(BEDAH ABDOMINAL)
UNIVERSITAS UDAYANA
2016
1
RINGKASAN
Laparotomy merupakan penyayatan pada dinding abdomen atau peritoneal atau dapat
diartikan sebagai pembedahan dinding abdomen melalui insisi ventral abdomen atau flank
(dinding perut samping). Laparotomy dapat dibagi menjadi bebrapa jenis, antara lain :
Laparotomy flank, medianus dan paramedianus. Masing-masing jenis Laparotomy ini dapat
digunakan sesuai dengan fungsi, organ target yang akan dicapai, serta jenis hewan yang akan
dioperasi. Untuk hewan besar, umumnya menggunakan laparotomy flank karena teknik ini
dapat meminimalisir terjadinya resiko prolapsus ataupun hernia, sedangkan hewan kecil
dapat menggunakan laparotomy medianus ataupun paramedianus. Laparotomy flank dapat
dibagi menjadi 2 yaitu: laparotomy flank kiri dan kanan. Laparotomy flank kiri merupakan
indikasi untuk operasi rumenotomi, abomasopexy, caesaria, splenectomi, reticulitis
traumatika , torsio uteri, dan lain-lain. Sedangkan laparotomy flank kanan digunakan indikasi
untuk operasi daerah intestinum, caecum, colon omentopexy sisi kanan dan abomasopexy.
Untuk sapi yang temperamennya tenang operasi dilakukan dengan posisi berdiri dengan
anestesi regional. Pada hewan kecil, laparotomi yang umumnya dilakukan adalah laparotomi
medianus dengan daerah orientasi pada bagian abdominal ventral tepatnya di linea alba.
Kata kunci : Laparotomy, Hewan Besar, Hewan Kecil
SUMMARY
Laparotomy is an incision in the abdomen or peritoneal and can be interpreted as the ventral
abdominal surgery through an incision in the abdomen or flank. Laparotomy is divided into
several types, among others: flank laparotomy, median and paramedianus. Each type of
laparotomy can be used in accordance with the function, organ targets to be achieved, as well
as the type of animal to be operated. For large animals, generally using flank laparotomy
because this technique can minimize the risk of prolapse or a hernia, while small animals can
use a median laparotomy or paramedianus. Flank laparotomy can be divided into two: the left
and right flank laparotomy. Left flank laparotomy is an indication for surgery rumenotomi,
abomasopexy, Caesaria, splenectomi, reticulitis traumatic, uterine torsion, and others. used
right flank laparotomy indications for surgery area intestine, cecum, colon omentopexy right
side and abomasopexy. For cattle temperament quiet operation is performed in a standing
position with regional anesthesia. In small animals, laparotomy is generally done with the
area median laparotomy orientation on the part precisely in the ventral abdominal linea alba.
Key word :Laparotomy, Large Animals, Small Animals.
i
KATA PENGANTAR
Puji syukur penulis ucapkan kepada Tuhan Yang Maha Esa, atas limpahan rahmat-
Nya lah penulis dapat menyelesaikan paper ini secara maksimal dengan judul “Bedah
Paper ini dibuat guna memenuhi tugas untuk mata kuliah Ilmu Bedah Khusus yang
Tidak lupa, penulis ucapkan terima kasih kepada dosen pengampu mata kuliah Ilmu
Bedah Khusus untuk segala bimbingan dan dukungannya. Selain itu, penulis juga
mengucapkan terima kasih kepada segala pihak yang turut serta membantu dalam pembuatan
paper ini sehingga paper ini dapat selesai tepat pada waktunya. Karena paper ini belum
sepenuhnya sempurna, maka penulis membutuhkan kritik dan saran yang bersifat
membangun.
Penulis
ii
DAFTAR ISI
RINGKASAN ........................................................................................................................ 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
2.2Manfaat Penulisan ..................................................................................................2
BAB III TINJAUAN PUSTAKA
3.1Pengertian Laparotomy ...........................................................................................3
3.2Tujuan dan Manfaat Laparotomy ............................................................................3
BAB IV PEMBAHASAN
4.1Persiapan pre-operasi Laparotomy ..........................................................................5
4.2Teknik dan Indikasi Laparotomy pada Hewan Besar..............................................5
4.3Teknik dan Indikasi Laparotomy pada Hewan Kecil ..............................................7
4.4Perawatan Pasca Laparotomy ................................................................................13
BAB V KESIMPULAN
5.1Simpulan ................................................................................................................14
5.2Saran ......................................................................................................................14
DAFTAR PUSTAKA ..........................................................................................................15
LAMPIRAN
iii
DAFTAR GAMBAR
Gambar 1 ................................................................................................................................6
Gambar 2 ................................................................................................................................7
Gambar 3 ................................................................................................................................7
Gambar 4 ................................................................................................................................8
Gambar 5 ................................................................................................................................9
Gambar 6 ................................................................................................................................9
Gambar 7 ................................................................................................................................9
Gambar 8 ..............................................................................................................................10
Gambar 9 ..............................................................................................................................10
Gambar 10 ............................................................................................................................10
Gambar 11 ............................................................................................................................11
Gambar 12 ............................................................................................................................11
Gambar 13 ............................................................................................................................11
Gambar 14 ............................................................................................................................12
Gambar 15 ............................................................................................................................12
Gambar 16 ............................................................................................................................12
iv
DAFTAR LAMPIRAN
v
BAB I
PENDAHULUAN
1
BAB II
Manfaat yang dalam penulisan paper ini didapat secara luas. Diantaranya
manfaat yang didapat untuk penulis sendiri adalah, menambah wawasan tentang
bedah. Terutama bedah abdominal berupa teknik operasi dan indikasi laparotomy
pada hewan kecil dan besar. Selain itu, manfaat lain juga didapat untuk teman sejawat
atau mahasiswa yaitu, memberikan informasi baru tentang perkembangan ilmu bedah
2
BAB III
TINJAUAN PUSTAKA
didefinisikan sebagai penyayatan pada dinding abdomen atau peritoneal atau dapat
diartikan sebagai pembedahan dinding abdomen melalui insisi ventral abdomen atau
sesuai dengan fungsi, organ target yang akan dicapai, serta jenis hewan yang akan
ventral tepatnya di linea alba. Organ-organ pada saluran pencernaan, saluran limfatik,
saluran urogenital dan saluran reproduksi merupakan organ tubuh yang berada dirung
abdomen. Semua organ tersebut dapat ditemukan dengan tekni operasi Laparotomy.
Laparotomy flank, yaitu Laparotomy flank kanan yang sering dilakukan untuk melihat
organ rumen dan operasi Caesar dan Laparotomy flank kiri digunakan untuk melihat
3
didaerah ventral abdomen. Tahapan yang harus diperhatikan untuk kelancaran operasi
atau kesuksesan operasi sebagai berikut :
1. Anestesi sebelum dilakukan harus betul sempurna , sehingga tidak ada rasa sakit
dan muskulus juga dalam keadaan relaksasi sempurna, bila ada rasa sakit maka isi
abdomen akan dihentakan dan berhamburan keluar.
2. Praktek antiseptika yang optimal, kalau tidak akan memperlama kesembuham
bahkan bisa berakiobat fatal.
3. Insisi yang dilakukan tidak boleh kurang tetapi tidak berlebihan, yang penting
dapat mengekspose organ yang dimaksud, bila terlalu kecil akan menyebabkan
trauma atau bisa sobek.
4. Jangan memperlakukan organ secara kasar karena akan menyebabkan edema atau
nekrosa jaringan.
5. Mengatasi perdarahan dengan baik, tampon,ligasi jangan membiasakan dengan
kauterisasi/panas api.Hemostasis yang jelek akan mempengaruhi pandangan
dokter pada obyek dan banyak kehilangan darah > 1/3 koma.
6. Kembangkan sikap dan trampil dalam operasi dan berorientasi pada hubungan
anatomi dan fisiologi struktur organ yang dioperasi.
7. Kerjasama yang harmonis dari team bedah.
4
BAB IV
PEMBAHASAN
5
a. Laparatomi pada flank kiri
Indikasi : untuk operasi rumenotomi, abomasopexy, caesaria, splenectomi,
reticulitis traumatika , torsio uteri, dan lain-lain.
b. Laparatomi pada flank kanan
Indikasi : untuk operasi daerah intestinum, caecum, colon omentopexy sisi
kanan dan abomasopexy. Untuk sapi yang temperamennya tenang operasi
dilakukan dengan posisi berdiri dengan anestesi regional.
Teknik Operasi
Adapun teknik operasi laparotomi pada hewan besar (sapi) yaitu :
1. Lakukan anestesi regional(paravertebral ataupun epidural anestesi).
2. Rambut yang cukup panjang dicukur dan didesinfeksi pada daerah yang akan
dioperasi.
3. Buat sayatan vertikal di tengah dari fossa paralumbal dan di bagian ventral
prosesus transversus vertebrae lumbalis.
4. Sayatan kulit di tekan secara halus, kemudian pisahkan kulit dengan subkutan
dari m.obliqus abdominis eksternus, lapisan ini juga disayat vertikal sampai m.
obliqus abdominis internus.
5. Sayatan dilanjutkan sampai m. abdominis transversus dan akan terlihat
peritoneum. Tindakan selanjutnya tergantung dari jenis operasinya.
6. Penutupan dilakukan lapis demi lapis dengan urutan pertama yaitu peritoneum
dengan pola jahitan menerus atau kombinasi menerus dengan jahitan matras
atau kombinasi dengan sederhana tunggal dengan catgut chromic ataupun
benang katun.
6
Gambar 2. Incisi pada daerah flank dexter
7
Gambar 4. Skema Laparotomi Anterior (A), Laparotomi Posterior (B), skema
potongan melintang muskulus abdomen anjing
Tempat Incisi
1. Incisi Garis Tengah Cranial (Cranial Midline/ Linea Mediana Cranial), mulai
dari umbilicus sampai cartilago xiphoideus.
Indikasi : Mencapai diaphragma, hepar, gaster dan pylorus.
2. Incisi Garis Tengah Caudal (Caudal Midline/ Linea Mediana Caudal) pada
hewan jantan.
Indikasi : Mencapai vesica urinaria, kelenjar prostat, colon dan abdomen bagian
caudal.
3. Incisi Garis Tengah Caudal pada hewan betina, yang dimulai dari umbilicus
sampai tepi pelvis.
Indikasi : Mencapai ovarium, uterus, usus, vesica urinaria dan abdomen bagian
caudal.
4. Incisi paramedian, di bagian lateral linea mediana melalui m. rectus abdominis.
Indikasi : mencapai ren, lien dan discus intervertebralis lumbalis.
8
Gambar 5. Macam-macam tempat incisi laparotomi
9
2. Suntikan anestesi bupivakain IM (2 mg/kgBB) mulai dari garis tengah tubuh
sisi ventral bagian cranial sampai kaudal.
3. Lakukan insisi dengan teknik four corner draping. Pada hewan jantan
(anjing,kucing), pegang bagian preputium dengan forcep dan arahkan kebagian
lateral dari garis tengah tubuh untuk mencegah kontaminasi urin. Untuk
mengatasi permasalahan insisi, dapat dilakukan insisi pada bagian parapreputial,
sehingga memisakan otot prepusium. Pembuluh darah yang ada dapat diligasi
dengan elektrocautery diikuti dengan insisi untuk memperlihatkan linea alba pada
bagian tersebut.
10
5. Buat tusukan kecil dengan scapel pada linea alba dan masukan satu jari untuk
memastikan tidak ada jaringan yang menempel pada bagian tersebut. Tusukan
tersebut membuatu darah akan masuk kedalam rongga perut dan menjauhkan
organ abdomen kearah dorsal.
11.Setelah pemeriksaan, cuci organ abdomen dengan cairan hangat (saline) dan
hisap saline dengan alat penghisap setelah selesai dicuci.
12
12. Tutup bagian abdomen dengan 3 lapisan jahitan.
Bagian dalam ditutup dengan jahitan pola simple continue suture atau
simple interrupted suture. Bahan yang digunakan adalah polydioxanone
atau polygliconate. Pada waktu menutup linea alba, jahitan harus
dilakukan bersamaan dengan pembungkus otot rectus abdominis.
Pada bagian subkutan, jahitan dilakukan dengan pola simple continue
suture dan bahan yang dipakai adalah material absorbable monofilament.
Ikatan yang dilakukan harus kuat dan tidak ada dead space. Karena itu,
perlu menjaga agar pada saat penjahitan dilakukan sedekat mungkin
(serapat mungkin).
Pada bagian kulit dilakukan jahitan dengan pola simple continue suture
atau ford interlocking atau intradermal pattern with buried knots atau
dengan staples.
13
BAB V
5.1 Simpulan
Laparotomy merupakan penyayatan pada dinding abdomen atau peritoneal
atau dapat diartikan sebagai pembedahan dinding abdomen melalui insisi ventral
abdomen atau flank (dinding perut samping). Laparotomy terdiri dari beberapa jenis,
antara lain : Laparotomy flank, medianus dan paramedius. Pada hewan besar, jenis
laparotomy yang digunakan yaitu laparotomy flank sedangkan pada hewan kecil
suatu diagnosa. Untuk hewan besar seperti sapi atau kuda posisi hewan seringkali
dalam keadaan berdiri tetapi untuk anjing atau kucing selalu dalam keadaan rebah
dorsal. Letak irisan pada hewan besar didaerah flank sedangkan anjing atau kucing
Adapun beberapa hal yang harus dilakukan dalam laparotomy, antara lain:
5.2 Saran
Untuk kepentingan pendiagnosaan ataupun pengobatan pada sapi ataupun
anjing yang berhubungan dengan abdominal, maka laparotomy dapat diberikan akan
tetapi laparotomy harus sesuai dengan prosedur yang telah ditetapkan agar tidak
yang dilakukan.
