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(BEDAH ABDOMINAL)
TEKNIK OPERASI DAN INDIKASI LAPAROTOMY
1109005067
1309005040
1309005050
Khoirul Nikmah
1309005075
1309005087
1309005127
1309005143
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.
KATA PENGANTAR
Puji syukur penulis ucapkan kepada Tuhan Yang Maha Esa, atas limpahan rahmatNya lah
penulis dapat menyelesaikan paper ini secara maksimal dengan judul Bedah
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
Lampiran 1. Exploratory Laparotomy in the Dog & Cat
Lampiran 2. Comparative Evaluation of Midventral and Flank Laparotomy Approaches in
Goat
Lampiran 3. Two-step protocol for surgical treatment of complicated or bilateral perineal
hernia in dogs: Laparotomy followed by herniorrhaphy
BAB I
PENDAHULUAN
BAB II
TUJUAN DAN MANFAAT
BAB III
TINJAUAN PUSTAKA
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.
BAB IV
PEMBAHASAN
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.
12
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 kulit dilakukan jahitan dengan pola simple continue suture
atau ford interlocking atau intradermal pattern with buried knots atau
dengan staples.
13
BAB V
SIMPULAN DAN SARAN
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
menggunakan laparotomy medianus ataupun paramedius.
Laparotomy memiliki tujuan untuk pengobatan ataupun untuk meneguhkan
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
didaerah ventral abdomen.
Adapun beberapa hal yang harus dilakukan dalam laparotomy, antara lain:
persiapan pre-operasi, operasi laparotomy, dan perawatan pasca operasi laparotomy.
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
terjadi kesalahan ataupun meminimalisir terjadinya infeksi sekunder akibat operasi
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 McIlwraiths 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
Research Article
Comparative Evaluation of Midventral and
Flank Laparotomy Approaches in Goat
A. A. Abubakar,1 R. A. Andeshi,1 A. S. Yakubu,1 F. M. Lawal,1 and U. Adamu2
1
2
Department of Veterinary Surgery and Radiology, Usmanu Danfodiyo University, Sokoto 2346, Nigeria
Department of heriogenology and Animal Production, Usmanu Danfodiyo University, Sokoto 2346, Nigeria
1. Introduction
Laparotomy in goat is an invasive surgical procedure into the
abdominal cavity that allows visual examination of abdominal organs and documentation and correction of certain
pathologic abnormalities observed [1, 2]. Generally, it constitutes the single largest group of surgical operations carried
out in ruminants [3, 4]. Laparotomy is indicated for exploration of abdominal and pelvic cavities and other surgical
procedures involving abdominal and pelvic organs; other
speciic indications are caesarean section, embryo transfer to
produce transgenic goats, ovariectomy, rumenotomy, abomasotomy, ventral abdominal herniorrhaphy, intestinal resection, anastomosis, and cystotomy [511]. Two approaches
(lank and midventral) have been recognized and are currently in use in both small and large animals surgery;
however in ruminants lank approach is the most widely and
frequently practiced [1, 2]; due to the fact that surgical site
can be visualized and observed from a distance and access
healing, it was also reported to have reduced potential risk
2
interval of the two laparotomy approaches. he aim of the
study was to compare and evaluate lank and midventral
laparotomy approaches in goats.
Haemorrhage
Seroma
Wound istula
Incisional hernia
0
None
None
None
None
Scores
1
Mild
Mild
Mild
Mild
2
Severe
Severe
Severe
Severe
Table 2: Postsurgical wound assessment score of lank and midventral approaches at 1824 hours and 10 days (mean SD).
Parameters
Discharge
Swelling
Erythema
Dehiscence
Groups
FA
MVA
FA
MVA
FA
MVA
FA
MVA
1824 hrs
ater surgery
0.80 0.45
0.80 0.84
1.80 0.45
2.00 0.00
1.40 0.55a
0.80 0.45b
0.00 0.00
0.00 0.00
Scores
1014 days ater
surgery
0.00 0.00
0.00 0.00
0.50 0.56
0.80 0.45
0.25 0.50a
0.00 0.00b
0.25 0.50a
0.00 0.00b
ab
3. Results
3.1. Postsurgical Wound Assessment. At 1824 hours ater
surgery, there was serous discharge in all groups; the mean
discharge scores were (0.800.45 and 0.800.84) for lank and
midventral approaches, respectively. here was no signiicant
diference between the two groups when compared. At 1014
days ater surgery, there was no discharge observed (Table 2).
