Ventral Midline Celiotomy Research Articles

Patent urachus with subcutaneous communication and ventral abdominal swelling in a domestic short‐hair cat

AbstractA 3‐month‐old, male, entire, domestic shorthair kitten underwent investigations for stranguria and haematuria, and was diagnosed with a urinary tract infection secondary to a suspected extramural vesicourachal diverticulum. Lower urinary tract signs resolved with a 14‐day course of amoxicillin clavulanate. Three months later, the kitten re‐presented for investigation of acute onset ventral abdominal discomfort and bruising. On presentation, clinical examination revealed omphalitis and subcutaneous bruising, with no evidence of an umbilical stoma. Ultrasonography demonstrated a patent urachus communicating with the subcutaneous tissue space, resulting in accumulation of urine at the level of the umbilicus. A ventral midline coeliotomy was performed to allow resection of the urachal remnant, including a partial cystectomy. The cat was urinating normally within 10 hours postoperatively, and the wound healed without complication. No postoperative complications or recurrent lower urinary tract signs were reported at follow‐up (312 days).

Tensile testing in feline ventral abdominal coeliotomy closure with different sizes of polydioxanone suture material: a biomechanical study.

The aim of this study was to evaluate, in vitro, the load and type of failure of the sutured ventral abdominal fascia of cats with different sizes of suture material made of polydioxanone (PDX) (2-0, 3-0, 4-0, 5-0 USP). A total of 32 samples of the ventral abdominal wall from 16 cadaveric cats were harvested using an hourglass-shaped template. The samples were sectioned longitudinally along the linea alba and then sutured together in a continuous pattern using four different randomly assigned sizes of pdx suture material (2-0, 3-0, 4-0, 5-0 USP). A universal testing machine was used for linear distraction of the samples. The tensile strength and type of failure were recorded and analysed. Three types of failure were defined: suture material failure (S), suture line failure (T1) and failure of the abdominal wall further away from the linea alba (T2). The frequency of suture material failure decreased with increasing suture size. Suture size 5-0 failed due to a S failure in 6/8 samples, PDX 4-0 failed in 2/8 samples and PDX 3-0 failed in only 1/8 samples. However, PDX 2-0 failed due to only T1 or T2 failures, with both failures being almost equally represented. No statistically significant differences in the load to failure between PDX 2-0, 3-0 and 4-0 were noted (P >0.05). The risk of suture failure increased with decreasing suture size diameter. PDX 2-0 and 3-0 can be used without reservation for the closure of ventral midline coeliotomy in cats. Although there was no statistically significant difference between PDX 2-0, 3-0 and 4-0, PDX 4-0 showed a higher probability for suture breakage and should be used only after careful consideration of the patient while clinical evaluation is pending. Pdx 5-0 cannot be recommended as a safe suture size for this type of surgical closure.

Outcomes of horses undergoing ventral midline celiotomy for colic with dorsal mesenteric attachment abnormalities of the colon and cecum

Outcomes of horses undergoing ventral midline celiotomy for colic with dorsal mesenteric attachment abnormalities of the colon and cecum

Tube cystostomy is effective for urinary outflow management in dogs with intervertebral disk extrusion and ischemic myelopathy cranial to the L3 spinal cord segment: 61 dogs (2018-2022).

To describe the application and owner experience of tube cystostomy for management of upper motor neuron urinary bladder dysfunction secondary to intervertebral disk extrusion (IVDE) or ischemic myelopathy, and to report complications associated with cystostomy tube management. 61 dogs. Medical records of dogs with IVDE or ischemic myelopathy cranial to the L3 spinal cord segment that underwent tube cystostomy placement via a short, caudal ventral midline celiotomy were reviewed. Days from tube placement to hospital discharge, days from placement to tube removal, and complications were recorded. An owner questionnaire was distributed to ascertain ease of use and perceived time commitment. 58 dogs were diagnosed with IVDE, and 3 dogs were diagnosed with ischemic myelopathy. The modal neurologic grade at cystostomy tube placement was 4 (range, 3 to 5). The median number of days from cystostomy tube placement to hospital discharge was 1 (range, 0 to 3). Follow-up data was available for 56 dogs. The median number of days from cystostomy tube placement until removal was 19 (range, 3 to 74). Fifteen minor and 6 severe postoperative complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Twenty-seven owners responded to the questionnaire and primarily reported that cystostomy tube use was easy (22/27) and perceived time commitment was low or minimal (20/27). Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs recovering from upper motor neuron urinary bladder dysfunction secondary to IVDE or ischemic myelopathy. This technique is simple for owners to use.

