Ventral Midline Laparotomy Research Articles

Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications.

Although rarely fatal, complications of ventral midline laparotomy incision in equine patients increase hospitalization cost and duration and may jeopardize return to athletic function. Therefore, many techniques have been developed to reduce their occurrence and expedite their resolution when they occur. Our technique of celiotomy incision closure includes the use of tension sutures (vertical U mattress) of polyglactin 910 on the linea alba, which is then apposed by polyglactin 910 interrupted sutures or a simple continuous pattern suture with a stop midway before routine closure of the superficial layers. The celiotomy incision is protected by an elastic bandage during the immediate postoperative period. This technique has been associated with favorable results: 5.3% confirmed incisional infections after a single celiotomy and 26.7% after repeat celiotomy. The overall incisional complication (serous/sanguineous discharge, hematoma, infection, hernia formation, and complete wound breakdown) occurrence was 9.5% and 33.3% after single and repeat laparotomy, respectively. In cases considered more susceptible to infection (early relaparotomy or laparotomy incisions longer than 30 cm), negative pressure therapy was found easy to apply on closed incisions. No detrimental effects were observed. However, the potential prophylactic benefit of this therapy needs to be confirmed in a larger group. In infected laparotomy wounds requiring drainage, the use of negative pressure therapy seemed to have a positive effect on the formation of granulation tissue. However, there was no control group to allow statistical confirmation. Finally, one case of complete breakdown of the laparotomy incision was managed by stainless steel retention sutures, the application of negative pressure therapy, and a hernia belt. At re-evaluation 15 months post-surgery, several small hernias were detected, but the horse had returned to his previous level of sports performance and had not shown any episode of colic.

Efficacy of Supplemental Diet Gels for Preventing Postoperative Weight Loss in Mice ( Mus musculus).

This study investigated whether the use of commercially available diet gels prevented the postoperative weight loss associated with major survival surgery in mice. C57BL/6 mice were divided into 3 groups ( n = 9 per group) that received moistened chow pellets alone or with one of 2 commercially available diet gels. Mice began receiving the test diets 3 d before surgery (baseline) and were weighed daily for 7 d after surgery. On day 0, mice underwent ventral midline laparotomy, during which the intestines were manipulated for 2 min and a segment of jejunum was briefly clamped. Compared with the baseline value for the same group, body weights for the mice that received moistened chow only were significantly lower on all postoperative days (days 1 through 7). In contrast, body weights of mice that received both moistened chow and diet gel differed from baseline only on days 2 and 3 for one product and were never different from baseline for the other product. This study indicates that the combination of diet gel and moistened chow prevented or mitigated postoperative weight loss after a laparotomy procedure in mice.

Diagnosis, treatment and outcome of metallic foreign body ingestion in two new world camelids

AbstractA 14‐year‐old alpaca and a 3‐year‐old llama presented independently with vague symptoms of abdominal discomfort. Bloodwork was unremarkable in the alpaca, but showed signs of sepsis in the llama, and abdominal ultrasonography was normal in both animals. Abdominal radiography revealed a metallic gastrointestinal foreign body in both cases. Ventral midline laparotomy was performed, and the foreign bodies were retrieved from the C3 compartment in the alpaca and from the proximal duodenum in the llama. Both camelids received broad‐spectrum antimicrobial drugs, non‐steroidal anti‐inflammatory drugs and supportive care. The alpaca and llama were discharged from the hospital 16 and 8 days after surgery, respectively. The alpaca was euthansed due to recumbency of unknown aetiology 2 months later, while the llama was doing well 4 months after discharge. This report shows the usefulness of abdominal radiographs in camelids presenting with unspecific clinical signs and demonstrates that hardware disease should be considered as a differential diagnosis.

Osteoporosis Preclinical Research: A Systematic Review on Comparative Studies Using Ovariectomized Sheep.

