2.9 Equine Laparotomy

What is laparotomy?

What is laparotomy?

The incision into the abdominal cavity, usually in the case of life threatening gastrointestinal abnormalities. Exploratory laparotomies can also be performed to address reproductive issues or lesions in other organs in the abdominal cavity.

What are the indications for laparotomy?

• Colic: to diagnose the exact cause of colic, and the obstructing lesion requires surgery.

• No exact diagnosis, but enough evidence to indicate that surgery is required to save the horse's life.

• No response to treatment of colic / recurrent colic over a period of days or weeks.

• Obstruction, neoplasia.

What are the different ways to open the abdominal cavity?

Inguinal, parainguinal, flank, paramedian, ventral midline

What is the inguinal approach to laparotomy?

• Cut: m. rectus abdominis.

• Does not alone allow a thorough exploration and decompression of the non-herniated bowel.

• Used in conjugation with ventral midline incision when operating on stallions with inguinal or scrotal hernia, cryptorchid castration.

What is the parainguinal approach to laparotomy?

• Cut: m. rectus abdominis.

• Incision located cranially to the external inguinal canal.

What is the flank approach to laparotomy?

• Cut: internal and external oblique + transverse abdominal muscles, tunica flava abdominis (covers external oblique).

• Standing approach. Most common in small (descending) colon, nondistended large colon, uterine torsion, cryptorchid.

• Incision is made in a vertical line midway between the last rib and the tuber coxae, starting dorsal and continuing ventral. The external abdominal oblique muscle is sharply divided. The internal abdominal oblique and transverse abdominal muscles are bluntly divided parallel to their fibre direction, then puncturing peritoneum and accessing abdominal cavity.

• Closure is done for three layers; two first layers of muscles are appositioned and sutured with absorbable material. Skin is the last layer and is sutured or stapled.

What is the paramedian approach to laparotomy?

• Cut: m. rectus abdominis.

• 10 cm lateral to the midline. Incision on either right or left midline through rectus abdominis muscle.

• Careful to avoid deep and superficial epigastric vessels.

• Closure by suturing of external fascia of the rectus abdominis sheath.

What is the ventral midline approach to laparotomy?

• Cut: linea alba.

• Mostly done in linea alba in case of colic.

• Complete revision of abdominal cavity. Incision for small intestine 15cm and for large 60cm.

• Initial incision is made accurately in the midline, through linea alba, extending cranially from the umbilicus. On incising peritoneum, note the colour and character of any effusion, distribution of pattern of distended bowel, and any discernible discoloration of visceral or peritoneal surfaces.

• Closure: do not include peritoneum, causes more irritation. Suture linea alba 1cm from the wound edge using simple continuous suture. Then suture the subcutaneous and the skin by Ford interlocking suture of prolene.

Which technique is used for removal of uroliths?

Ventral midline.

Why is it common to do a sternal laparotomy in Germany?

To gain access to the caecum.

What parameter in blood is important during colic?

Lactate.

What does it mean when there are high levels of lactate in the blood?

Hypoxia of tissue (may be due to strangulation).