14
DAFTAR PUSTAKA
Abubakar, A.A, et.al. 2014. Comparative Evaluation of Midventral and Flank Laparotomy
Approaches in Goat. Hindawi Publishing Corporation, Journal of Veterinary Medicine :
Vol.2014, p.1-6
Dorner J, Dupre G. 2010. Two Step Protocol for Surgical treatment of Complicated or Bilateral
Perineal Hernia in Dogs: Laparotomy Followed by Herniorraphy. The European
Journal of Companion Animal Practice, Oktober Vol.20 p.186-192
Hickman, J et.al 1995. An Atlas of Veterinary Surgery Third Edition. Blackwell Science. Great
Britain.
Papazoglou, L. G; Basdani, E. 2015. Exploratory Laparotomy in the Dog & Cat. Ed.
Oktober 2015, p. 15-21
Anonim. 2015. Abdominal Exploratory laparotomy.
http://www.michigananimalhospital.com/abdominal-exploratory (diakses tanggal: 1
Oktober 2016)
Hendricson, D. A. et.al. 2013. Turner and McIlwraith’s Techniques in Large Animal Surgery 4th
Edition. Wiley Blackwell Publishing: United Kingdom.
Sudarminto. Teknik Bedah Dasar, Restrain dan Casting. Yogyakarta : Universitas Gadjah
Mada.file:///C:/Users/kersa%20jaya/Downloads/Teknik%20Bedah%20Dasar,%20Restr
ain%20&%20Casting%20(5).pdf (diakses : Senin, 03 Oktober 2016)
Bailey, J dan Saphiro Mj. 2006. Abdominal compartement syndrome. Crit care 4: 23-9.
Davidson W, Davidson C (Ed). 2008. Practice of anesthesia 6th edition. Little brown. Boston.
15
LAMPIRAN
16
Hindawi Publishing Corporation
Journal of Veterinary Medicine
Volume 2014, Article ID 920191, 6 pages
http://dx.doi.org/10.1155/2014/920191
Research Article
Comparative Evaluation of Midventral and
Flank Laparotomy Approaches in Goat
Received 29 May 2014; Revised 21 July 2014; Accepted 21 July 2014; Published 24 August 2014
Copyright © 2014 A. A. Abubakar et al. his is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
he aim of the study was to compare two laparotomy approaches (lank and midventral). Ten (� = 10) apparently healthy goats of
diferent breeds and sex, average age of 12 ± 2.1 months, and average weight of 13.4 ± 2 kg were used for the investigation. he goats
were randomly divided into lank and midventral groups, each group comprising ive goats (� = 5). Standard aseptic laparotomy
was performed under lumbosacral epidural anaesthesia with mild sedation. Postsurgical wound score showed signiicant diference
(� < 0.05) in erythema at 18–24 hours and 10–14 days ater surgery between the two approaches; signiicant diference of dehiscence
between the two groups was also recorded at 10–14 days ater surgery. Total white blood cells (WBC) and lymphocytes counts were
signiicantly diferent (� < 0.05) at the irst and second week ater surgery. here was signiicant diference of platelets critical value
and platelets dimension width at the irst and second week ater surgery. Signiicant diference of packed cells volume between
the two approaches was also recorded one week ater surgery. It was concluded that midventral laparotomy approach can be
conveniently and safely performed under aseptic precautions without fear of intra- and postoperative clinical problems.
interval of the two laparotomy approaches. he aim of the Table 1: Criteria used to score intraoperative and postsurgical
study was to compare and evaluate lank and midventral complications.
laparotomy approaches in goats.
Scores
Outcome
0 1 2
2. Material and Methods Haemorrhage None Mild Severe
Seroma None Mild Severe
Ten (� = 10) apparently healthy goats free of any der-
matological lesions with average age of 12 ± 2.1 months Wound istula None Mild Severe
(mean ± SD), male and female of diferent breeds, and Incisional hernia None Mild Severe
average weight of 13.4 ± 2 kilograms (mean ± SD) were used
for the investigation. he goats were kept at the Usmanu
Danfodiyo University Veterinary Teaching Hospital facilities Each animal was placed on dorsal recumbency exposing the
and were conditioned for two weeks during which they were midventral region. Laparotomy was done through linea alba
evaluated and stabilized for surgery. During evaluation serial in all female goats with little paramedian incision at the level
blood sampling was done for comprehensive haematology to of prepuce in all the males according to standard procedure
ascertain that the goats are it for surgery and fecal sample described by [1, 3, 4]. he incision was closed routinely in
was also collected to ascertain the intestinal worms burden. three layers from within outward (linea alba, subcutaneous
he goats were maintained on daily ration comprising wheat layer, and skin) with the same suture materials as described
bran, bean husks, ground nut hay, and water ad libitum. he in FA group. he linea alba was closed using interrupted hor-
goats were randomly grouped into lank (FA) and midventral izontal mattress pattern with simple interrupted reinforce-
(MVA) approaches. Five (� = 5) goats were allocated to each ment. 5% acetaminophen injection 10 mg kg−1 intramuscular
group. (Cadence Pharmaceutical Inc., Ireland) was administered for
3 days ater surgery to take care of postoperative pain. Long
acting 15% amoxicillin injection 20 mg kg−1 (Vetrimoxin) was
2.1. Surgical Procedure. Feed and water were withdrawn from administered once ater surgery.
animals at least 12 hours prior to the surgery. he let lank
region of each goat in the FA group was prepared for routine
aseptic surgery by clipping the hairs around the proposed 2.1.1. Surgical Wound Assessment. he clinical appearance of
surgical site; the site was scrubbed with Purit solution the skin was assessed and scored twice: 18–24 hours and 10–14
containing chlorhexidine gluconate B. P. 0.3% W/V (Saro days ater surgery as described by [15] using 4-point scoring
Lifecare Limited, Lagos, Nigeria) and rinsed with methy- scale, based on the following criteria: discharge, swelling,
lated spirit (Binji Pharmaceutical Company, Sokoto, Nige- erythema, and dehiscence.
ria). Regional anesthesia was achieved with plain lignocaine
hydrochloride and lignocaine injection B. P. 2% (Sahib Singh 2.1.2. Haematology. Blood samples were collected from each
Agencies, Mumbai, India) at 4 mg kg−1 through lumbosacral animal in the two groups through the jugular vein ater
epidural anaesthesia as described by [13]. he epidural space thorough disinfection of the area with methylated spirit; the
was identiied by loss of resistance to injection of 1 mL of sample was collected using 5 mL syringe and needle into
air ater piercing the ligamentum lavum. Mild sedation EDTA bottles. he samples were collected before surgery
was achieved using xylazine 20 (xylazine HCl 20 mg mL−1 , as baseline, 18–24 hours ater surgery, and subsequently
on weekly interval till complete healing when sutures were
Kepro Holland) at 0.025 mg kg−1 intramuscular and atropine
removed. he samples were analyzed using digital auto-
sulphate 0.6 mg mL−1 (Laborate Pharmaceuticals India) at mated haemoanalyser (Full Automated Blood Cell Counter
0.05 mg kg−1 intramuscular as vagolytic agent. PCE-210, Erma Inc., Tokyo, Japan) according to procedure
Goats in FA group were placed on right lateral recum- described [16].