Midventral group had higher swelling score (2.00 00)
in comparison with lank approach (1.8 0.45) and the
overall swelling score was higher at 1824 hours ater surgery
compared to 1014 days ater surgery (0.50 0.56 and 0.80
0.45) in lank and midventral, respectively (Table 2). here
was no signiicant diference between lank and midventral
approach both at 1824 hrs and at 1014 days ater surgery.
he lank approach at 1824 hours had higher erythema
score (1.40 0.55) when compared with midventral group
(0.80 0.45) and there was signiicant diference ( < 0.05)
of erythema between the two approaches (Table 2). At 1014
days ater surgery, lank approach had higher erythema score
(0.25 0.50) while midventral approach had no erythema
record and there was signiicant diference ( < 0.05)
between the two approaches.
Dehiscence was not recorded at 1824 hours ater surgery
in all the groups; however, at 1014 days ater surgery
dehiscence was observed in lank approach with signiicant
diference ( < 0.05) between the two groups (Table 2).
3.2. Intra- and Postsurgical Complications. Intraoperative
haemorrhage score was higher in lank approach (1.4 0.55)
when compared with midventral approach (1.000.70); there
was no signiicant diference ( > 0.05) between the two
groups (Table 3). here were no postoperative complications
of incisional hernia, seroma, and wound istula recorded.
Groups
Scores
FA
MVA
1.40 0.55
1.00 0.70
FA
MVA
FA
MVA
FA
MVA
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Postoperative complications
Incisional hernia
Seroma
Wound istula
Table 4: Total leucocytes and diferential leucocytes counts before and ater surgery of the lank and midventral approaches (mean SD).
Parameters
Groups
FA
MVA
FA
MVA
FA
MVA
FA
MVA
Before surgery
25.48 4.19
33.86 9.96
11.10 3.69
11.38 4.41
11.74 3.27
33.86 3.40
2.60 0.89
4.14 1.02
Mean scores
One week ater surgery
34.93 3.12a
51.08 5.07b
10.23 5.72
18.62 5.07
21.33 8.22a
28.32 11.98b
3.35 0.66
4.12 0.44
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).
Parameters
Groups
3
Platelets (10 /)
Platelets critical value (%)
Mean platelets volume ()
Platelets dimension width ()
Mean scores
1824 hrs ater surgery One week ater surgery
375.60 99.58
369.95 144.66
416.60 94.88
376.20 90.78
0.21 0.06
0.21 0.08
0.24 0.05
0.22 0.03
5.68 0.22
5.60 0.09
5.74 0.08
5.72 0.22
684.80 0.29a
684.30 0.05
684.2 0.18
684.22 0.20b
Pair of means bearing diferent superscript are signiicantly diferent ( < 0.05).
35
Subjective healing interval (days)
ab
FA
MVA
FA
MVA
FA
MVA
FA
MVA
Before surgery
287.20 123.58
351.40 75.20
0.16 0.07
0.20 0.04
5.60 0.14
5.72 0.09
683.90 0.37
684.26 0.13
30
12
14
13
25
11
12
20
17
15
13
12
13
10
10
5
0
1
4. Discussions
Table 6: Erythrocytic indices before and ater surgery of the two approaches (mean SD).
