EDITOR'S NOTE: SurgerySTAT is a collaborative column between the American College of Veterinary Surgeons (ACVS) and
DVM Newsmagazine
.
Abdominal exploratory surgery—a systematic evaluation of the abdominal cavity and its contents—is often done in veterinary
practice for therapeutic reasons, including elective sterilization, retrieval of urinary calculi, gastrointestinal foreign
body removal and treatment of neoplastic conditions and other abdominal maladies. Looking beyond the therapeutic benefits,
abdominal exploratory is an invaluable diagnostic tool as well, particularly in patients with nonspecific chronic gastrointestinal signs, hepatopathy or abnormal findings
on radiographic or ultrasonographic examination. Acquiring good biopsy samples is key to maximizing the information gained
during an exploratory.
An exploratory can be done via open laparotomy or laparoscopy. Open laparotomy has the advantage of allowing visual and tactile
inspection as well as the ability to address any problems identified. Laparoscopy is a minimally invasive alternative that
allows good visual inspection of the abdomen, acquisition of excellent biopsy samples and completion of many procedures.
Steps for successful abdominal exploratory
Figure 1: An abdominal exploratory revealing splenic neoplasia.
|
1. Prepare the patient and operating room. A complete sponge count (4-x-4 gauze sponges and laparotomy sponges) and instrument count (hemostats) should be done before
entering any body cavity.
Figure 2: Evaluation of the small intestine during an exploratory.
|
2. Approach the abdomen via the ventral midline through the linea alba. A full exploratory is best done with an incision from the xyphoid to pubis. Excision of the falciform ligament and associated
fat allows better access to the cranial abdomen.
Figure 3: A laparoscopic exploratory evaluating the kidney, intestine, liver and adrenal gland.
|
3. Begin exploration as soon as the linea is incised. Note the appearance of the abdomen, the presence and character of fluid, organ positions, gut motility and the integrity of
the peritoneal wall and diaphragm. Traditionally, the abdomen is explored cranially to caudally, but the order of exploration
doesn't really matter as long as you use a systematic approach and do it the same way every time. Look at and feel everything
(Figures 1-3). And be sure to evaluate the entire abdomen before addressing any problems you identify. Good technique and
tissue handling throughout the procedure are a must.
Figure 4: A liver biopsy sample being obtained via laparoscopy.
|
4. Complete your plan once the entire abdomen has been evaluated. Isolate the area of interest with moistened laparotomy sponges, particularly if entering a lumen. Use stay sutures, atraumatic
retractors, clamps and forceps to minimize tissue damage. Use appropriate suture materials—ideally, in most cases, this involves
monofilament, absorbable sutures on small taper needles. Biopsies are indicated for any abnormalities noted (e.g., thickened
bowel, lymphadenopathy, lesions or nodules on the liver or spleen) (Figure 4). Organs commonly biopsied, indications for biopsy,
general rules of thumb and basic techniques regarding biopsies are listed in Table 1. Local lavage of the surgical site or,
if warranted, lavage of the entire abdomen with warm, sterile saline solution can be done at the end of the procedure. Evacuate
as much fluid as possible from the abdomen, and perform sponge and instrument counts before closure.
Table 1: Guidelines for biopsy of organs during abdominal exploratory
|
5. Close the abdomen by using the external fascia of the rectus abdominis, not the muscle or subcutaneous fat. A local block using bupivacaine can be performed along the linea for additional analgesia. Then perform standard subcutaneous
and skin closures. To ensure a good recovery, administer appropriate analgesia, heat support and supportive care.
Conclusion
Abdominal exploratory is a useful therapeutic and diagnostic tool when done appropriately. Even if you have a plan going into surgery, be prepared for surprises and be ready
able to adapt your plan to address the findings. Never leave the abdomen without doing something—there should never truly
be a negative exploratory.
Dr. Janice Buback is a surgeon with Lakeshore Veterinary Specialists in Port Washington, Glendale and Oak Creek, Wis. She
and her family, including Angus and Pinot (a.k.a. "Steak and Wine"), enjoy working and playing in southeast Wisconsin.
Featuring Information from:
