THE ABDOMINAL EXPLORATORY: FROM XIPHOID TO PUBIS DR. STEVEN MEHLER, DACVS Chief Medical O ffi cer, Veterinarian Recommended Solutions In the VETgirl webinar, “The Abdominal Exploratory: From xiphoid to pubis,” Dr. Steven Mehler, DACVS reviews how to perform a systematic abdominal exploratory in small animals including general surgical principles, client/team/operating room/patient preparation, and when to biopsy and also discusses common abdominal procedures.
KEY HIGHLIGHTS
ABDOMINAL EXPLORATORY LAPAROTOMY SURGICAL APPROACH Surgical approach for exploratory celiotomy - through the linea alba. 1 Incision is of adequate length to expose all four abdominal quadrants following retraction of the body wall. Purpose of the procedure is to see and explore the entire abdominal and retroperitoneal areas. • Rule of thumb: adequate visualization for exploration requires an incision that begins at the xiphoid process in all animals and extends to midway between the umbilicus and pubic brim in most companion animals. • Deep-chested dogs - incision is made to the pubic brim. • Male dogs - skin incision is curved slightly just cranial to the
prepuce on the side adjacent to the surgeon and is continued as a paramedian incision to the brim of the pelvis. • Preputial branches of the external pudendal vessels may require double ligation (unless electrosurgery is available) and transection on the side of the paramedian skin incision. • Preputial muscle must be incised in the area of the ligated (or coagulated) branches of the external pudendal vessels so that the prepuce can be reflected laterally to expose the caudal aspect of the linea alba. • Non-midline incisions, i.e. flank approaches, o ff er no advantages and several disadvantages over the linea alba incision. 2 Elevate the linea alba by grasping at the umbilical scar with thumb forceps, and a stab incision is made just caudal to the thumb forceps using the scalpel with the sharp edge of the blade pointing upward (i.e., upside down pencil grip of the scalpel).
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