Untitled Quiz

Laparotomy

• Laparotomy is a surgical procedure to open the abdominal wall for good exposure of abdominal and/or pelvic organs.
• Lapar means abdomen; otomy means incision or opening.
• Laparotomy is the same as celiotomy.

Indications

• Exploration: Used to facilitate diagnosis (Open and See).
• Drainage: Used for fluid (as in cases of hepatic, cardiac, and renal dysfunction), urine (ruptured urinary bladder), and lavage (perforated abdominal wound).
• Gastrointestinal tract: Includes procedures like gastrotomy, enterotomy, rumenotomy, abomasopexy, intestinal resection, and anastomosis.
• Surgical interference in internal organs: Also includes excision of abdominal neoplasms, hepatic, splenic, and pancreatic surgeries.
• Urogenital tract procedures: Includes procedures like ovariectomy, ovarohysterectomy, caesarian section, cystotomy, nephrotomy, nephrectomy, prostatectomy, and cryptochidectomy. Applicable to herniorrhaphy.
• Experimental studies: Laparotomy can be used for this purpose as well.

Surgical Anatomy

• The abdomen is divided into three regions by two planes: one line between the margins of the last ribs, and another between the tuber coxae.
• Regions: Epigastric (Cranial third), Mesogastric (Middle third), and Hypogastric (Caudal third).
• Epigastric region: Xiphoid area (suitable for gastrotomy and splenectomy), left paracostal (hypochondric) area (suitable for splenectomy), right paracostal (hypochondric) area (suitable for hepatic surgeries).
• Mesogastric region: Umbilical area (suitable for ovariectomy), left lumbar area (suitable for surgeries of the left kidney), right lumbar area (suitable for surgeries of the right kidney).
• Hypogastric region: Prepubic area (suitable for cystotomy and hysterectomy in females), left inguinal (iliac) area (suitable for cystotomy in males), right inguinal (iliac) area (suitable for cystotomy in males).
• Surgical approaches: Ventral midline, cranial midline, middle midline, caudal midline, paramedian per-rectus (cranial paramedian, middle paramedian, caudal paramedian), paramedian lateral-rectus, paracostal, ventral midline-paracostal, paralumbar-paracostal (lazy S shape), inverted T (Mercedes shape).

Laparotomy Technique

• Anesthesia:
  • Equine: Inhalation anesthesia or deep narcosis with chloral hydrate (5g/50kg, 10% solution, IV), combined with local linear infiltration of lignocaine HCl (1mL/1cm).
  • Ruminants: Xylazine HCl 2% (0.1mg/kg) with local linear infiltration of lignocaine HCl (1mL/1cm).
  • Dogs and cats: General anesthesia with atropine sulphate (0.1mg/kg, SC), xylazine HCl 2% (1mg/kg, IM or IV), ketamine HCl 5% (5-10mg/kg in dogs, 20-33mg/kg in cats, IM or IV), and thiopental sodium (25mg/kg 2.5%, IV) for maintenance.
• Pre-operative technique: Fasting, clipping/shaving hair, washing with water and soap, drying in a sterile towel, disinfection with ethyl alcohol, painting with povidone iodine, and draping with sterile towels.
• Surgical technique: Skin incision, blunt dissection of subcutaneous tissues, raising abdominal muscles during peritoneal cavity opening by stab incision, widening with scissors while guarding viscera with fingers, exteriorization of the affected organ, wrapping affected organ with sterile gauze soaked in saline.
• Post-operative manipulation: Returning affected organ to its normal position, suturing peritoneum (interrupted or horizontal mattress pattern in large animals, continuous pattern in small animals), suturing subcutaneous tissues (simple continuous pattern), suturing skin (simple interrupted pattern).
• Post-operative care: Application of abdominal bandage, administration of systemic antibiotics, subcutaneous administration of anti-tetanic serum (equines 3000 IU, donkeys 1500 IU), daily dressing of wound with povidone iodine, removal of stitches (7-10 days).