Incisional complications after skin closure with stainless‐steel skin staples compared to nylon sutures in horses undergoing colic surgery

SummaryBackgroundIncisional complications following ventral midline celiotomy represent a challenge for equine surgeons. Preventative measures to minimise risks of incisional complications are continuously being investigated. This includes the search for an ideal surgical closure method.ObjectiveTo compare the incidence of incisional complications after skin closure with nylon sutures versus stainless‐steel skin staples (SSS) following ventral midline celiotomy for colic surgery in horses and to assess additional risk factors for incisional complications.Study designProspective blinded randomised study (2012–2014).MethodsOne hundred and twenty‐three horses that underwent colic surgery between May 2012 and May 2014 and survived for >2 weeks were included in the study. Horses were allocated randomly to two groups—65 horses were closed with skin staples, and 58 horses were closed with skin sutures (nylon‐0). Patient records and a follow‐up questionnaire were used to record incisional complications that occurred during hospitalisation and after discharge.ResultsFollow‐up information was available in 119 of 123 horses. Four horses without follow‐up were excluded. With strict inclusion criteria, incisional drainage was recorded in 43% (49/115) of the horses, including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group. Pregnancy and large colon intestinal lesions were risk factors for incisional complications. Surgeon 3 was found to decrease the incidence of incisional infection. No association was detected between incisional complications and hernia development.Main limitationsThe non‐uniformity of the follow‐up examination; reliance on owners or caregiver of the horse for follow‐up information, horses lost to follow‐up, incomplete data. Another limitation was the single‐centre design of the study.ConclusionsAlthough not significantly superior, the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure.

Persistent hypoxaemia and pulmonary oedema in a horse anaesthetised for emergency exploratory laparotomy

AbstractA 16‐year‐old, 550 kg Connemara gelding was anaesthetised for resection of multiple small intestine strangulating lipomas via ventral midline celiotomy. Severe hypoxaemia, detected throughout the anaesthetic period (lowest PaO2 58 mmHg [7.6 kPa]), was unresponsive to the ventilatory strategies implemented. Flared nostrils and increased respiratory rate were present at recovery from anaesthesia. When the horse was returned to the yard, bilateral foamy nasal discharge and increased respiratory effort and rate were noticed, consistent with pulmonary oedema. The horse received oxygen supplementation and furosemide, which led to complete resolution within 24 hours.

Negative pressure wound therapy for the management of surgical site infections with zoonotic, drug‐resistant pathogens on the upper body of the horse

SummaryThis case series reviews the use of negative pressure wound therapy (NPWT) for surgical site infections (SSI) on the upper body of six horses at an academic referral institution between 2016 and 2020. The SSIs consisted of three ventral midline celiotomy incisions post‐abdominal exploratory, one paralumbar flank incision for removal of an ovarian abscess, an incision for resection of a septic jugular vein, and a large defect resulting from the resection of chronically abscessed skin and subcutaneous tissue on the shoulder and pectoral region. All SSIs contained zoonotic, polymicrobial, multi‐drug resistant pathogens (methicillin‐resistant Staphylococcus aureus or extended spectrum beta‐lactamase Klebsiella or Enterobacteriaceae) that were managed without systemic, regional, or topical antimicrobials. All horses were discharged from the hospital, and long‐term follow‐up revealed satisfactory functional and cosmetic outcomes according to owner questionnaires. Duration of NPWT ranged from 4 to 15 days in five horses, but one horse required NPWT for 70 days due to the large nature of the defect. The NPWT system was easy to use, well‐tolerated by patients, and produced acceptable functional and cosmetic outcomes for the clients. By containing wound exudate and reducing daily wound care, it improved hospital biosecurity and reduced exposure to hospital personnel.

