This document provides information on laparotomy techniques and postoperative care. It discusses the abdominal regions and incision sites for laparotomy. Common techniques are described such as skinning, flank laparotomy, intestinal resection and anastomosis. Postoperative assessment of the incision and potential complications like dehiscence are outlined. Proper surgical technique and factors that can increase risk of dehiscence are highlighted.

1. Fourth Year Student
First Lecture
Applied Surgery
Laparotomy
University of Sulaimani
College of Veterinary medicine
Department of Surgery &
Theriogenology

2. Laparotomy
celiotomy
• Surgical approach to the abdomen is commonly performed in
veterinary prac7ce.
• Suture apposi7on of the peritoneum is no longer performed since the
peritoneum heals rapidly without closure.
• The abdominal musculature is o;en apposed with a simple
con7nuous pa<ern.
• Con7nuous pa<erns are faster than interrupted closure and leave
less suture material in the wound, reducing foreign body reac7on.
• Con7nuous closure has sufficient strength for uncomplicated healing
as long as the external rectus sheath is included in each suture bite.
• If surgical technique is appropriate, use of a con7nuous closure does
not increase the risk of incisional dehiscence.

3. For topographic purposes the abdomen is divided into nine regions
by imaginary planes.
1- Left parachondriac-------- Left lumbar-----------Left iliac
2- Xiphoid----------------------- Umbilical-----------------Prepubic
3- Right parachondriac----- Right lumbar-------------Right iliac
were injected. Sometimes, an area in the abdomen will
have been skinned and cut to inject the hepatic portal
system.
You need not make all the incisions before you begin
skinning. Using a new scalpel blade, make a shallow
longitudinal incision along the back, about 1 cm to one
side of the neural processes of the vertebrae. As you cut,
ensure that you have cut only through the skin by
reflecting the edge of the flap. Extend the cut from near
the base of the tail forward onto the back, neck, and
head past the pinnae. At about the level of the eyes,
make a sideways incision toward the other side eye (that
is, cut back across and past the middorsal line), angling
the incision toward the back of the eye. Continue to cut
toward the back of the mouth and onto the underside
of the lower jaw. Follow around the mandible to the
other side. Return to the base of the tail and extend the
incision back across the midline, around and under
the tail. Continue forward, anterior to and then around
the external genitalia. Continue the incision to just
past the midventral line. Make an encircling cut around
the forelimb, about midway along the antebrachium.
Do the same for the hind limb, just past the ankle. Then
make another incision, on the lateral surface of the hind
limb, between this encircling incision and the longitudi-
nal incision on the back.
Skinning can be accomplished by various techniques.
For much of the back, for example, the skin is often
readily removed, and a blunt probe, forceps, or your
fingers will do the job of tearing through the fibrous
connective tissue. In other areas, the skin adheres more
strongly, and requires a scalpel. When using a scalpel,
hold the blade parallel with the surface of the body and
use short strokes; often, simply nicking the connective
tissue will suffice, especially if you pull the skin flap
away from the body to tense the connective tissue. You
will encounter small nerves and blood vessels passing to
the skin. Cut through them. As you skin the trunk, you
Incision line
Animal's midline
1
2
3

4. 1- Left parachondriac-------- Left lumbar-----------Left iliac
2- Xiphoid----------------------- Umbilical-----------------Prepubic
3- Right parachondriac----- Right lumbar-------------Right iliac

5. FIG 19-1. Anatomy of the rectus sheath.
Rectus
abdominis muscle
External leaf
Internal leaf
Rectus
sheath
External
abdominal
oblique muscle
Transversus
abdominis
muscle
Internal
abdominal
oblique muscle
Peritoneum
Transversalis
fascia
External abdominal
oblique muscle
External leaf
Transversalis
fascia
Peritoneum

6. Most frequently, the abdomen is opened along its ventral midline to avoid large vessels
in the subcu9s and muscle. (Ventral para-median, Per-rectus, Para-rectus)
• In cats, the linea can be easily visualized once the subcutaneous fat has been incised.
• In dogs, subcutaneous fat a?aches to the abdominal wall along the midline,
obscuring the linea. Subcutaneous fat a?achments to the linea can be transected
sharply with a “push-cut” technique to reduce the risk of 9ssue trauma and seroma
forma9on that can occur with extensive undermining.
• In pa9ents that have previously undergone laparotomy, the ini9al linea perfora9on
should be made in an unscarred area. Before extending the incision, the peritoneal
surface of the linea should be palpated with an index finger or blunt instrument to
verify that there are no visceral adhesions.
• Once the abdomen is open, the falciform ligament can be torn or ligated and
transected.

