abdominal surgery Flashcards
what is a laparotomy?
- Surgical incision into the abdominal
cavity - Technically refers to a flank incision
- Rarely if every performed
- Used synonymously with celiotomy
what is a celiotomy
- Correct terminology
- Routinely along the midline
- “Ex lap” = Exploratory Celiotomy
“ACUTE ABDOMEN” means:
Acute clinical signs referable to the abdominal cavity :
how to clip to prep for ex lap
- Wide clip!!
- Few cm’s cranial to xiphoid
- Few cm’s caudal to inguinal region
how long should our incision be to explore the abdomen?
- Exploring the entire abdomen – incision xiphoid to pubis
what number blade should we incise with for our first cut into the abdomen? how far do we go?
- Incise (xiphoid to pubis) with #10 (for big) or #15 (for small) skin blade
-incise subcutaneous tissue down to external rectus fascia > 15 blade or metzenbaum scissor
-identify the linea alba
how do we get through the linea alba?
Tent the abdominal wall at the linea alba and make a stab incision (#15 blade) facing upwards
* Palpate for adhesions
* Mayo scissors to extend cranially and caudally along the linea
what should we do with the falciform ligament?
can either:
* Leave in abdomen
* Excise (remove) it for better view
- Clamp and ligate the cranial attachment (blood supply enters)
- Amputate distal to the suture
when should we count our gauzes/ sponges?
-before and after surgery
what do we want to do with the prepuce of male dogs to prep
-clip and prepare
-lateralize with towel clamp
-drape over tip
what tool can we use to help us see into the abdomen?
balfour retractor
when closing the abdomen, we have layers of skin, fascia, muscle, fat, and peritoneum. What are the strongest parts? weakest? which heals fastest but does not contribute to wound healing?
- Skin and Fascia:
- Strong
- Muscle and Fat:
- Weak
- Peritoneum:
- Heals fast
- Does not contribute to wound healing
what type of suture pattern should a less experienced surgeon use on the linea? what are the advantages and disadvantages?
simple interuppted
- Advantages:
- More secure when learning
- Disadvantages:
- More foreign material in wound
- Longer Surgical Time
- Use more suture (cost?)
what type of suture pattern should a more experienced surgeon use to close the linea alba? how many knots? how long should tags be?
- Simple Continuous
- No increased risk dehiscence when properly performed
- Secure knots (5-6 start, 7-8 end)
- Appropriate suture material
- Appropriate suture size
- Good bites
- Suture tags ~0.5cm
should we use a surgeons knot on the skin layer?
no
advantages and disadvantages of continuous pattern closure of linea alba
Advantages:
* Rapid closure
* Less foreign material in the wound
* Use less suture (cost?)
Disadvantages:
* Catastrophic failure
what suture materials should we never use for linea closure?
DO NOT USE CATGUT OR STEEL FOR LINEA ALBA CLOSURE
NON ABSORBABLE BRAIDED SUTURE MAY CAUSE SINUS FORMATION (NOT RECOMMENDED)
how big should our bites be when closing the linea? what layer should we be focusing on, and what should we not include? how far apart should sutures be?
- Full thickness bites (linea) – 4-10mm bites
- External rectus sheath – 10 mm bites
- Do not include falciform or subcutaneous fat (delay healing)
- Place sutures 5-7mm apart (animal size dependent)
- Tighten but do not strangulate (ischemia)
when closing the first layer of the abdomen, if we are off the linea, what should we include in our bites?
-if not on the linea alba, include the external fascia only, not the rectus muscle
what is the most major cause of dehiscence? how to we minimize risk?
weakness of the tissue caught in bites
> take large bites of the external leaf of the fascia
what types of suture materials should we use to close the linea alba?
PDS, Biosyn, Maxon
what size of suture should we use to close the linea alba with a simple interrupted pattern? what about with continuous?
depends on size of dog:
2-12kg: 3-0 (2-0 for simple continuous)
12-30kg: 2-0 (2-0 to 0 for simple continuous)
>30kg: 0 (0 for simple continuous)
keys to success when closing the linea alba
- Full thickness bites
- Wide bites
- Good distance between suture bites
- Long enough suture tags
what suture pattern and material should we use to close the subcutaneous layer? what size?
- Simple continuous pattern to close
- Monocryl
- Vicryl
- Absorbable suture (4-0, 3-0, 2-0 depending on size of animal)
knots must be ___ in subcutaneous closure
buried
subcutaneous skin sutures will be more ___ than functional
aesthetic
how do we close the subcutaneous tissue in male dogs, with regards to the prepuce?
- Close subcutaneous tissue in sub-preputial area
- Re-appose the preputial muscle to realign prepuce
- Close subcutaneous tissue in a simple continuous pattern
when complications can arise in male dogs, relating to subcutaneous closure around the prepuce?
- Paraphimosis
- Seroma formation
- Crooked urination
what pattern, size, and general material of suture should we use for skin?
- Simple interrupted or cruciate pattern (4-0 or 3-0)
- Non absorbable suture
what surgeries do not warrant antibiotics?
- Surgeries <1.5-2h with no entry into a hollow viscous or contamination do not warrant prophylactic antibiotics (clean surgery)
what does perioperative antibiotics mean? what is the general protocol?
- Perioperative means to start within 1⁄2 hour of cutting skin and stop once the procedure is done or within 24 hours
post-operatively, check twice daily for:
- Redness
- Swelling
- Discharge
- Pain
- Dehiscence
at what point do we remove skin sutures?
10-14 days
