Ventral Midline Celiotomy Research Articles

Significance of reperfusion injury after venous strangulation obstruction of equine jejunum.

Fifteen horses under halothane anesthesia were assigned randomly to three groups of 5 horses each as follows. In group 1, the distal 50% of the small intestine was measured through a ventral midline celiotomy and replaced in the abdomen so that these horses could serve as sham-operated controls. In group 2, the same segment of small intestine was subjected to venous strangulation obstruction (VSO) for 180 min. In group 3, the same segment of small intestine was subjected to VSO for 90 minutes, followed by 90 minutes of reperfusion. Biopsies of small intestine were taken from all horses to assess mucosal morphologic injury by light microscopy, to measure tissue levels of malondialdehyde as an indicator of lipid peroxidation, and to measure tissue myeloperoxidase activity as a measure of neutrophil accumulation. VSO for 90 min in horse jejunum increased lipid peroxidation and neutrophil influx to levels that remained constant over the following 90 min, regardless of whether VSO was maintained or was interrupted to allow reperfusion of the tissue. Reperfusion induced a similar mucosal lesion as continued VSO for the same time. From these results, it would appear that VSO causes more severe mucosal damage and inflammation than the subsequent reperfusion period, in contrast to the classical paradigm of reperfusion injury in small intestine.

Unilateral adrenalectomy as a treatment for adrenocortical tumors in ferrets: Five cases (1990-1992)

Summary Adrenocortical tumors were diagnosed in 5 adult spayed ferrets. Four ferrets had bilaterally symmetrical alopecia of the caudal femoral region, abdomen, and tail, and 1 had alopecia of the distal limbs and feet. All 5 ferrets had vulvar swelling. During abdominal ultrasonography, irregular masses, believed to involve the adrenal glands, were seen in all 5 ferrets. Unilateral adrenalectomy was performed successfully in each ferret by use of ventral midline celiotomy. On histologic examination of biopsy samples, 4 ferrets were found to have adrenocortical adenomas, and 1 ferret was found to have an adrenocortical adenocarcinoma. All clinical signs resolved after adrenalectomy, suggesting that the adrenocortical tumors had been secreting adrenocortical hormones.

Evaluation of sodium carboxymethylcellulose for prevention of adhesions after uterine trauma in ewes

Summary Efficacy of a 1% solution of sodium carboxymethylcellulose (cmc) infused into the peritoneal cavity of ewes was evaluated for prevention of intraperitoneal adhesions resulting from surgery of the reproductive tract. Six ewes were assigned to each of 4 groups. Group-1 ewes were controls that underwent ventral midline celiotomy and exploration of the abdominal viscera. Group-2 ewes were treated similarly to group-1 ewes, except that a 1% solution of cmc (14 ml/kg of body weight) was infused into the peritoneal cavity. This group was studied to determine whether cmc would cause changes in the peritoneal cavity. Group-3 comprised ewes representing a uterine trauma model. Ewes underwent abdominal exploration, but in addition had a standard embryo collection technique performed on 1 uterine horn and hysterotomy performed on the opposite uterine horn. Group-4 ewes were treated like group-3 ewes, except that, similar to treatment of group-2 ewes, cmc was infused into the peritoneal cavity. All ewes were euthanatized and necropsied 12 to 14 days after surgery. Abdominal adhesions were evaluated, and an adhesion severity score was assigned to each ewe on the basis of number and severity of the adhesions. Ewes of all groups had abdominal adhesions. Significantly (P < 0.05) lower adhesion score was observed in ewes given cmc (groups 2 and 4) than in the adhesion model (group 3). Significant difference was not observed in adhesion score when groups 1, 2, or 4 were compared. Though not statistically significant, fewer adhesions were observed in ewes of groups 2 and 4 than in group-1 ewes.

Cryptorchidism and monorchism in cats: 25 cases (1980-1989)

Summary Of 1,345 cats admitted for orchiectomy during a 10-year period, 23 (1.7%) were cryptorchid and 2(0.1%) were monorchid. Persian cats were overrepresented in the cryptorchid population (P = 0.01). Cats were more likely to be unilaterally than bilaterally cryptorchid (P = 0.01). A predisposition for location of undescended testes (abdominal vs inguinal or right vs left side) was not identified in unilateral cryptorchids. All bilateral cryptorchids had abdominally located testes. The most common surgical approaches used for orchiectomy of cryptorchid cats were a caudal ventral midline incision for inguinal testes and a caudal ventral midline celiotomy for abdominal testes.