Diagnosis and Clinico-Surgical Management of Secondary Laminitis due to Ovarian Tumour in a Kathiawari Mare

Granulosa cell tumours (GCTs) are the most common ovarian tumours in equine which involves around 2.5% of all tumours of horses and 85% of reproductive tract tumours (McCue et al. 2006). Tumours may originate from tissue present within the equine ovary. GCTs are most often first detected during either routine reproductive examination for breeding or when behavioral changes caused by the presence of the tumour in ovary requiring further investigation (McKinnon and Barker, 2010). Mares with GCTs remain infertile due to atrophy of the contralateral ovary, which has been variably associated with elevated serum inhibin, testosterone or anti-Mullerian hormone concentrations (Ball et al., 2012). Surgical removal is regarded as the treatment of choice for GCTs (McCue et al., 2006). Surgical removal of the affected ovary almost always results in the resumption of normal heat cycles and the ability to carry a normal pregnancy. Lameness in mare which suffered from GCT was also reported earlier by Meagher et al. (1977). Various scientists reported different technique for removal of affected ovary. Standing laparoscopic ovariectomy is associated with a lower complication rate than other surgical methods like colpotomy (Colbern and Reagan 1987), flank, paramedian or ventral midline celiotomy (Lee and Hendrickson, 2008; Azizi et al., 2014). Most of GCTs are benign and affect the left ovary (McCue et al. 2006; Korany et al., 2020). The present document reports clinical diagnosis and surgical management of secondary laminitis due to ovarian tumour in a Kathiawari mare by left flank ovariectomy of the affected ovary.

Surgical enlargement of the epiploic foramen in horses.

To assess the safety and efficacy of a method for digitally enlarging the caudal aspect of the epiploic foramen (EF). Healthy horses and clinical cases of EF entrapment (EFE). Fourteen healthy horses and three clinical cases. Through a ventral midline celiotomy under general anesthesia, the EF was enlarged by digital separation of the caudal attachments of the caudate lobe of the liver from right dorsal colon, right kidney, gastropancreatic fold, and pancreas. Healthy horses were euthanized under anesthesia, and the enlarged EF was measured at necropsy. The method used for enlarging the EF did not cause clinically relevant hemorrhage, as determined by visual inspection of the EF in 14 horses at necropsy and by vital parameters under anesthesia in all horses. In clinical cases, EFE was reduced following enlargement of the EF, and no intraoperative complications were encountered. In one clinical case, necropsy at 30 days confirmed partial closure of the enlarged EF. The method proposed enlarged the EF safely and effectively. Limitations of the study include the small number of clinical cases and the lack of postoperative follow-up on the healthy horses. Enlargement of the EF at its caudal extent should be considered in selected cases of EFE in which manual reduction is difficult or protracted. Although the procedure was safe in this study, knowledge of the anatomy, practice on cadavers, and careful selection of cases with greatest need are recommended before clinical use.

Transcutaneous Detection of Intramural Microchips for Tracking the Migration of the Equine Large Colon: A Pilot Study.

Colic remains the number one cause of mortality in horses, and large colon displacement including colonic volvulus is one of the leading causes for equine hospitalization and surgery. Currently, there is not an adequate model to study the pathophysiology of this condition. The objective of this proof-of-concept study was to determine if subserosal implantation of bioinert microchips in the large intestine would be detectable by a RFID (radio-frequency identification) receiver when the implanted microchips were adjacent to the body wall, thus identifying the location of the colon within the abdomen. A horse with no history of gastrointestinal disease underwent a ventral midline celiotomy to implant twelve bioinert microchips into the subserosa at predetermined locations within the large colon and cecum. A RFID scanner was used to monitor the location of the colon via transcutaneous identification 1-3 times daily for a one-month period. Following humane euthanasia, a postmortem examination of the horse was performed to assess microchip implantation sites for migration and histologic assessment. Eleven out of the 12 implanted microchips were successfully identified transcutaneously at occurrences as high as 100%. Odds ratios were calculated for the likelihood of identifying each chip in a location different from its most common location. Microchips implanted into the subserosa of the equine large colon can be used as a means of identifying the approximate location of the equine large colon via transcutaneous identification with an RFID scanner.

