L23a: surgical approaches to the abdominal cavity (small animal)

MCQ: after a routine ventral midline celiotomy in a dog, which tissue layer provides the greatest tensile strength and is considered the primary holding layer for abdominal closure?

external rectus sheath

celiotomy

surgical incision into the abdominal cavity

laparotomy

flank approach to the abdominal cavity

where do you make the incision for a ventral midline approach?

linea alba

what is the most used abdominal approach in small animal?

ventral midline

what are characteristics of the ventral midline approach?

1. minimal bleeding

2. exposure of all abdominal organs

3. easiest and quickest approach

where do you incise on a paramedian approach?

ventral abdominal incision parallel to the midline

what are the characteristics of the paramedian approach?

1. increased exposure to organs on one side

2. increased bleeding

3. increased closure time

where do you incise on the flank approach?

lateral incision between last rib and tuber coxae

what are the characteristics of the flank approach?

1. limited access to entire abdomen

2. excellent exposure of one kidney, one adrenal gland, and one ovary

how do you position a cat for a flank approach?

right lateral recumbency with the pelvic limbs extended caudally

what are the the points of the triangle in a flank approach in cats?

1. greater trochanter

2. wing of ilium

3. midpoint of the proposed incision

where do you incise in the paracostal approach?

caudal and parallel to the last rib

what are the combined abdominal approaches?

1. ventral midline plus median sternotomy

2. ventral midline plus paracostal

which abdominal approach has increased exposure of the cranial abdomen?

ventral midline plus median sternotomy

what abdominal approach requires assisted ventilation?

ventral midline plus median sternotomy

what abdominal approach has increased exposure of the gallbladder and liver lobes?

ventral midline plus paracostal

how long should the skin incision be for a ventral midline approach?

should be extended 1 cm cranial and caudal to the anticipated body wall incision

where is the linea alba in dogs most easily recognized?

cranial to the umbilicus

what vessels run parallel to the linea and cranial to the umbilcus?

cranial superficial epigastric vessels

what structure may be displaced or removed with the ventral midline approach?

falciform ligament

what is the arrow pointing to?

caudal superficial epigastric vessels

what is the yellow arrow pointing to?

linea alba

green box

linea alba

pink box

abdominal fascia

yellow box

subcutaneous layer

what muscle must be severed in half and ends tagged later for reattachment in male dogs during the ventral midline approach?

preputialis muscle

where do you push the omentum during the ventral midline abdominal approach?

pushed cranially

1

pancreas

2

mesocolon

what are the “anatomical retractors” in the abdomen?

mesocolon

what size suture do you use in a ventral midline closure in an animal below 5 kg?

3/0

what size suture do you use in a ventral midline closure in an animal between 5-20 kg?

2/0

what size suture do you use in a ventral midline closure in an animal 20-40 kg?

0

what size suture do you use in a ventral midline closure in an animal above 45 kg?

1

what is the holding layer of the ventral body wall?

external rectus fascia

where are sutures placed in the closure in a ventral midline approach?

placed 3-5mm apart and must incorporate 3-5mm of tissue

MCQ: when closing the linea alba following a routine ventral midline celiotomy in a dog, which type of suture needle is most appropriate to minimize tissue trauma while providing adequate penetration?

taper-cutting needle tip with a round body

what suture patterns do you use to close the abdomen in a ventral midline approach?

1. simple interrupted

2. simple continuous

how tight must sutures be in the closure of the ventral midline?

must achieve adequate apposition of the incised edges

how do you close the subcutaneous layer?

simple continuous or simple interrupted pattern, using 2/0 to 4/0 synthetic absorbable suture