Parameters
Groups
FA
MVA
FA
PCV (%)
MVA
FA
Haemoglobin (g/d)
MVA
FA
Mean corpuscular volume ()
MVA
FA
Mean corpuscular haemoglobin (pg)
MVA
FA
Mean corpuscular haemoglobin con. (g/L)
MVA
FA
RBC distribution width (%)
MVA
RBC (106 /)
ab
Mean scores
Before surgery 1824 hrs ater surgery One week ater surgery Two weeks ater surgery
12.32 1.35
12.79 1.23
12.23 1.32
12.10 2.07
13.13 0.51
13.69 0.52
13.36 0.85
13.03 1.05
21.92 2.56
24.66 5.24
16.15 2.85a
22.75 5.98
25.22 1.19
25.90 1.15
25.72 4.37b
23.84 3.07
8.12 1.36
8.98 2.25
8.63 1.51
8.68 2.19
9.16 0.43
9.84 0.59
9.86 1.28
9.30 1.36
17.72 2.56
19.08 2.37
17.58 0.88
18.58 1.98
19.10 2.09
18.06 0.57
14.10 2.09
18.20 1.13
6.50 0.42
6.88 0.95
6.78 0.50
7.00 1.13
6.92 0.04
7.13 0.26
7.37 0.61
7.04 0.48
36.80 2.16
36.26 3.50
38.5 1.94
37.36 2.18
36.32 1.91
37.96 1.90
38.58 3.12
38.94 1.82
30.18 4.71
32.00 4.37
30.98 4.86
29.80 6.19
32.18 1.26
34.48 1.96
33.40 2.23
32.92 2.72
Pair of means bearing diferent superscript are signiicantly diferent ( < 0.05).
6
wound healing when compared with 12.4 0.5 mean days
for midventral approach. he slight variation of days of
healing interval might be due to surgical site interference
with the object coming contact with the surgical wound as
reported by [22, 23], as the chance of surgical site contact
with surrounding object is higher in lank laparotomy site
compared to midventral site. he variation could also be a
result of other local factors that afect wound healing like
oxygenation, foreign body contact with the surgical wound,
and venous insuiciency as reported by [23].
5. Conclusion
It was concluded that the midventral laparotomy approach
can be safely and conveniently performed without fear of
clinical complications in goats. When correctly performed,
it will ofer less intraoperative hemorrhage and postoperative
tissue reactions.
We recommend the use of midventral laparotomy
approach for routine abdominal surgery in goats as an
alternative to lank approach. Further study on pregnant goats
to see whether midventral abdominal incisional closure can
withstand pressure of gravid uterus also needs to be conducted.
Conflict of Interests
he authors declare that there is no conlict of interests
regarding the publication of this paper.
Acknowledgments
he authors appreciate the efort of Mallam Bello Kaura
of haematology laboratory, college of health sciences, for
processing the blood samples. hey also appreciate the efort
of technical staf too numerous to mention in large animal
surgery of Veterinary Teaching Hospital, Usmanu Danfodiyo
University, Sokoto.
References
[1] N. K. Ames, Noordsy's Food Animal Surgery, Wiley-Blackwell,
5th edition, 2007.
[2] D. A. Hendrickson, Techniques in Large Animal Surgery, Blackwell Publishing, Ames, Iowa USA, 3rd edition, 2007.
[3] D. E. Freeman, Abdominal Surgery: Summary Procedure and
Principles, International Veterinary Information Service, New
York, NY, USA, 2003.
[4] S. R. R. Haskell, Surgery of the sheep and goat digestive system,
in Farm Animal Surgery, S. L. Fublin and N. G. Ducharme, Eds.,
pp. 521526, Saunders an Imprint of Elservier, 2004.
[5] S. N. Dehghani and A. M. Ghadrdani, Bovine rumenotomy:
comparison of four surgical techniques, he Canadian Veterinary Journal, vol. 36, no. 11, pp. 693697, 1995.
[6] M. hibier and B. Guerin, Embryo transfer in small ruminants: the method of choice for health control in germplasm
exchanges, Livestock Production Science, vol. 62, no. 3, pp. 253
270, 2000.
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REPRINT PAPER (A)
recurrent hernia.
Any additional complication contributes to the severity of PH and
should be carefully evaluated during the initial examination.
Rectal alterations associated with PH are classiied as deviation
(abnormal rectal orientation), sacculation (symmetric or
asymmetric sudden increase in rectal diameter) and diverticulum
(protrusion of rectal mucosa associated with tearing of the
muscular wall of the rectum) [Mann and Boothe, 1985;
Krahwinkel, 1975; Hosgood et al., 1995].
Brissot et al. established a grading scheme for rectal lesions
Introduction
Diagnosis of perineal hernias (PH) is based on the patients history
and physical and rectal examinations. Hernias are characterized
as unilateral or bilateral, simple or complicated (with additional
pathologies of urinary bladder and/or prostate or rectum) or
(1) Clinic of Surgery and Ophthalmology, Vienna University of Veterinary Medicine; Veterinrplatz 1, A-1210 Vienna.
