THE ABDOMINAL EXPLORATORY: FROM XIPHOID TO PUBIS DR. STEVEN MEHLER, DACVS
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• Caution: With gastric dilatation-volvulus (GDV) surgery such a stab could inadvertently puncture the dilated stomach. • Some surgeons will use a standard pressure cut rather than a stab entry. • Regardless, either technique has the potential to inadvertently enter the stomach, and both can be performed safely if appropriate care is taken. 3 The incision in the linea alba may be continued to the limits of the skin incision using a scalpel and groove director (thumb forceps) or Mayo scissors. • Scissors are preferred for long linea alba incisions, such as for exploratory celiotomy. • Extending lineal incision beyond the limits of the skin incision will make closure of the external rectus fascia di ffi cult.
• Incision o ff of the midline will also make closure di ffi cult; paramedian incisions require more time and e ff ort to suture due to appositional problems. 4 Identify the falciform ligament and ventral ligament of the bladder. Each should be removed at its origin on the ventral midline to facilitate visualization. • Excise the falciform ligament bilaterally. • Then at the cranial aspect, excise the falciform o ff the dorsal surface of the xiphoid process. • Access the dorsal side of the xiphoid by grasping the falciform ligament and pulling it in a cranial direction until the xiphoid process everts cranially. • Be careful to avoid incising the diaphragm while cutting the falciform fat o ff the xiphoid process. • Bleeding from the falciform ligament excision may require ligation or electrocoagulation, particularly when excision is caudal to the xiphoid. 5 The wound margins should be protected with the large, moistened radiopaque laparotomy pads or radiopaque gauze pads and the wound edges retracted with a self-retaining retractor of appropriate size for the patient. When placing the Balfour retractors, be sure that no viscera are trapped between the blades of the Balfour and the abdominal wall. 6 Next, abdominal fluid is collected, if present, and saved for possible cytologic and culture testing. 7 Any area of active gastrointestinal leakage or hemorrhage is identified and immediately isolated to prevent further peritoneal contamination or to temporarily cease hemorrhage. • Radiopaque laparotomy pads or radiopaque gauze pads are placed underneath and around the a ff ected area to isolate it while a more detailed inspection is completed. Surgical repair is by debridement, ligation, suture closure, resection and anastomosis, partial organ excision, or other techniques. 8 Following repair of areas that demand immediate attention, the abdominal area is explored systematically. • No right way or wrong way to explore the abdominal cavity. • It is important, however, that the surgeon explore every abdomen in the same way, systematically, to assure that every organ and region is explored.
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