bency exposing the let lank. Laparotomy was done accord-
ing to standard procedure described by [1, 3, 14]. he laparo-
tomy was routinely closed from within outward; muscle 2.1.3. Intra- and Postoperative Complications. Intra- and post-
layers were closed using Becton chromic catgut of the size surgical complications were assessed using 3-point scoring
of 1/0 and atraumatic 1/2 circle taper point needle (Anhui system designed by ourselves; parameters considered were
Kangning Industrial Groups, China) using interrupted hor- intraoperative haemorrhages, postsurgical seroma, incisional
izontal mattress suture pattern with simple interrupted rein- hernia, and wound istula (Table 1).
forcement. he subcutaneous layer was closed using Becton
chromic catgut of the size of 2/0 and atraumatic 1/2 circle 2.2. Subjective Healing Interval. Subjective healing interval
taper point needle using simple continuous suture pattern. was determined by visual observation and taking notes of
he skin was closed using Ford interlocking pattern with days of apparent surgical site healing according to [17].
Agary nylon of the size of 0 and atraumatic 3/8 curved,
cutting needle (Agary PharmaceuticalsLtd, Xinghuai, China). 2.3. Statistical Analysis. Data generated from the four param-
In MVA group, the cranial midventral area was prepared eters (surgical wound scoring, haematology, surgical compli-
for aseptic procedure as described in FA group. Regional cations, and healing interval) were tabulated and mean and
anesthesia was also achieved as described in FA group. standard deviation were computed in each case. Student’s
Journal of Veterinary Medicine 3
Table 2: Postsurgical wound assessment score of lank and midven- Table 3: Intra- and postsurgical complications scores of lank and
tral approaches at 18–24 hours and 10 days (mean ± SD). midventral approaches (mean ± SD).
Table 4: Total leucocytes and diferential leucocytes counts before and ater surgery of the lank and midventral approaches (mean ± SD).
Mean scores
Parameters Groups
Before surgery 18–24 hrs ater surgery One week ater surgery Two weeks ater surgery
FA 25.48 ± 4.19 37.70 ± 3.90 34.93 ± 3.12a 32.98 ± 5.28a
Total WBC (×103 /�ℓ)
MVA 33.86 ± 9.96 50.52 ± 16.32 51.08 ± 5.07b 45.62 ± 6.85b
FA 11.10 ± 3.69 13.24 ± 3.45 10.23 ± 5.72 13.85 ± 5.33
Granulocytes (×103 /�ℓ)
MVA 11.38 ± 4.41 20.90 ± 10.51 18.62 ± 5.07 15.06 ± 3.52
FA 11.74 ± 3.27 19.16 ± 2.61 21.33 ± 8.22a 15.20 ± 5.05a
Lymphocytes (×103 /�ℓ)
MVA 33.86 ± 3.40 24.06 ± 7.37 28.32 ± 11.98b 25.48 ± 6.00b
FA 2.60 ± 0.89 4.08 ± 1.21 3.35 ± 0.66 3.88 ± 0.66
Monocytes (×103 /�ℓ)
MVA 4.14 ± 1.02 5.60 ± 1.54 4.12 ± 0.44 5.06 ± 3.52
ab
Pair of means bearing diferent superscript are signiicantly diferent (� < 0.05).
Table 5: Platelet characteristics before and ater surgery of the two approaches (mean ± SD).
Mean scores
Parameters Groups
Before surgery 18–24 hrs ater surgery One week ater surgery Two weeks ater surgery
3 FA 287.20 ± 123.58 375.60 ± 99.58 369.95 ± 144.66 269.75 ± 128.18
Platelets (×10 /�ℓ)
MVA 351.40 ± 75.20 416.60 ± 94.88 376.20 ± 90.78 444.40 ± 149.93
FA 0.16 ± 0.07 0.21 ± 0.06 0.21 ± 0.08 0.15 ± 0.04a
Platelets critical value (%)
MVA 0.20 ± 0.04 0.24 ± 0.05 0.22 ± 0.03 0.25 ± 0.08b
FA 5.60 ± 0.14 5.68 ± 0.22 5.60 ± 0.09 5.55 ± 0.24
Mean platelets volume (�ℓ)
MVA 5.72 ± 0.09 5.74 ± 0.08 5.72 ± 0.22 5.68 ± 0.13
FA 683.90 ± 0.37 684.80 ± 0.29a 684.30 ± 0.05 684.30 ± 0.47
Platelets dimension width (�ℓ)
MVA 684.26 ± 0.13 684.22 ± 0.20b 684.2 ± 0.18 684.12 ± 0.18
ab
Pair of means bearing diferent superscript are signiicantly diferent (� < 0.05).
30
week interval between the two approaches (Table 6). here 12
were no signiicant diferences (� > 0.05) between the 25
14 13
two approaches in all other erythrocytic indices (red blood 12 11
cells count, haemoglobin, mean corpuscular volume, mean 20
corpuscular haemoglobin, mean corpuscular haemoglobin 17
concentration, and red blood cells distribution width). How- 15
13 13 12
ever, the values of midventral approach are higher at diferent 10
10
timing intervals in all other erythrocytic indices (Table 6).
5
3.4. Subjective Healing Interval. he mean subjective healing
intervals were 13.0 ± 1.14 and 12.4 ± 0.5 for lank and
0
1 2 3 4 5
midventral approach. Midventral approach had lower mean Number of animals per group
healing intervals in days compared to the lank approach.
here was no signiicant diference (� = 0.643) between the MVA
FA
two groups when compared (Figure 1).
Figure 1: Subjective healing interval (days) of the animals lank (FA)
4. Discussions and midventral (MVA) approaches.
Table 6: Erythrocytic indices before and ater surgery of the two approaches (mean ± SD).