E-mail: Judith.Doerner@vetmeduni.ac.at
(2) Univ. Prof. Dr. Gilles Dupr, Clinic of Surgery and Ophthalmology, Vienna University of Veterinary Medicine; Veterinrplatz 1, A-1210 Vienna.
* Presented by VK (Austria)
186
Case report
An 8.5 year old male intact Smooth Dachshund was presented
to the Clinic of Surgery and ophthalmology at the Vienna
University of Veterinary Medicine with a history of long-standing
defecation problems and tenesmus. in addition, the dog showed
acute anuria, which had started the day before. A right-sided
soft and luctuant perineal swelling of about the size of a ist
was observed (Fig. 1).
187
Two-step protocol for surgical treatment of complicated or bilateral perineal hernia in dogs - J. Drner and G. Dupr
Fig. 4: Two rows of simple continuous sutures were used for colopexy
188
Fig. 5: Cystopexy
189
Two-step protocol for surgical treatment of complicated or bilateral perineal hernia in dogs - J. Drner and G. Dupr
Discussion
Perineal hernias are classiied as complicated if the following
criteria are met: unilateral PH with rectal lesions grade 2 or
worse, unilateral PH with bladder retrolexion and/or prostatic
disease, or recurrent PH. Bilateral or complicated PH can be
successfully treated using laparotomy to perform incisional
colo-, vaso- and cystopexy and, if necessary, surgical treatment
of prostatic lesions (prostate omentalization, cyst resection),
followed by herniorrhaphy. Recurrence rate is low and in most
cases the inal outcome is satisfactory. in the study carried out
by Brissot et al. [2004], a total of 41 dogs with complicated PH
were treated using the two-step protocol, and in 90 % of the
cases, PH could be permanently resolved.
Rectal disorders included dilations, sigmoidal deviation or
diverticulum [Mann and Boothe, 1985; Krahwinkel, 1983;
Hosgood et al., 1995; Dupre et al., 1993]. in dogs with rectal
dilation, colopexy reduces the rectal diameter avoiding further
accumulation of faeces; in addition, reduction of the pressure
on the pelvic diaphragm is achieved by cranial ixation of the
rectum [Huber et al., 1997; Dupre et al., 1993, Maute et al, 2001].
Colopexy not only corrects rectal deviations, but also reduces
the size of any existing sacculation. By this procedure, the linear
morphology of the colorectal ampulla can be re-established. this
also reduces the possibility of faecal accumulation in the rectum
[Huber et al., 1997; Dupre et al., 1993, Maute et al, 2001].
Perineal hernias associated with retrolexion of the urinary
bladder show higher mortality rates (30 %) and worse prognosis
than cases without bladder retrolexion [SJollema and Van
190
Complication
Number
Percent Course
local sepsis
17
Healing by local
treatment
local abscess at
the ColP site
10
n=2 Re-intervention
(laparotomy)
Perineal suture
dehiscence
tenesmus
18
41
n = 14 intermittent
n = 4 Permanent
Urine
incontinence
15
36
n = 3 Up to 15 days
postoperative
n = 5 Up to 6 months
postoperative
n = 7 > 6 months
postoperative
Healing by local
treatment
Abbreviations:
PH = perineal hernia
ioMF = internal obturator muscle lap
ColP = colopexy
CYSP = Cystopexy
DeFP = Vas deferens pexy
PoM = omentalization of the prostate
References
Bellenger CR. Perineal hernia in dogs. Aust Vet J. 1980; 56: 434-438
Bilbrey SA, Smeak, DD, Dehoff W. Fixation of the deferent ducts for
retrodisplacement of the urinary bladder and prostate in canine
perineal hernia. Vet Surg. 1990; 19: 24-27
Bongartz A, Caroiglio F, Balligand M, Heimann M,Hamaide A. Use of
autogenous fascia lata graft for perineal herniorrhaphy in dogs.