7. • The abdominal incision is usually closed in two or three layers.
• Abdominal musculature is apposed with monofilament, synthetic,
absorbable material. Suture size depends on the thickness of the abdominal
wall.
• Usually, cats are closed with 3-0 suture and large dogs are closed with 0
suture.
• In very thin animals, sutures are often placed full thickness; including muscle
fibers or peritoneum, however, does not increase the strength of the
closure.
• In some animals, closure of the subcutis has no effect on healing. In others,
it may actually increase postoperative swelling.
• The subcutaneous tissues should be apposed if there is dead space,
persistent hemorrhage, or tension on the skin closure.

9. Ventral abdomen

10. Lateral flank region

11. General considerations and anaesthesia
L1
L1
T
13
L2
L2
L3
L3
L4
BSAC01 3/5/05 4:28 PM Page 25
Field of analgesia
Field of analgesia runs slightly obliquely ventrally and caudally to midline.
• T13: dorso-cranial flank, ventrally to umbilicus
• L1 (n. iliohypogastricus): dorsal mid-flank abdominal wall
• L2 (n. ilioinguinalis): caudal flank skin over stifle and inguinal region,
scrotum and prepuce, or udder
• L3 (n. genitofemoralis): caudal flank, especially ventrally, stifle,
inguinal region, scrotum and prepuce, or udder
Variations of technique have included
production of insensitive skin wheal prior
to insertion of a longer needle, and
insertion of a stout 2.1 mm diameter
needle to infiltrate the musculature,
later replaced by a finer and longer
needle.

12. 82 Chapter 3
T13 L1
1 2
5
3
4
L2 L3 L4
L5
L6
BSAC03 3/5/05 4:27 PM Page 82
Position of various left flank incisions
1. Para-costal (18 –25 cm), cranial in sub-lumbar fossa: rumenotomy (essential to be
as far cranial as possible in large-framed cow and short surgeon)
2. Left flank abomasopexy (Utrecht technique) or exploratory laparotomy (25 cm);
3. Low flank incision in recumbent cow or heifer for caesarean section, where it is
anticipated that it will be difficult to bring uterine wall to flank (35 cm);
4. standard caudal left flank
(35–40 cm)
5. oblique flank incision
(35 – 40 cm) for caesarean section
in standing animal.
6- Right flank abomasopexy.
7- Ventral Midline
8- Ventral paramedian
9- Ventral oblique
102 Chapter 3
3
4
2
1
BSAC03 3/5/05 4:27 PM Page 102

13. Flank laparotomy

14. • Caecotomy in ca,le

15. Intestinal resection and anastomosis

16. POSTOPERATIVE CARE AND ASSESSMENT
• The abdominal incision should be checked twice daily for redness,
swelling, or discharge. If the animal licks or chews at the incision, an
Elizabethan collar or sidebar should be used to prevent iatrogenic
suture removal.
• Early signs of altered wound healing include inflammation and
edema. Swelling and serosanguineous drainage from the incision are
consistent signs of acute incisional dehiscence.
• Dehiscence usually occurs 3 to 5 days after surgery, when minimal
healing has occurred and the sutures have weakened; however, it
may occur earlier if knots were tied improperly or if fascia was not
incorporated into the sutures.

17. • Evisceration usually causes sepsis and severe blood loss secondary to
mutilation of exposed intestine; the patient must be treated promptly.
• The abdomen should be bandaged, fluid therapy initiated, and broad-
spectrum antibiotics given while the animal is prepared for surgery. If
technical failure such as poor knot tying or improper suturing is
suspected, the entire suture line should be removed and replaced.
• The abdominal cavity should be lavaged copiously with warmed,
sterile saline.
• Open abdominal drainage or suction drainage may be considered in
animals with generalized peritonitis. Wound disruption after 10 to 21
days usually causes hernia formation rather than evisceration.
• Hernia repair in these animals may require excision of fibrotic tissues.
Subsequent closure requires that tissue layers be accurately apposed.

18. COMPLICATIONS
• Dehiscence (incisional hernias) and abdominal eviscera3on may
occur if improper surgical technique is used.
• The most common causes of wound dehiscence in the early
postopera3ve period are suture breakage, knot slippage or untying,
and sutures cu@ng through 3ssue.
• A higher rate of dehiscence may be seen in animals with wound
infec3on, fluid or electrolyte imbalance, anemia, hypoproteinemia,
metabolic disease (e.g., hyperadrenocor3cism, diabetes mellitus),
immunosuppression (e.g., feline immunodeficiency virus [FIV], feline
leukemia virus), or abdominal disten3on, or in those that have been
treated with cor3costeroids, chemotherapeu3c agents, or radia3on.
• Suture sinus forma3on has been reported with nonabsorbable
suture material. Such cases require surgical resec3on of affected
3ssues and removal of offending sutures.

19. • https://www.youtube.com/watch?v=UkqKG6
m8elU