Elective cesarean section in mares: Eight cases (1980-1989)

Summary From 1980 to 1989, 8 cesarean sections were performed on an elective basis in 5 mares. Four mares had partially obstructed pelvic canals; 2 of these mares had previously lost foals because of dystocia. Cervical adhesions that might obstruct passage of the fetus through the pelvic canal was suspected in the fifth mare. Cesarean section was performed prior to mares entering the first stage of labor. Readiness for birth was estimated by development of the mare's mammary gland and the presence of colostrum in the udder. A ventral midline celiotomy provided excellent exposure and healed without complications in all instances. Eight viable foals were produced. One foal developed bacterial pneumonia and septicemia after surgery and died. Follow-up evaluation of the 7 foals discharged from the hospital failed to reveal complications associated with elective cesarean section. All mares survived the procedure. Fetal membranes were retained for up to 72 hours following surgery; however, systemic complications secondary to retained placenta did not develop. Three mares were bred subsequent to elective cesarean sections, with each mare conceiving the year following surgery. Three foals were produced by 1 mare and 2 foals have been produced by another mare by elective cesarean sections.

Cesarean Section in 19 Mares Results and Postoperative Fertility

The case records of 19 mares undergoing caudal ventral midline celiotomy for cesarean section were reviewed. Surgical exposure to the uterus was good, and the incisions healed by first intention in surviving mares. Seventeen mares (89%) survived to time of hospital discharge. Six foals (32%) were delivered alive, of which three were euthanatized because of severe deformity (1 died on day 6 and 2 survived to time of discharge). The most frequent postoperative complications were abdominal pain (13 mares), anemia (10 mares), and retained placenta (6 mares). Sixteen mares were bred during at least one season after the cesarean section and eight (50%) produced at least one foal. The collective foaling rate for these mares, bred a total of 25 seasons, was 36%. Only one mare bred during the same year as the surgery produced a live foal. The collective foaling rate for mares bred after the year of the surgery was 50%.

Incisional Hernias in the Horse Incidence and Predisposing Factors

Medical records of 210 horses that survived ventral midline celiotomy for at least 4 months were examined and owners were queried to determine factors contributing to incisional hernia formation. The incidence rate of incisional hernias within 4 months was 16%. Factors significantly associated with occurrence of incisional hernias were incisional drainage, closure of the linea alba with chromic gut suture material, previous midline celiotomy, excessive incisional edema, castrated male sex, postoperative leukopenia, and postoperative pain (colic). Factors not significantly associated with occurrence of incisional hernias were suture pattern used for linea alba closure, concurrent enterotomy or intestinal resection, postoperative bandage or stent, postoperative fever, hypoproteinemia, diarrhea, respiratory disease (coughing), and peritonitis. Hernias developed in horses within 12 weeks of surgery, with the earliest hernia recognized at week 2. Of 30 horses for which information was available, only one hernia developed in 24 (80%) and two or more hernias developed in 6 (20%) along the incision. Multiple hernias tended to be smaller than single hernias.

Surgical Diseases of the Equine Cecum

Cecal impaction and cecal perforation, the two most common equine cecal diseases, are thought to develop after slowing or interruption of a single progressive motility pattern, which begins in a pacemaker area near the apex, occurs once every 3 minutes, and propels ingesta from the cecum to the right ventral colon. Rectal examination in horses with cecal impaction is the most useful technique to grade the severity of the condition. Medical treatment is undertaken if the impaction is judged to be mild to moderate. Surgical correction of cecal impaction in severe cases requires a ventral midline celiotomy, and exploration reveals a large ingesta-filled cecum and relatively empty large colon. Currently, the techniques of typhlotomy with manual evacuation of ingesta, combined with a complete bypass of the cecum by use of a jejunocolostomy, is the preferred method of surgical management. The use of a cecocolic anastomosis remains a viable alternative surgical procedure. Cecal perforation (CP), a uniformly fatal disease of horses, most often develops when the subtle signs of cecal impaction are missed or are masked by the administration of nonsteroidal antiinflammatory agents. CP can occur in mares around the time of foaling and, in this form, is not associated with cecal outflow dysfunction. Surgical management of cecocecal or cecocolic intussusception is required and involves resection of the diseased portion of cecum, either with extra- or intraluminal techniques. Both the side-to-side and end-to-side jejunocecal anastomoses are useful and successful techniques for bypass of simple or strangulating lesions of the ileum.

Hepaticojejunostomy for Treatment of Common Hepatic Duct Obstructions Associated with Duodenal Stenosis in Two Foals

Two female Standardbred foals 2 and 3 months of age were presented with signs of gastroduodenal obstruction that was confirmed with contrast radiography and exploratory surgery. Ventral midline celiotomy was performed, showing stenosis of the duodenum proximal and distal to the hepatopancreatic ampulla. The common hepatic duct, the pancreatic duct, and the sigmoid section of the duodenum proximal to the stenosis were greatly dilated. To bypass the intestinal obstruction, a side-to-side duodenojejunostomy was performed. Obstruction of the common hepatic duct was relieved by side-to-side hepaticojejunostomy. In addition, jejunojejunostomy was performed distal to the other anastomoses. Both foals recovered. On admission, the foals' total bilirubin, aspartate aminotransferase, and gamma glutamyl transferase levels were greatly elevated. During the subsequent 6 to 8 months, they returned to normal. Six months after the first surgery, one foal was readmitted with an acute abdominal crisis. At surgery, there was greater than 360 degrees clockwise rotation of the mesenteric root involving most of the jejunum. At necropsy, the previously created stomas were patent. The liver and bile duct were grossly and histologically normal. The second foal continues to progress normally 12 months after surgery.