Mean scores
Parameters Groups
Before surgery 18–24 hrs ater surgery One week ater surgery Two weeks ater surgery
FA 12.32 ± 1.35 12.79 ± 1.23 12.23 ± 1.32 12.10 ± 2.07
RBC (×106 /�ℓ)
MVA 13.13 ± 0.51 13.69 ± 0.52 13.36 ± 0.85 13.03 ± 1.05
FA 21.92 ± 2.56 24.66 ± 5.24 16.15 ± 2.85a 22.75 ± 5.98
PCV (%)
MVA 25.22 ± 1.19 25.90 ± 1.15 25.72 ± 4.37b 23.84 ± 3.07
FA 8.12 ± 1.36 8.98 ± 2.25 8.63 ± 1.51 8.68 ± 2.19
Haemoglobin (g/d)
MVA 9.16 ± 0.43 9.84 ± 0.59 9.86 ± 1.28 9.30 ± 1.36
FA 17.72 ± 2.56 19.08 ± 2.37 17.58 ± 0.88 18.58 ± 1.98
Mean corpuscular volume (�ℓ)
MVA 19.10 ± 2.09 18.06 ± 0.57 14.10 ± 2.09 18.20 ± 1.13
FA 6.50 ± 0.42 6.88 ± 0.95 6.78 ± 0.50 7.00 ± 1.13
Mean corpuscular haemoglobin (pg)
MVA 6.92 ± 0.04 7.13 ± 0.26 7.37 ± 0.61 7.04 ± 0.48
FA 36.80 ± 2.16 36.26 ± 3.50 38.5 ± 1.94 37.36 ± 2.18
Mean corpuscular haemoglobin con. (g/L)
MVA 36.32 ± 1.91 37.96 ± 1.90 38.58 ± 3.12 38.94 ± 1.82
FA 30.18 ± 4.71 32.00 ± 4.37 30.98 ± 4.86 29.80 ± 6.19
RBC distribution width (%)
MVA 32.18 ± 1.26 34.48 ± 1.96 33.40 ± 2.23 32.92 ± 2.72
ab
Pair of means bearing diferent superscript are signiicantly diferent (� < 0.05).
with lank approach having the highest erythema score and muscle mass when compared to poor vasculatures associated
this could be due to surgical trauma elucidated by the with tendons and ligament in the linea alba. his could serve
traumatic surgical instruments on the sot tissue in the as one of the advantages of midventral approach particu-
course of surgery; this is because the lank region has three larly when dealing with nonelective laparotomy in which
layers of abdominal muscles that have to be passed through the patient hematocrit reading is below normal range. he
before getting access into the abdominal cavity in comparison packed cell volume (PCV) of the lank approach decreased
with midventral approach through linea alba aponeurosis signiicantly one week ater surgery when compared with
(ligament) which is passed through before gaining access to midventral approach; this could be due to high intraoperative
abdominal cavity; the ligament poorly responds to pressure of hemorrhage recorded. his inding was in line with the
traumatic surgical instruments which brought about the less inding of [20, 21], both in a study involving laparotomy
erythematous response. he high erythema score recorded with goat; they noted that remarkable hematocrit decreased
in lank approach could also be a result of abdominal ater surgery with signiicant diference. [8] also reported
muscles tissue response to absorbable suture materials used signiicant decrease in PCV in postoperative abdominal
for apposing the muscles mass which is more bulky than surgery in bovine.
that of midventral approach. he overall scoring showed Higher values of total white blood cells count and
higher erythema earlier before surgery at 18–24 hours and lymphocytes count were recorded in midventral approach
this inding is consistent with the studies conducted by [15, at the second week ater surgery with signiicant diference
17] where signiicant diferences among the variables were when compared with the lank approach and this could be
observed. attributed to high persistent chronic inlammatory response
Dehiscence was also observed in the lank approach at in the course of tissue repair or it could be due to surgical
10–14 days ater surgery with signiicant diference when stress because midventral approach is more stressful in
compared with midventral approach; this could be a result relation to surgical positioning than lateral recumbency. Our
of scratching the surgical site (lank) with available objects in inding is also in line with those of [20, 21] who also recoded
the pen as a result of tissue irritation in the course of healing elevated values leukocytes count. But [8] noticed an average
process. It could also be due to self-mutation with horn of total leukocytes value within normal physiologic range ater
hind limbs in response to tissue irritation. Dehiscence score abdominal surgery in dairy cows. Percentage platelets critical
was by far less in midventral approach due to lesser chances of value recorded was higher in midventral approach; this could
scratching and self-mutilation around the region. Our inding be due to lesser whole blood loss observed intraoperatively
was contrary to that of [15], which recorded no dehiscence in as decrease in whole total blood volume leads to gross
a similar study using canine species, and that of [17], which interference of the diferent components of the blood cells
recorded mild dehiscence both at 18–24 hours and at 10– including platelets. his may also serve as an advantage in
14 day ater surgery but without signiicant diference in a midventral approach because the higher the platelets critical
similar study using caprine species. values, the quicker the chances of blood clotting response.
he intraoperative hemorrhage score recorded was higher here were slight variations of means subjective heal-
in the lank approach compared with the midventral ing interval of the two approaches but without signiicant
approach, though without signiicant diference; this could be diference (� = 0.643), with the lank approach having
a result of high vascular channels available in the abdominal higher means number of days (13± 1.14) to complete surgical
6 Journal of Veterinary Medicine
wound healing when compared with 12.4 ± 0.5 mean days [7] D. C. van Metre, J. W. Tyler, and S. M. Stehman, “Diagnosis of
for midventral approach. he slight variation of days of enteric disease in small ruminants.,” he Veterinary Clinics of
healing interval might be due to surgical site interference North America: Food Animal Practice, vol. 16, no. 1, pp. 87–115,
with the object coming contact with the surgical wound as 2000.
reported by [22, 23], as the chance of surgical site contact [8] K. Nuss, B. Lejeune, C. Lischer, and U. Braun, “Ileal impaction
with surrounding object is higher in lank laparotomy site in 22 cows,” Veterinary Journal, vol. 171, no. 3, pp. 456–461, 2006.
compared to midventral site. he variation could also be a [9] F. A. Al-Sobayil and A. F. Ahmed, “Surgical treatment for
result of other local factors that afect wound healing like diferent forms of hernias in sheep and goats,” Journal of
oxygenation, foreign body contact with the surgical wound, Veterinary Science, vol. 8, no. 2, pp. 185–191, 2007.
and venous insuiciency as reported by [23]. [10] T. S. Sang, K. J. Sung, S. Y. Hong et al., “Laparoscopy versus
laparotomy for embryo transfer to produce transgenic goats
(Capra hircus),” Journal of Veterinary Science, vol. 9, no. 1, pp.
5. Conclusion 103–107, 2008.
[11] P. P. M. Teixeira, L. C. Padilha, T. F. Motheo et al., “Ovariectomy
It was concluded that the midventral laparotomy approach by laparotomy, a video-assisted approach or a complete laparo-
can be safely and conveniently performed without fear of scopic technique in Santa Ines sheep,” Small Ruminant Research,
clinical complications in goats. When correctly performed, vol. 99, no. 2-3, pp. 199–202, 2011.
it will ofer less intraoperative hemorrhage and postoperative [12] L. G. Schultz, J. W. Tyler, H. D. Moll, and G. M. Constantinescu,
tissue reactions. “Surgical approaches for cesarean section in cattle,” Canadian
We recommend the use of midventral laparotomy Veterinary Journal, vol. 49, no. 6, pp. 565–568, 2008.
approach for routine abdominal surgery in goats as an [13] A. B. Sadegh, Z. Shaiei, and S. D. Nazhvani, “Compari-
alternative to lank approach. Further study on pregnant goats son of epidural anesthesia with lidocaine-distilled water and
to see whether midventral abdominal incisional closure can lidocaine-magnesium sulfate mixture in goat,” Veterinarski
withstand pressure of gravid uterus also needs to be con- Arhiv, vol. 79, no. 1, pp. 11–17, 2009.
ducted. [14] R. P. S. Tuagi and S. Jit, “Ruminant surgery,” in Textbook of the
Surgical Disease of Cattle, Bufaloes, Camels, Sheep and Goats,
pp. 195–223, C.S.B Publishers and Distributors, New Delhi,
Conflict of Interests India, 1993.
he authors declare that there is no conlict of interests [15] A. Sylvestre, J. Wilson, and J. Hare, “A comparison of 2 diferent
suture patterns for skin closure of canine ovariohysterectomy,”
regarding the publication of this paper.