Pneumopericardium after peritoneopericardial diaphragmatic hernia repair in a dog

A one-year-old neutered, Goldendoodle presented for evaluation. One week prior to presentation, the surgical closure of a peritoneopericardial diaphragmatic hernia was performed via ventral midline celiotomy. Since the procedure, the dog had been lethargic and anorexic at home. Thoracic radiographs revealed a pneumopericardium. Pericardiocentesis was performed which evacuated approximately 100 mL of air from the pericardial sac. The dog recovered well and began eating in the hospital and resumed normal activity. This is the first reported case of a pneumopericardium post-peritoneopericardial diaphragmatic hernia repair requiring pericardiocentesis. Clinicians should be aware of this rare complication in patients with post-operative peritoneopericardial diaphragmatic hernia.

Successful management of gastroesophageal intussusception in an adult puma (Puma concolor)

AbstractA 7‐year‐old entire female puma (Puma concolor) presented with a history of regurgitation and diarrhoea of 2 weeks duration. Conventional medical management was initially attempted to alleviate the clinical signs, which were unsuccessful. Oesophagoscopy allowed for the diagnosis of gastroesophageal intussusception (GEI) through the observation of gastric mucosa in the lumen of the distal portion of the oesophagus. The intussusception was reduced using the endoscope, which did not result in resolution because the intussusception recurred within 24 hours. A ventral midline celiotomy was performed, followed by a left‐sided belt loop gastropexy. No postoperative complications related to the surgery were observed. The puma resumed eating within 48 hours following the surgery, and no regurgitation recurred for a period of 24 months following surgery. To the knowledge of the authors, this is the first report of GEI in a puma that was successfully resolved.

Ileal impactions: How to proceed when a ventral midline celiotomy is not an option?

Ileal impactions: How to proceed when a ventral midline celiotomy is not an option?

Comparison of the zip skin closure system with conventional suture for skin closure of ventral midline incisions in horses.

To compare the application and healing of the zip skin closure system (ZSCS) with sutured closure by use of a split-scar model of ventral midline incisions in horses in a prospective, randomized experimental study. 8 adult horses. All horses underwent an exploratory ventral midline celiotomy with a standardized 30-cm skin incision. Each horse was randomized to have either the cranial 15 cm closed with suture and caudal 15 cm with the ZSCS or vice versa (split-scar model). Skin closure time was recorded and compared. Photography and skin biopsies were taken preoperatively and 14 days postoperatively. Cosmetic appearance was assessed by use of a proposed equine celiotomy incision score. Healing at 14 days was assessed by histopathology. Skin closure times were faster with the ZSCS compared to sutured incisions. At 14 days postoperatively, the cosmetic appearance (equine celiotomy incision scores) for ZSCS incisions were better than sutured closure and histologic healing scores were not different between methods of closure. Subcuticular sutures were associated with deep dermal inflammation and necrosis independent of epidermal closure methods. While limitations to the utility of the ZSCS are recognized, the potential benefits of expedient closure, good cosmetic outcome, and satisfactory healing make this method viable for closure of linear wounds or incisions in horses.

Cardiopulmonary function and intestinal blood flow in anaesthetised, experimentally endotoxaemic horses given a constant rate infusion of dexmedetomidine.