A TECHNIQUE FOR DIRECT LYMPHANGIOGRAPHY OF THE THORACIC DUCT SYSTEM IN THE CAT

The thoracic duct system is often evaluated radiographically in animals with chylothorax. Mesenteric lymphangio‐graphy has improved contrast studies of the thoracic duct system. A technique for identifying intestinal lymphatic trunks for cannulation to perform mesenteric lymphangiography was evaluated in five cats. Evans blue solution was injected into the right colic lymph node of each cat following ventral midline celiotomy, and the flow of dye was used to identify the intestinal lymphatic ducts for cannulation. Following catheter placement, mesenteric lymphangiograms were performed on each cat and the radiographic appearance of the thoracic duct system compared with previously reported anatomic descriptions in the cat. The technique provided rapid visualization of intestinal lymphatic trunks for cannulation. The radiographic appearance of the thoracic duct system varied considerably between cats and previous anatomic descriptions. A mild inflammatory reaction to injection of lymph nodes with Evans blue dye was observed 4 weeks later.

Transdiaphragmatic approach to thoracic duct ligation in the cat.

An approach combining ventral midline celiotomy with transdiaphragmatic thoracotomy was evaluated in eight healthy cats for ligation of the thoracic duct system. Evans Blue solution was injected into the right colic lymph node to outline the intestinal lymphatic trunk and the thoracic duct system. Three cats (group 1) had mesenteric lymphangiograms and three (group 2) had only lymph node dye injection before thoracic duct ligation. The thoracic duct system was ligated with hemostatic clips just cranial to the aortic hiatus of the diaphragm, through a left transdiaphragmatic thoracotomy. Two cats (group 3) had prethoracotomy mesenteric lymphangiograms and thoracic duct isolation without ligation. Mesenteric lymphangiography was performed immediately after the surgery. In all of the cats, an absence of contrast medium in the thoracic duct system cranial to the surgical site was interpreted as complete obstruction. Four weeks after ligation, there was complete obstruction of the thoracic duct system with alternate lymphaticovenous communications in four of the six cats with ligated thoracic duct systems. Partial obstruction of the thoracic duct system with alternate lymphaticovenous communications was present in the other two cats. Both cats without thoracic duct ligation had patent thoracic duct systems. At necropsy of the six cats with ligated thoracic ducts, there was mild focal lymphadenitis of injected lymph nodes in three cats. The wall of the aorta adjacent to the hemostatic clips was normal in all six cats. The surgical technique was simple and provided excellent exposure. Vital staining with Evans Blue helped visualize the thoracic duct system, but mesenteric lymphangiography did not. Postligation lymphangiography was not of value in identifying incomplete ligation.

Ileocolostomy. A technique for surgical management of equine cecal impaction.

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.

Transdiaphragmatic Approach for Permanent Cardiac Pacemaker Implantation in Dogs

An approach combining ventral midline celiotomy with transdiaphragmatic thoracotomy for permanent electronic cardiac pacemaker implantation was evaluated in seven dogs with bradycardia. Dogs ranged in body weight from 6.7 to 32 kg, with a mean of 22.2 ± 11.1 kg. Body conformation varied from narrow, deep‐chested animals to very broad‐chested animals. The new approach was used with equal facility in all of these dogs. Thoracocentesis was performed intraoperatively after diaphragmatic closure. No dogs required postoperative thoracocentesis or tube thoracostomy. All seven dogs survived the surgical procedure. Two dogs required three subsequent operations by the new approach for correction of exit block or faulty pulse generators. No problems were encountered during these reoperations, which occurred 2 days, 1 month, and 5 months, respectively, following the previous surgery. No serious complications attributable to the surgical approach were seen in any of the dogs, with follow‐up times ranging from 6 hours to greater than 12 months (five dogs still alive). The transdiaphragmatic approach is a rapid, cosmetic, and subjectively less painful means for permanent pacemaker implantation in dogs.

Two Methods for the Treatment of Ureterolithiasis in a Mare

Ureteroliths were removed on two occasions from a mare by different techniques. A 3 cm calculus was removed by right ureterolithectomy during a ventral midline celiotomy. Blood urea nitrogen (BUN) and serum creatinine were measured monthly and remained within normal limits for 5 months. During the fifth postoperative month, after 9 days of lumbar pain, the mare was represented with an increased BUN and creatinine and a ureterolith in the left ureter. Using a Dormia basket stone dislodger, the second ureterolith was removed through a vestibulourethral approach. Fourteen days after surgery, the BUN and creatinine had returned to normal limits and the mare remained asymptomatic for 3 months. The mare then developed severe laminitis after 2 days of strenuous exercise and was euthanized. At necropsy, both kidneys contained multiple calculi.