Canadian Veterinary Journal, vol. 43, no. 9, pp. 699–702, 2002.
[16] D. J. Weiss, “Application of low cytometric techniques to
Acknowledgments veterinary clinical hematology,” Veterinary Clinical Pathology,
vol. 31, no. 2, pp. 72–82, 2002.
he authors appreciate the efort of Mallam Bello Kaura [17] A. A. Abubakar, J. B. Adeyanju, R. O. C. Kene et al., “Evaluation
of haematology laboratory, college of health sciences, for of three suture techniques based on surgical wound assessment
processing the blood samples. hey also appreciate the efort in Caprine,” Scientiic Journal of Veterinary Advances, vol. 1, no.
of technical staf too numerous to mention in large animal 4, pp. 101–104, 2012.
surgery of Veterinary Teaching Hospital, Usmanu Danfodiyo [18] P. Mulon and A. Desrochers, “Surgical abdomen of the calf,”
University, Sokoto. Veterinary Clinics of North America—Food Animal Practice, vol.
21, no. 1, pp. 101–132, 2005.
[19] Z. B. Ismail, A. Al-Majali, and K. Al-Qudah, “Clinical and
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[4] S. R. R. Haskell, “Surgery of the sheep and goat digestive system,” tion and duodenal cannulation in West African Dwarf Sheep,”
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pp. 521–526, Saunders an Imprint of Elservier, 2004. [22] J. L. Burns, J. S. Mancoll, and L. G. Phillips, “Impairments to
[5] S. N. Dehghani and A. M. Ghadrdani, “Bovine rumenotomy: wound healing,” Clinics in Plastic Surgery, vol. 30, no. 1, pp. 47–
comparison of four surgical techniques,” he Canadian Veteri- 56, 2003.
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gASteRointeStinAl SYSteeM
REPRINT PAPER (A)
SUMMARY
Incidence of recurrences after surgical repair of perineal hernias in dogs is a well-known and frequently observed
problem. Depending on the method used, recurrence rates can be as high as 45% [Bellenger, 1980; Burrows and
Harvey, 1973]. Particularly in cases of complicated perineal hernias with concomitant diseases of the rectum and/
or prostate or urinary bladder retrolexion, morbidity is considerably increased. These concurrent conditions are
also responsible for higher recurrence rates after perineal hernia surgery. On the basis of a case report originally
presented by [Brissot et al. 2004], this paper describes a two-step protocol for surgical repair of complicated, bilateral
or recurrent perineal hernia. Before performing the perineal herniorrhaphy, laparotomy is carried out as the initial
step of repair, including colopexy, vasopexy and – in dogs with urinary bladder retrolexion – also cystopexy.
During laparotomy, alterations of the affected organs (urinary bladder, rectum, prostate gland) cannot only be
evaluated macroscopically but can immediately be treated surgically. A few days later, herniorraphy is performed
using an internal obturator muscle lap for closure of the hernia or other modiied methods like supericial gluteal
muscle transposition or fascia lata graft.
This article focuses on the advantages and disadvantages of this two-step protocol and gives a description of speciic
indications for this procedure.
Key words: Perineal hernia, dog, herniorraphy, laparotomy, colopexy
(1) Clinic of Surgery and Ophthalmology, Vienna University of Veterinary Medicine; Veterinärplatz 1, A-1210 Vienna.
E-mail: Judith.Doerner@vetmeduni.ac.at
(2) Univ. Prof. Dr. Gilles Dupré, Clinic of Surgery and Ophthalmology, Vienna University of Veterinary Medicine; Veterinärplatz 1, A-1210 Vienna.
* Presented by VÖK (Austria)
186
EJCAP - Vol. 20 - Issue 2 October 2010
Fig. 1: Right-sided perineal bulging; male Dachshund (8.5 years) Fig. 2: Perineal cystocentesis
where 0 = no lesion, 1 = deviation without rectal dilation, 2 for transposition, i.e. in small dogs, in recurrent PH or in dogs
= mild rectal dilation, 3 = severe unilateral, or mild to severe with severe atrophy of the obturator muscle, a fascia lata graft
bilateral dilation. or a polypropylene hernia mesh can be used to close the defect
Mild rectal dilation is deined as asymmetric dilation with [Vnuk et al., 2006; Bongartz et al. 2005].
accumulation of impacted faeces but without any visible perineal the high incidence of perineal hernias with concomitant lesions
deformation. Manual evacuation of the rectum is usually possible of the rectum, prostate or bladder [Dupre et al. 1993, 1996
without any problems. in contrast, asymmetric rectal dilation and 2000] has led to the development in 1993 of a two-step
with massive faecal impaction and obvious perineal swelling is approach for surgical repair of complicated or bilateral PH. As a
qualiied as severe dilation. irst step, laparotomy is performed followed by the second step,
Retrolexion of the urinary bladder is clinically assessed the perineal herniorraphy using an internal obturator muscle
by palpation of a more or less luctuant perineal swelling lap [Dupre et al., 1993]. With this protocol, the mentioned
(depending on bladder illing). the bladder is no longer palpable authors carried out a long-term outcome study. During four
in the caudal abdomen. Ultrasonography of the abdomen is years, a total of 41 dogs with complicated or bilateral perineal
recommended. the perineal region can also be examined by this hernias were treated according to this protocol, and outcome
technique, and an ultrasound-guided puncture of the swelling was followed for more than six months. Satisfactory results were
may be advisable in selected cases; aspiration of urine conirms obtained in complicated PH using laparotomy in combination
the tentative diagnosis of bladder retrolexion. with colopexy (ColP), cystopexy (CYSP) or vas deferens pexy
According to Brissot et al. [2004], PH is deined as complicated (DeFP) as additional treatment [Bilbrey et al., 1990; Huber et al.,
if the following criteria are met: recurrent PH, unilateral PH 1997; Dupre et al., 1993; Maute et al., 2001].
with severe rectal dilation, PH with concurrent prostate disease on the basis of one case report, this paper describes the protocol
requiring surgical intervention (e.g. prostate omentalization) or recommended by Brissot et al. [2004] discussing advantages and
PH in combination with urinary bladder retrolexion. disadvantages of the technique.
the traditional approach to treatment of perineal hernias is
by closure of the defect using the pelvic diaphragm. Several
techniques have been described like the transposition of the
Case report
supericial gluteal muscle [Spreulll and Frankland, 1980; Weaver An 8.5 year old male intact Smooth Dachshund was presented
and omamegbe, 1981], the internal obturator muscle lap to the Clinic of Surgery and ophthalmology at the Vienna
[Weaver and omamegbe, 1981; Hardie et al., 1983; Sjollema University of Veterinary Medicine with a history of long-standing
and van Sluijs, 1989; orsher,1986; Hosgood et al., 1995] or a defecation problems and tenesmus. in addition, the dog showed
combination of both [Raffan, 1993]. Also remote laps like the acute anuria, which had started the day before. A right-sided
semitendinosus muscle lap have been used [Chambers and soft and luctuant perineal swelling of about the size of a ist
Rawlings, 1991]. in cases where the obturator muscle is not apt was observed (Fig. 1).