Endotoxaemia causes untoward inflammatory-mediated effects that might be attenuated by dexmedetomidine. To evaluate the effects of a dexmedetomidine intravenous (IV) infusion on systemic and intestinal haemodynamics and arterial blood gas values in sevoflurane-anaesthetised horses administered Escherichia coli O55:B5 lipopolysaccharides (LPS). Randomised controlled in vivo experiment. A total of 13 horses weighing 456±86kg (mean±standard deviation) and aged 13.9±9.0years donated for euthanasia underwent ventral midline celiotomy using sevoflurane anaesthesia. Baseline physiological variables were recorded after a 90-minute equilibration period. All horses were given 0.1mcg/kgbwt LPS IV. Horses were randomly assigned to no further treatment (group LPS; seven horses) or IV administration of dexmedetomidine (loading dose 1.75mcg/kgbwt followed by 1.75mcg/kgbwt/h; group LPS-Dex; six horses) with concurrent target sevoflurane dose reduction of 50%. Cardiac index (CI; thermodilution), intestinal blood flow, arterial blood parameters and plasma dexmedetomidine concentration measurements were recorded every 30minutes until euthanasia at 390minutes. Data were compared between and within groups to baseline using a mixed model analysis (significance P<.05). In LPS-Dex horses, intestinal blood flow and CI were transiently decreased after the dexmedetomidine loading dose, but no significant differences were found compared with baseline during the infusion. Sevoflurane dose was reliably reduced by approximately 40%. Significant differences were identified in creatinine (115 umol/L LPS-Dex; 195umol/L LPS), bicarbonate (29.7mmol/L LPS-Dex; 23mmol/L LPS) and base excess (2.0mmol/L LPS-Dex; -5.3mmol/L LPS). Dexmedetomidine plasma concentrations were highest after the loading dose and stable during infusion dosing. Experimental conditions are not reflective of clinical colic management. A dexmedetomidine infusion with sevoflurane dose reduction attenuated some deleterious changes in anaesthetised horses administered LPS without sustained negative cardiovascular effects and may be beneficial during colic surgery.

Equine inflammatory response to abdominal surgery in the absence of gastrointestinal disease.

To investigate the, equine inflammatory response to ventral midline celiotomy in the absence of gastrointestinal disease in horses of varying body condition scores primarily using serial measurements of serum amyloid A (SAA). Experimental clinical study. University teaching hospital. Ten adult light breed horses free of any clinical disease, 5 with body condition score (BCS) 3-4/9 and 5 with BCS 7-8/9. Horses had a ventral midline celiotomy performed under general anesthesia, including manual decompression of the small intestine. SAA, semiquantitative fibrinogen, plasma lactate, and WBC count were measured in the blood preoperatively and at 12, 24, 48, 72, 120, and 168hours postoperatively. Complete serum biochemistry was performed preoperatively and 24 and 72hours postoperatively. Serial abdominocentesis was also performed with peritoneal fluid analysis of SAA, total protein, lactate, WBC count, and cytology. Significant (P<0.05) increases in serum SAA were noted at 12, 24, and 48hours postoperatively (124.6 ± 68.6, 390.8 ± 209.0, 568.6 ± 197.7μg/mL), and most horses had values approaching normal at 168hours postoperatively (174.4 ± 307.7μg/mL). Other values such as fibrinogen also increased in response to surgery but did not return to normal within the measured time points. Horses with high BCS did not have significantly different serum SAA compared to horses with low BCS. Peritoneal fluid SAA did not increase significantly at 12hours postoperatively. The information from this study can be used to help determine the effect of anesthesia and surgical intestinal manipulation resulting in increased SAA when a comparison to clinical or experimental cases is needed.

Ex vivo comparison of the bursting strength of an equine ventral midline celiotomy covered by two standard abdominal bandages

To determine the compressive effect of abdominal bandages after ventral midline celiotomy closure in horses. Ex vivo, experimental study. Equine cadavers (n = 18), six per group. A 20-cm ventral midline celiotomy was created in each of 18 equine cadavers. A 200-L inflatable bladder was placed in the abdomen, and the linea alba was apposed. Horses were randomly assigned to no bandage (C), elastic (E), or Velcro inelastic (I) bandage groups for testing. Circumferential bandages were placed with a subbandage pressure monitoring system over the incision. The bladder was insufflated until construct failure, which was determined by a decrease in pressure reading. Bursting pressure, location of body wall or bandage failure, and subbandage pressures were recorded. Maximum bursting pressure was different between groups E and C (P = .004), with no difference between groups E and I (P = .146) or I and C (P = .085). Group I achieved higher subbandage pressure compared with group E (P = .036). Abdominal compliance was not different between groups (P = .099). Location of failure differed between groups (P = .011), with failure at the diaphragm more common in group I (6/6, 100%) compared with groups E (3/6 [50%]) and C (1/6 [16.7%]). Elastic abdominal bandages had higher abdominal bursting pressures compared with unbandaged incisions.

