1609511061
Kartika Dewi Kusumawardhani 1609511063
Laras Ayu Nadira 1609511064
Widia Insani 1609511083
Luh Gede Setyawati 1609511090
Apa itu Colopexy?

Colopexy merupakan suatu cara untuk menciptakan


perlekatan permanen antara serosa kolon dan dinding
perut yang bertujuan untuk mencegah pergerakan
caudal kolon dan rektum. Colopexy paling sering
digunakan untuk mengatasi
prolap rektum berulang.
Pre Operasi
Siapkan Alat dan Bahan lalu sterilkan
Persiapan Alat, Bahan, Obat  Siapkan Premedikasi, Anestesi,
Antibiotik, Analgesik, Cairan NS.

Siapkan dan bersihkan ruang


Persiapan Ruang Operasi operasi  Meja operasi diberi
desinfektan.

Persiapan Operator & Co-operator Sesuai SOP & steril

Puasakan makan minim 8 jam & minum


kurang lebih 12 jam  Pemeriksaan fisik 
Premedikasi  Anestesi  Posisikan rebah
Persiapan Hewan dorsal  Pencukuran rambut pd site
operasi  Desinfeksi  Tutupi dgn kain
drape
Anestesi

Premedikasi Anestesi
• Atropin Sulfat 0.025% (0.04 • Ketamin HCL 10% (15
mg/kg SC) mg/kg) dan Xylazin 2% (2
• Cefriaxone (25 mg/kg IV) mg/kg) IM
• Pentazocine (1 mg/kg IV) • Thiopental Sodium IV
• Diazepam (0.5 mg/kg IV)
Teknik Operasi Colopexy
• Laparotomy pada ventral midline abdomen
• Ditentukan lokasi kolon descenden dan
kolon diangkat ke permukaan
• Insisi longitudinal 3-4 cm pada lapisan serosa dan
muskuler dinding kolon descenden
• Insisi pada dinding kiri abdomen 2.5 cm dari linea
alba melalui peritoneum dan dibawah otot
Penautan kedua insisi dengan pola sederhana menerus menggunakan benang polyglycolic acid 2-0

Jahitan dilakukan hanya pada lapisan seromuskuler dan submukosa untuk menghindari penetrasi ke
lumen dari colon dan mencegah kontaminasi pada situs colopexy
• Penutupan dinding abdomen, berturut-turut: pada
muskulus dengan pola sederhana menerus menggunakan
benang plain catgut 3-0; jaringan subkutan dengan pola
sederhana menerus menggunakan benang plain catgut 3-0;
dan kulit dijahit dengan benang non-absorbable
menggunakan pola sederhana terputus
Indikasi
• Untuk mencegah timbulnya prolapsus
berulang
• Prolapsus adalah protrusion atau keluarnya
satu atau lebih lapisan rektum melalui anal
orifisium
• Pada hewan kecil prolapsus terjadi karena
gangguan sistem digesti seperti diare,
tenesmus, gangguan prostat dan saluran
urinaria
Komplikasi
Kebocoran usus besar
Perdarahan
Peradangan

Dalam banyak kasus komplikasi jarang


terjadi, dimana usus anjing akan
kembali ke fungsi aslinya
Pascaoperasi
Antibiotik dan
obat pereda nyeri

Mengubah pola
Pemeriksaan rutin
makan menjadi
luka operasi
normal

Istirahat dan diet


Melepaskan
ketat (susu dan
jahitan
bubur)
• Diberikan Ceftriaxone ditambah tazobactum selama 5
Setelah hari

operasi • 5% DNS (250 ml dua kali setiap hari) dan analgesik


diberikan selama 3 hari

Pemberian • Cremaffin plus) dimulai setelah 4 hari pasca operasi dan


dilanjutkan selama 10 hari untuk memungkinkan
lewatnya feses dengan mudah dan mencegah
oral pencahar ketegangan saat buang air besar.

Penggantian • Ganti kulit secara teratur luka dilakukan dengan


menggunakan larutan povidone iodine 5% dua kali sehari
kulit selama 7 hari
THANKYOU 

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