187
Two-step protocol for surgical treatment of complicated or bilateral perineal hernia in dogs - J. Dörner and G. Dupré
A clinical and rectal examination was performed. the patient addition to severe dilation of the rectum (grade 3) there were also
displayed cardiovascular instability, dry and reddened mucosae, retrolexion of the bladder and sonographically evident prostate
a weak pulse and a cardiac frequency of 200 beats/min. inner alterations. For this reason, laparotomy was recommended as
body temperature was 38.9 °C and the patient´s abdomen was the initial step of the staged surgery protocol.
painful on palpation. the urinary bladder could not be palpated After premedication with 0.2 mg/kg butorphanol (Butomidor®)
in the abdomen. and 0.1 mg/kg diazepam (Valium®), anaesthesia was induced
Rectal examination to assess the grade of rectal alterations with 1.5 mg/kg etomidate (etodmidat-lipuro®). the dog was
revealed severe dilation and deviation of the rectum to the right, then intubated and anaesthesia was maintained with isolurane
with massive faecal impaction and obvious perineal bulging. in oxygen. in addition, the patient received a perioperative
Based on abdominal, perineal and rectal palpation indings, a constant rate infusion of butorphanol (0.2 mg/kg/h).
unilateral perineal hernia was diagnosed. the luctuant swelling Before starting the procedure, the caudal part of the dog´s
in the perineal region was punctured yielding urine. As this was rectum was manually evacuated and the patient was positioned
a clear sign of bladder entrapment in the hernia, immediate in dorsal recumbency.
therapy was indicated and it was tried to introduce a urinary Before opening the peritoneal cavity, the dog was castrated. For
catheter into the urethra. this was not possible due to bladder surgical repair or at least improvement of the rectal dilation, an
retrolexion so the bladder had to be emptied by perineal incisional musculo-muscular colopexy was performed by digitally
cystocentesis (Fig. 2). once the bladder had been reduced in retracting the caudal part of the colon into the abdominal cavity
size, it could be advanced cranioventrally into the abdomen by and making a longitudinal seromuscular incision of 3-5 cm in
applying moderate pressure. With the bladder in normal position, the antimesenterial side of the distal descending colon. At the
it was possible to place the urinary catheter. A closed system (a same level, on the left abdominal wall (approx. 3 cm lateral to
catheter directly connected to a scaled urine bag) was used to the linea alba) another incision of the same length was made
collect and measure the produced urine. the catheter was sewed in the peritoneum and through the underlying muscular layer
to the tip of the prepuce and remained in place until surgery was (Fig. 3). then, the incisional edges of colon and abdominal wall
performed. After stabilization of the patient´s cardiovascular were apposed and pexied by two rows of simple continuous
system by administration of a shock treatment infusion (60 ml/ sutures (Fig. 4). each suture included the submucosa of the
kg lactated Ringer´s solution [Ringerlactat Fresenius®] during 30 colon but extreme care was taken in order not to perforate the
minutes) and analgesics (0.1 mg/kg methadone [Heptadon®]), mucosa completely, as this would have meant severe bacterial
ultrasonography of the abdomen was performed. contamination of the entire surgical ield.
Sonographic examination revealed a hyperechoic, dense and to prevent recurrence of bladder retrolexion, the urinary bladder
enlarged prostate (5.4 x 4 cm) with inhomogeneous parenchyma was also ixed to the abdominal wall performing an incisional
as well as several irregularly shaped intraprostatic cysts of up musculo-muscular cystopexy (Fig. 5). For that purpose, two
to 0.8 cm. the urinary bladder was small with an irregularly incisions were made: the irst one of about 2-3 cm in the ventral
thickened wall. Mesenteric and sublumbar lymph nodes were pole of the bladder (taking care not to damage the mucosa)
not enlarged. Both testicles showed homogeneous texture of and another one into the abdominal wall, at the same level as
intermediate echogenicity. Perineal tissue was characterized by the irst incision and some centimetres from the midline. then,
signiicant liquid accumulation around the rectum and by severe the bladder was ixed to the abdominal wall by placing several
oedema. Wall thickness of the ampulla recti was increased simple interrupted sutures.
measuring up to 3 mm. A vasopexy should contribute to maintain bladder and prostate
According to perineal hernia (PH) classiication as mentioned in in a cranial position. Both the right and the left ductus deferens
the introduction, the dog suffered from a complicated PH, as in were secured to the abdominal wall (Fig. 6). Approximately 1-2
Fig. 3: Incision in the left abdominal wall to prepare colopexy Fig. 4: Two rows of simple continuous sutures were used for colopexy
188
EJCAP - Vol. 20 - Issue 2 October 2010
cm above the colopexy site on the left side, an incision was periosteum along the caudal border of the ischium. the internal
made into the peritoneum and the underlying muscular layer, obturator muscle was then dissected in cranial direction up to
and the deferent duct was ixed by two simple interrupted the obturator foramen and elevated from the ischium. then,
sutures placed at a certain distance to each other. the same the muscle was transposed dorsomedially to allow apposition
procedure was performed on the right side to secure the right between the coccygeus, levator ani and external anal sphincter
deferent duct. muscle, and simple interrupted sutures were placed to ix the
For all pexies, 3-0 or 4-0 monoilament synthetic absorbable lap. As the internal obturator muscle was very weak in this dog
suture was used. As the patient´s prostate was enlarged and – a phenomenon frequently observed in dogs of small breeds
several intra- and paraprostatic cysts had been detected, – an additional fascia lata graft was used. For this purpose, a
two biopsies were taken from the prostatic parenchyma part of the fascia lata (Fig. 8) was taken from the ipsilateral
for pathohistological examination and microbial cultures. thigh, directly placed into the perineal defect and secured to
Considering the reduced size of the intraprostatic cysts, it the adjacent muscles using simple interrupted sutures. Routine
was decided to refrain from performing an omentalization closure of all surgical wounds was done using 3-0 monoilament
of the prostate. After lavage of the abdominal cavity using synthetic sutures (Fig. 9).
warm Ringer´s solution, the abdomen was closed in three immediately after surgery, rectal examination was performed to
layers. Postoperatively, the patient was given buprenorphine evaluate the irmness of the pelvic diaphragm.