Complications

• Hemorrhage:
  • Causes: Opening of abdominal wall (external bleeding), improper suturing of visceral organs (internal bleeding).
  • Treatment: Ligation of bleeders, cauterization.
  • Prevention: Proper suturing.
• Post-operative seroma: Post-operative swelling due to inflammation.
  • Treatment: Systemic antibiotics, good drainage (removal of lowest stitch), daily exercise.
• Infection (either local or diffuse peritonitis):
  • Causes: Improper surgical asepsis, dehiscence of visceral suture.
  • Treatment: Intra-abdominal and systemic antibiotics, suturing of ruptured organs.
  • Prevention: Proper aseptic surgery and correct suturing.
• Fistulation:
  • Cause: Improper suturing of gut leading to leakage, consequential subperitoneal abscess formation, and abscess opening to outside.
  • Treatment: Re-operation for fistula excision.
  • Prevention: Proper gut suturing.
• Incisional hernia:
  • Causes: Improper suturing of abdominal wall, weak scar tissue formation, increased intra-abdominal pressure after laparotomy.
  • Treatment: Re-operation.
  • Prevention: Proper suturing, avoiding increased intra-abdominal pressure.
• Incarceration of the bowel:
  • Cause: Improper suturing of peritoneum.
  • Treatment: Re-operation.
  • Prevention: Proper suturing of peritoneum.
• Subcutaneous abdominal emphysema: Accumulation of air or gases under skin.
  • Cause: Improper peritoneum suturing leading to air escaping into subcutaneous tissues.
  • Treatment: Daily massage of emphysema.
  • Prevention: Proper peritoneum suturing.
• Wound dehiscence: Rupture of stitches, with or without prolapsed viscera.
  • Causes: Improper suturing of abdominal wall, infection, damage by aggressive animals (licking, biting, scratching).
  • Treatment: Re-operation, excision of necrosed tissues.
  • Prevention: Proper suturing of abdominal wall, application of abdominal bandage, daily dressing with antiseptic solutions.

Umbilical Disorders

• Umbilical Infections
• Umbilical Hernia and Umbilical Infections
• Umbilical Eventration
  • is a congenital anomaly, characterized by prolapse of jejunum, frequently contained in a sac of peritoneum
• Patent Urachus (Persistent/Patent Urachus): A condition where the urachus, typically closing during fetal development, remains open.
• Umbilical Granuloma: Tumor-like mass of granulation tissue at the umbilicus, often caused by navel sucking or self-sucking.

Navel Ill/Joint Ill

• Definition: Disease of newborn animals (calves, foals, lambs, piglets) characterized by umbilical infection and/or polyarthritis.
• Incidence: Usually seen in young calves (< 1 week old).
• Causes: Infection enters via umbilical cord, soon after birth. Bacteria may spread to various parts, depending on spread route, resulting in joint ill or septicemia. May enter via gut or upper respiratory tract, especially in cases where colostrum intake is insufficient.
• Predisposing factors: Inadequate colostrum intake, poor hygiene. Risk higher in male calves due to slower drying of umbilical cord.
• Symptoms:
  • Navel (Omphalitis, Omphalophlebitis, Omphaloartertitis, Urachitis): Swollen, painful navel that doesn't dry up, abscess may develop, or firm cord, fever, loss of appetite.
  • Joint (Infectious polyarthritis): Infection spreads, settling in joints (fetlock, carpal, hock, stifle); joints swell, are hot, and painful.
  • Other symptoms: Drainage from lymph nodes (prescapular or popliteal), general lameness to non-weight-bearing, crab-like stance, muscle atrophy.
• Diagnosis: Clinical history, clinical symptoms, clinical examination (aseptic aspiration), ultrasonography, arthrocentesis, radiography (limited use in acute cases).
• Differential diagnosis: Localized peritonitis, patent urachus, umbilical hernia, fractures, osteomyelitis, rickets, muscular dystrophy.
• Treatment: Early treatment is critical, infected animals should be separated, treated with broad-spectrum antibiotics, and pain killers. Antibiotic treatment (penicillin) often continued after symptoms subside. Surgical intervention (joint lavage, abscess drainage) for large cases.
• Complications: Peritonitis, polyarthritis, meningitis, pericarditis, hepatic abscesses, umbilical hernia, septicemia, death.
• Prevention: Strict hygiene in calving boxes and ensuring complete drying of the navel, proper planning and preparation of calving areas, full immersion of umbilicus in strong povidone iodine solution, feeding calves sufficient amounts of colostrum within first 6 hours, especially by esophageal feeding method.

Patent Urachus

• Definition: Congenital condition where the urachus remains open. Related to membranous urethral diaphragms preventing urachus closure.
• Symptoms: Often associated with omphalitis, urine dripping from umbilicus, wet umbilical region, hair loss at umbilicus, multiple ulcers around umbilicus, ability to urinate from urachus alongside urethra.
• Diagnosis: Case history, clinical signs, ultrasonography.
• Treatment: Laparotomy, surgical removal of urachus and umbilical vessels, addressing any membranous diaphragms.

Umbilical Eventration

• Definition: Congenital anomaly where small intestines (jejunum) prolapses or are contained in sac of peritoneum at umbilicus.
• Symptoms: Extruded intestine, potentially rupture upon movement or necrosis due to damage from ischemia (especially prolonged cases).
• Treatment: For very recent cases (<3 hours), surgical intervention is possible, involving washing prolapsed lobes with warm saline solution, retaining the prolapse inside the abdomen for suturing, and systemic antibiotics.

Umbilical Granuloma

• Definition: Tumor-like mass of granulation tissue at umbilicus, often in calves, due to chronic inflammation from navel sucking or self-sucking.
• Symptoms: Loss of hair at umbilicus, secondary infection, slightly painful.
• Treatment: Ligation at the base, surgical removal; if left untreated, persistence into adulthood is possible.