Anaesthetic management of a bovine for ventral midline coeliotomy approach to hysterotomy

AbstractAn eight‐year‐old, multiparous Chianina cow presented for the removal of a term, emphysematous calf following a dystocia. Delivery of the calf trans‐vaginally intact or piecemeal by fetotomy was impossible due to the partially closed cervix. A midline coeliotomy approach to hysterotomy under general anaesthesia was elected in order to reduce peritoneal spillage of uterine content. This case report aims to discuss the peri‐anaesthetic management of the cow, specifically the ventilation strategy, approach to premedication and analgesic protocol.

Incisional complications after skin closure with n-butyl cyanoacrylate or stainless-steel skin staples in horses undergoing colic surgery.

To compare the prevalence of incisional complications after skin closure with n-butyl cyanoacrylate (NBC) or stainless-steel skin staples (SS) after ventral midline celiotomy for colic surgery in the horse. Retrospective study (2014-2018). Two hundred eighteen horses. Medical records of horses that underwent exploratory celiotomy for colic were included when the skin was closed with NBC or SS and the horse survived ≥15 days after surgery. Records and a follow-up questionnaire were used to determine in-hospital and posthospital discharge incisional complications. Associations between variables were assessed by using bivariable and multivariable analysis. The cutaneous incision was closed with SS in 113 of 218 (51.8%) horses and with NBC in 105 of 218 (48.2%) horses. Follow-up information was available in 166 of 218 horses. Five horses with incisional complications prior to discharge but without follow-up were included in the overall analysis. Incisional complications were recorded in 17.5% (30/171) of horses, including 19.1% (17/89) of closures with SS and 15.9% (12/82) of closures with NBC (P = .54). Complications occurred before discharge in 14 of 218 (6.4%) horses and after discharge in 16 of 166 (9.6%) horses. Four horses with in-hospital incisional complications (surgical site infection) developed a second complication after discharge (hernia). Packed cell volume was a risk factor for in-hospital incisional complications (P = .04), and in-hospital incisional complications were associated with posthospital discharge incisional complications (P = .01). Occurrence of incisional complications did not differ between NBC and SS. N-butyl cyanoacrylate is a suitable alternative to SS to close the cutaneous incision for ventral midline celiotomy for colic surgery in the horse.

Surgical Management of Bicornual Uterine Prolapse in a Siamese Cat: A Case Report

Uterine prolapse is a rare condition in cats that can be managed by performing either an external hysterectomy or manual reduction followed by ovariohysterectomy. This article describes surgical management of bilateral uterine prolapse in a queen. A one year old female, pluriparous Siamese cat (Felis catus) with no past history of dystocia and weighing 2.8 kg was presented to Andys Veterinary hospital, Nairobi, Kenya with a protruding mass through the vulval. The queen had a history of recent queening and had delivered three kittens a week earlier. The owner noticed the protruding mass about 24 hours after the delivery of the last neonate. A few days later, the cat was not suckling the kittens well and was in appetent. As a sequel to this, two kittens died. After a week, the protruding mass had a pungent smell and the client presented the cat to the hospital. Complete bilateral uterine prolapse was diagnosed after a visual examination and palpation of the mass. The uterus was swollen, had necrotic areas and debris. Accordingly, a two staged ovariohysterectomy was opted for to manage the case. An internal ovariectomy was first done via a ventral midline celiotomy followed by an external hysterectomy. Post-operative management included pain medication and antibiotic therapy and the patient recovered well and was discharged after 2 days. The skin sutures were removed 10 days postoperatively. The cat recovered uneventfully with no further complications reported by the owner. In conclusion, this article shows that when the prolapsed uterus is swollen, damaged and necrotic, a two staged ovariohysterectomy should be the method of treatment and the outcome is good despite the duration of the condition.