Vet Surg 2005; 34: 405-413
Brissot Hn, Dupr gP, Bouvy BM. Use of laparotomy in a Staged
Approach for Resolution of Bilateral or Complicated Perineal
Hernia in 41 dogs. Vet Surg 2004; 33: 412-421
Burrows CF, Harvey Ce. Perineal hernia in the dog. J Small Anim Pract
1973; 14: 315-332
191
Two-step protocol for surgical treatment of complicated or bilateral perineal hernia in dogs - J. Drner and G. Dupr
192
PROCEDURES PRO
SURGERY
PEER REVIEWED
Exploratory Laparotomy
in the Dog & Cat
Lysimachos G. Papazoglou,
DVM, PhD, MRCVS
Aristotle University of hessaloniki
hessaloniki, Greece
ary tree; spleen and stomach; duodenum and pancreas), caudal quadrant
(jejunum, ileum, and colon; urinary
bladder; urethra and prostate or
uterus), right paravertebral region by
retracting the mesoduodenum, and left
paravertebral region by retracting the
mesocolon (kidneys, adrenal glands,
ureters, and ovaries).2
for performing an
exploratory laparotomy
includes a well-equipped
general surgery pack.
Swabs and sponges
should be counted at the
beginning and the end
of surgery.
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PROCEDURES PRO
SURGERY
PEER REVIEWED
STEP-BY-STEP
EXPLORATORY LAPAROTOMY
STEP 1
Generously clip and prepare the surgical site, extending 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
3
ROSTRAL
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October 2015
STEP 4
STEP 6
6
ROSTRAL
After skin incision, seal subcutaneous vessels via elecrocautery and undermine subcutaneous tissues from
attachment to the rectus sheath 1 cm laterally to visualize the linea alba. Avoid excessive undermining to prevent vascular compromise of the fascia and dead space
creation and subsequent seroma formation.
STEP 5
STEP 7
7A
5
ROSTRAL
7B
ROSTRAL
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PROCEDURES PRO
SURGERY
PEER REVIEWED
STEP 8
STEP 10
10A
ROSTRAL
10B
STEP 9
ROSTRAL
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Use a systematic approach for abdominal exploration. Abdominal organs should be inspected by
direct vision and palpation. Gently lift the right
lobe of the duodenum and mesoduodenum toward
the left side of the animal to allow exposure of the
right kidney, adrenal gland, ovary, and ureter (A).
Gently lift the colon and mesocolon toward the
right side of the animal to expose abdominal
organs of the left paravertebral fossa (B).
STEP 11
STEP 12
11A
12A
ROSTRAL
12B
11B
he midline laparotomy incision is closed in 3 layers. he abdominal wall is closed using the external leaf of the rectus abdominis muscle sheath in a
simple continuous or simple interrupted suture
pattern. Most surgeons favor a continuous
polydioxanone or polyglyconate suture pattern,
which provides a quick and secure closure.
Sutures should be placed 510 mm from the incision edge and spaced 510 mm apart, depending
on the size of the animal (A).6,7 Suture size
depends on the animals weight (animals <5 kg:
3/0; 520 kg: 2/0; 2040 kg: 0; and >45 kg: 1)(B).
Author Insight:
Closure of the linea alba must include the
external leaf of the rectus sheath.
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PROCEDURES PRO
SURGERY
PEER REVIEWED
STEP 13
STEP 14
13A
14A
ROSTRAL
13B
14B
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ROSTRAL
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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.
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STEP 15
15A
15C
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
200 nontraumatized dogs and cats. Vet Surg. 1992;21(6):452-457.
2. Boothe HW. Exploratory laparotomy in small animals. Compendium
Contin Educ Pract Vet. 1990;12:1057-1066.
3. Savvas I, Papazoglou LG, Kazakos G, et al. Incisional block with
bupivacaine for analgesia ater celiotomy in dogs. JAAHA.
2008;44(2):60-66.
4. Campagnol D, Teixeira-Neto FJ, Monteiro ER, Restitutti F, Minto BW.
Efect of intraperitoneal or incisional bupivacaine on pain and the
analgesic requirement ater ovariohysterectomy in dogs. Vet Anaesth
Analg.2012;39(4):426-430.
5. Nawrocki MA, MacLaughlin R, Hendrix PK. The efects of heated and
6.
7.
8.
9.
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