(temgesic®; 0.3 mg/kg every 8 hours) and carprofen (Rimadyl®;
4.4 mg/kg every 24 hours). Fig. 7: Positioning of the patient for herniorrhaphy and harvesting
After two days of hospitalization, the dog was discharged from of the fascia lata graft
the clinic for home care during the next four days. the owner
was instructed to administer 2 ml lactulose (laevolac®) orally
twice a day in order to facilitate defecation.
Four days after the irst intervention, the dog was again
hospitalized to prepare the second step of the staged surgery
protocol and perform herniorrhaphy.
Premedication and anaesthesia were the same as for the irst
surgery. in addition, epidural anaesthesia was performed
administering 1 mg/kg bupivacaine (Carbostesin®) and 0.2 mg/
kg methadone (Heptadon®). the dog was placed in sternal
position with the pelvis slightly elevated. the entire tail was
clipped and ixed over the back in cranial direction without
applying excessive tension. the rectum was digitally evacuated
removing a small quantity of faeces, and the anal sacs were
manually expressed. A purse-string suture was placed around
the anus to achieve its temporary closure. the lumbosacral area,
the perineum and the caudolateral part of the right thigh were
also clipped and aseptically prepared for surgery (Fig. 7).
Herniorraphy was performed by ioMF (internal obturator
muscle lap) [Hardie et al. 1983] using 0 monoilament synthetic
absorbable sutures. the fascia was incised at the origin of the
internal obturator muscle and an incision was made into the
189
Two-step protocol for surgical treatment of complicated or bilateral perineal hernia in dogs - J. Dörner and G. Dupré
190
EJCAP - Vol. 20 - Issue 2 October 2010
191
Two-step protocol for surgical treatment of complicated or bilateral perineal hernia in dogs - J. Dörner and G. Dupré
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closure on wound infection rate in perineal hernia surgery. Vet White RAS, Williams JM. (1995): intracapsular prostatic omentalization:
Surg 31: 301 (abstract) a new technique for management of prostatic abscesses in dogs.
Mann FA, Boothe, HW. (1985): Rectal diverticulum in a dog with Vet Surg 24: 390-395
perineal hernia. Calif Vet 8-10
192
PROCEDURES PRO h SURGERY h PEER REVIEWED
Exploratory Laparotomy
in the Dog & Cat
Lysimachos G. Papazoglou,
DVM, PhD, MRCVS
Aristotle University of hessaloniki
hessaloniki, Greece
Exploratory laparotomy is routinely per- 1. Surgical bowl, 2. bulb syringe for irrigation, 3. laparotomy pads, 4. 4 x 4” gauze
formed in small animal practice and is sponges, 5. monopolar diathermy cable, 6. suction tube, 7. Poole suction tip, 8.
indicated when organ dysfunction or 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
trauma involving the abdominal cavity
Metzenbaum scissors, 14. straight Mayo scissors, 15. Balfour retractors, 16.
requires deinitive diagnosis along with
Debakey tissue forceps, 17. Rat-tooth thumb forceps, 18. Mayo-Hegar needle
surgical treatment and prognosis.1 Sur-
holders, 19. straight and curved Rochester-Carmalt hemostatic forceps, 20.
gical exploration provides information straight and curved mosquito hemostatic forceps.
through inspection, palpation, and/or
hollow organ luminal mucosa observa-
tion. Samples can be obtained for micro-
biologic and cytologic examination or ary tree; spleen and stomach; duode-
biopsy for histopathologic examination. num and pancreas), caudal quadrant WHAT YOU WILL NEED
Abdominal exploration should be per- (jejunum, ileum, and colon; urinary
formed in a timely manner to increase bladder; urethra and prostate or d Necessary instrumentation
the likelihood of successful diagnosis uterus), right paravertebral region by for performing an
and management without negatively retracting the mesoduodenum, and left exploratory laparotomy
afecting the patient. paravertebral region by retracting the includes a well-equipped
mesocolon (kidneys, adrenal glands, general surgery pack.
Swabs and sponges
A ventral midline laparotomy of adequate ureters, and ovaries).2
should be counted at the
length from xiphoid to the pubis is the
A ventral midline laparotomy beginning and the end
standard approach to explore the entire of surgery.
abdominal cavity in a systematic manner. of adequate length from
Every surgeon may develop his or her xiphoid to the pubis is the
own technique, but a suggested method standard approach to explore
includes exploring the cranial quadrant the entire abdominal cavity in
(diaphragm; liver, gallbladder, and bili- a systematic manner.
STEP-BY-STEP
EXPLORATORY LAPAROTOMY
STEP 1
Generously clip and prepare the surgical site, extend-
1 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
4 6
ROSTRAL
After skin incision, seal subcutaneous vessels via elec- Insert thumb forceps with the tips placed caudally to
rocautery and undermine subcutaneous tissues from lift upward on the linea alba and make a cranial to cau-
attachment to the rectus sheath 1 cm laterally to visual- dal incision. Extend the incision cranially by directing
ize the linea alba. Avoid excessive undermining to pre- thumb forceps with tips placed cranially.
vent vascular compromise of the fascia and dead space
creation and subsequent seroma formation.
STEP 7
STEP 5 7A
5
ROSTRAL
STEP 8 STEP 10
8 10A
ROSTRAL
10B
ROSTRAL
ROSTRAL
12B
11B
Author Insight:
Closure of the linea alba must include the
external leaf of the rectus sheath.
STEP 13 STEP 14
13A 14A
ROSTRAL
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.
ROSTRAL
15B 15D
ROSTRAL
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 room-temperature abdominal lavage solutions on core body
200 nontraumatized dogs and cats. Vet Surg. 1992;21(6):452-457. temperature in dogs undergoing celiotomy. JAAHA. 2005;41(1):61-67.
2. Boothe HW. Exploratory laparotomy in small animals. Compendium 6. Rosin E. Single layer simple continuous suture pattern for closure of
Contin Educ Pract Vet. 1990;12:1057-1066. abdominal incisions. JAAHA. 1985;21(6):751-756.
3. Savvas I, Papazoglou LG, Kazakos G, et al. Incisional block with 7. Rosin E, Richardson S. Efect of fascial closure technique on strength
bupivacaine for analgesia ater celiotomy in dogs. JAAHA. of healing abdominal incisions in the dog. A biomechanical study. Vet
2008;44(2):60-66. Surg. 1987;16(4):269-272.
4. Campagnol D, Teixeira-Neto FJ, Monteiro ER, Restitutti F, Minto BW. 8. Mufy TM, Kow N, Iqbal I, Barber MD. Minimum number of throws
Efect of intraperitoneal or incisional bupivacaine on pain and the needed for knot security. J Surg Educ. 2011;68(2):130-133.
analgesic requirement ater ovariohysterectomy in dogs. Vet Anaesth 9. Marturello DM, McFadden MS, Bennett RA, Ragently GR, Horn G. Knot
Analg. 2012;39(4):426-430. security and tensile strength of suture materials. Vet Surg.
5. Nawrocki MA, MacLaughlin R, Hendrix PK. The efects of heated and 2014;43(1):73-79.