Approaches to the abdominal cavity Flashcards
Surgical incision into abdominal cavity
Celiotomy
Flank approach to abdominal cavity
Laparotomy
What is the most common approach into the abdomen used in SAM?
Ventral midline
Incision that goes thru the SQ tissue and the linea alba?
Ventral midline
Advantages of a Ventral Midline Approach
- Minimal bleeding
- Easiest and quickest approach & closure
- Exposure to of all abdominal organs→incisions made xiphoid to pubis
Venral abdomial incision parallel to midline (R or L) is called
Paramedian
Advantages of Paramedian incision
Increased exposure to organs on one side of the abdominal cavity
Disadvantages of Paramedian incision
- Increased bleeding
- Increased closure time
Refers to “thru the rectus abdomens”
Transrectal
Refers to “rectus abdominus muscle pulled to one side before incision”
Pararectal
Lateral incsion b/w last rib & tuber coxae
Flank
Advantages of Flank incisions
Excellent exposure to 1 kidney, 1 adrenal gland, & 1 ovary
Disadvantages of Flank incisions
Limited access to entire abdomen
Techniques used when making a flank incision
- Cut thru external & internal abdominal oblique
- Grid approach
Describe the grid approach flank incision
- Separate mm. fibers by the direction they are running
- Let mm. fibers return to normal position
- Suture layer by layer to close
Incision caudal or parallel to last rib (1 or 2 fingers behind last rib)
Paracostal
Which incision gives very little exposure and is rarely used alone?
Paracostal
What are the combined approaches to the abdomen?
(2)
- Ventral midline + Paracostal
- Ventral midline + Medial Sternotomy
Advantages & Disadvantages of the
Ventral Midline + Paracostal approach
-
Advantages
- Increased exposure →esp. of gall bladder & liver lobes (R)
-
Disadvantages
- Increased bleeding & prolonged exposure/closure time
Advantages & Disadvantages of the
Ventral midline + Median sternotomy approach?
-
Advantages:
- Increased exposure of cranial abdomen (liver and diaphragm)
-
Disadvantages:
- Opens pleural cavity →requires assisted ventilation
- Thoracic drainage required
With the midline approach, what determines the location and length of the incision?
Determined by the goal of surgery
How far is the skin incision extended past the anticipated body wall incision?
1 cm cranial & caudal to the anticipated body wall incision
True/False: The SQ layer is not incised in the same line as the skin
False
It is incised in the same line as the skin
What do you do to the linea alba after you identify it?
Tent and incise it
What provides the holding strength for closure?
External rectus sheath or abdominal fascia
Where is the linea alba most easily identified?
@ or cranial to the umbilicus in dogs
Where are the CRANIAL superficial epigastric vessels located?
Run parallel to linea & cranial to the umbilicus
What must be done in males to complete the ventral midline incision?
Displace penis
What grip is used for short, precise cutting?
Pencil grip
Grip used for long incisions?
Fingertip grip
(Marta says violin or modified violin)
Why do you need to apply tension while making an incision?
To avoid jagged incision edges
What degree angle should you use when stabbing the linea alba?
45°-60°
In male dogs, is the preputial orifice draped in or out of the surgical field?
Out of the field
If working on a ventral midline incision in a male dog,
what should you do when you reach the prepuce?
Detour R or L of the prepuce
What is a stay suture?
- Stich placed thru tissues but not tied
- Long sutrue end is left exposed
- -Clamp end w/ hemostat to elevate tissue or tag something
True/False: During a ventral midline incision of a male dog,
Preputial muscles must be severed in half
True
During a ventral midline incision of a male dog,
what vessels must be ligated before returning to the midline?
Branches of the CAUDAL superficial epigastric vessels
What may happen if you grab the penis with the hemostats when draping?
Hemorrhage
What do you do if urine enters the abdominal cavity?
- Flush w/ saline at end of surgery → not a major problem (Relax yo!)
- Prophylactic antibiotics can be given
How should you clip for a celiotomy?
WIDE!!!!!!
What is the first thing visualized when opeing during a celiotomy?
The Omentum →displace it to visualize the intestines
If you lose your ovarian pedicle, what do you do?
Lift the intestines to visualize
During abdominal surgery, what structure should you avoid squeezing?
Pancrease
What is the holding layer during closure of ventral midline incision?
External rectus fascia = holding layer of ventral body wall
When closing a Ventral Midline incision, is it okay to suture the rectus muscle layer?
Why or why not?
Never suture thru muscle!!!!
B/c it doesn’t add strength to closure and it increases inflammation
When closing a ventral midline incision, do you close the internal sheath?
Why or Why not?
Usually not closed
B/c it doesn’t add strength to closure & may increase adhesion formation
You are closing an incision….. when may you place full thickness bites?
If the incision is on the midline
Where do you place your sutures if the muscles are exposed during the closure of a ventral midline approach?
Sutures are placed in the external rectus sheath (fascia) only
When closing a ventral midline approach, how far apart should your sutures be placed?
How much tissue should be incorporated?
Place 5-10mm apart & incorporate 5-10mm of tissue
What may be a consequence of suture being placed too far apart
when closing a ventral midline approach?
Seroma or Hernia
What is the preferred suture pattern(s) to use when closing the linea alba during a
ventral midline approach?
Simple Interupted
or Simple Continuous (w/ more practice)
What is the preferred suture material for closing a ventral midline approach?
What are the sizes used for dogs? cats?
- Monofilament synthetic absorbable or non-absorbable suture
- Monocryl or PDS
- Dogs → 3/0 to 0
- Cats → 3/0 or 4/0
What is a consequence of not closing properly?
Dehiscence
What does Dr. Bruhl-Day say about the size of the suture when closing a ventral midline approach?
It is not the size of the suture that matters, but the technique you apply with it
Use the minimum size to do the job
What type of suture material should you NOT use in a continuous pattern to close the linea alba?
Chromic gut or Stainless steel
What is the technique for suturing a ventral midline approach closed?
- One end to the other OR Each end to the middle (tie 2 sutures together at center)
- **SQ tissue is closed in simple continuous pattern or simple interrupted **
- 2/0 or 4/0 synthetic absorbable suture
- **Preputialis mm. must be correctly apposed in male dog - pull 2 stay sutures **
- Skin is closed in simple interrupted or cruciate pattern
- 3/0 or 4/0 nylon
- Dead space should be properly closed - accumulation of serosanguineous fluid or serum leads to hematoma or seroma formation
With a celiotomy, you use the ventral midline approach. The abdomen is opened from _____ to _____, and what is the landmark?
**Opened from the xiphoid process to pubis **
**Umbilicus should be the landmark **