Sheep ovariectomy (OVX) alone or associated to steroid therapy, deficient diet, or hypothalamic–pituitary disconnection has proven to be of critical importance for osteoporosis research in orthopedics. However, the impact of specific variables, such as breed, age, diet, time after OVX, and other variables, should be monitored. Thus, the design of comparative studies is mandatory to minimize the impact of these variables or to recognize the presence of unwanted variables as well as to better characterize bone remodeling in this model. Herein, we conducted a systematic review of the last 10 years on PubMed, Scopus, and Web of Knowledge considering only studies on OVX sheep where a control group was present. Of the 123 records screened, 18 studies were included and analyzed. Results showed that (i) Merino sheep are the most exploited breed; (ii) 5–6 years of age is the most used time for inducing OVX; (iii) ventral midline laparotomy is the most common approach to induce OVX; (iv) OVX associated to steroid therapy is the most widely used osteoporosis model; and (v) success of OVX was mostly verified 12 months after surgery. In detail, starting from 12 months after OVX a significant decline in bone mineral density and in microarchitectural bone parameters as well as in biochemical markers were detected in all studies in comparison to control groups. Bone alteration was also site-specific on a pattern as follows: lumbar vertebra, femoral neck, and ribs. Before 12 months from OVX and starting from 3–5 months, microarchitectural bone changes and biochemical marker alterations were present when osteoporosis was induced by OVX associated to steroid therapy. In conclusion, OVX in sheep influence bone metabolism causing pronounced systemic bone loss and structural deterioration comparable to the situation found in osteoporosis patients. Data for treating osteoporosis patients are based not only on good planning and study design but also on a correct animal use that, as suggested by 3Rs principles and by ARRIVE guidelines, includes the use of control groups to be directly contrasted with the experimental group.

Surgical management of ileocolic intussusception in two dogs

Background: Intussusception is the invagination or telescoping of one part of the bowel into an adjacent part which causes bowel obstruction, and compromises blood flow to the affected portion. It can occur anywhere along the gastrointestinal tract; however, usually occurs in the middle portion of the small intestine or where the small intestine joins the large intestine. Although ileocolic intussusception is common in dogs, its proper surgical management is urgent to save the life of the animal. Methods: Two mixed-breed dogs of5-7 months old and 12-14 kg BW were presented with hemorrhagic and protruded mass of bowel through anus. Clinical examination revealed intussusception with severe dehydration in the dogs, and there after ventral midline laparotomy was performed in both dogs which exposed and confirmed the cases as ileocolic intussusceptions. Results: The laparotomy was successful in both cases which involved certain level of intestinal resection and anastomosis. Postoperatively, the dogs were provided with adequate feed and necessary drugs; and successfully improved after 14 days of operation. Conclusion: Ileocolic intussusception in dogs can be successfully treated by urgent laparotomy with intestinal resection and anastomosis, which resumes the adequate potency and vitality of the bowel segments.

Standing flank laparotomy for colic: 37 cases.

Standing flank laparotomy can be an alternative to ventral midline laparotomy in horses with colic. Standing flank laparotomy avoids general anaesthesia, provides excellent access to some regions of the abdominopelvic cavity and costs less than ventral midline laparotomy. To report a series of cases of peritoneal and intestinal diseases other than SC diseases managed with standing flank laparotomy. Retrospective case series. Records from equids with colic subjected to standing flank laparotomy at five hospitals (2003-2020) were reviewed. Descriptive data analysis was performed. Thirty horses (sixteen survived to discharge), six ponies (four survived) and one donkey (euthanised) were subjected to standing flank laparotomy via the left flank (n=31), right flank (n=2) or both flanks (n=4). The primary disease affected the peritoneum (0/5 survived), SI (5/9 survived) and caecum and/or LC (15/23 survived). Enterotomy was performed in four animals (all survived). Partial typhlectomy was performed in one horse (euthanised). Resection-anastomosis of the SI or LC was performed in three animals (one survived). Three animals had intraoperative complications that negatively affected the outcome: Two ponies had intolerance to abdominopelvic exploration; one mare had spontaneous exteriorisation of a long segment of the SI leading to a large tear in the mesentery. In seven cases, severe/extensive lesions found during standing flank laparotomy warranted immediate euthanasia. The survival rate was 54%. All owners were satisfied with the decision to perform standing flank laparotomy. The retrospective design, lack of a control group, small number of cases and lack of standardised protocols between hospitals. Although ventral midline laparotomy is the standard of care for horses with colic, standing flank laparotomy is a viable approach for some types of colic. Systemic administration of analgesics may not produce sufficient peritoneal analgesia, which can lead to intolerance to abdominopelvic exploration during standing flank laparotomy in horses with colic and may negatively affect the outcome.

Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study.

Incisional complications are a common cause of morbidity following laparotomy. Although uncommon, acute abdominal dehiscence (AAD) is a potentially fatal post-operative complication. However, few AAD cases are described in the literature. To describe common features of cases of AAD following ventral midline laparotomy, management and outcomes. Retrospective case series. Hospital records of horses that underwent a ventral midline laparotomy at nine hospitals in the UK, Ireland and USA over a 10-year period (2009-2019) were reviewed. Data were collected for pre-, intra- and post-operative factors that were considered relevant. Descriptive statistical analysis was performed. A total of 63 cases of AAD were identified. AAD occurred due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line in 46 horses (73%). AAD occurred at a median of 5days (0.5-70days) post-operatively and broodmares accounted for 25% of the cases (n=16). Surgical site infection developed prior to AAD in 28 horses (44%); leakage of peritoneal fluid occurred in 5% of horses prior to AAD being identified. Surgical repair was performed in 27 horses (43%), 10 (16%) were treated conservatively and 26 (41%) were euthanised immediately. Repair was most frequently performed using suture (n=14), wire (n=5) or a combination (n=5). Overall survival to hospital discharge was 39% (24/63). Where surgical repair was performed, 15 horses (56%) survived to hospital discharge; 9 horses (90%) managed conservatively survived to hospital discharge. Follow-up was not performed for all cases following hospital discharge and some data were incompletely recorded in hospital files. Previously stated causative factors for AAD were not consistent features in the present study. Surgical site infection following laparotomy and pregnant or early post-partum mares may be important risk factors for AAD and warrant further investigation.

Linea alba dehiscence following ventral midline laparotomy in horses

Linea alba dehiscence following ventral midline laparotomy in horses

Non‐surgical manual reduction of indirect inguinal hernias in 89 adult stallions

SummaryBackgroundIndirect inguinal hernia (IIH) is the most commonly reported acquired hernia in adult horses. Outcomes following surgical intervention comprising of immediate ventral midline laparotomy (IVML) and simultaneous castration are well known. The outcome following reduction of IIH utilising a noninvasive manual reduction (MR) technique in a large number of horses has not been previously reported.ObjectivesTo describe a nonsurgical MR technique developed by the authors and to report our long‐term experiences and clinical outcome.Study designRetrospective study.MethodsMedical records of 89 stallions presenting with IIH and treated with MR were reviewed. Extensive patient data was collected, with cases grouped based on outcome of the MR procedure and whether or not laparotomy was performed. Data on short‐ and long‐term outcome was obtained.ResultsManual reduction was successful in 80 of 89 (90%) horses. Fifty of 89 (56%) horses were treated with MR only and without exploratory laparotomy. In total 29 of 89 (33%) horses underwent IVML and 10 of 89 (11%) delayed ventral midline laparotomy (DVML). Resections were performed in 6 of 89 (8%) horses. Concurrent small intestinal volvulus was diagnosed in 8 of 89 (9%) horses. Horses undergoing DVML following a successful MR had the highest mortality rates during hospitalisation (4/10, 40%). Short‐term survival was 92% (82/89). Ipsilateral reoccurrence of IIH post‐hospital discharge was recorded in 7 of 47 (15%) horses. Overall long‐term survival with a median of 12 years was 72% (34/47).Main limitationsThese include the retrospective nature of data collection, lack of standardised pre‐ and post‐MR clinical assessments and a biased Warmblood population.ConclusionsManual reduction appears to be a feasible nonsurgical technique to reduce IIH in adult Warmblood horses, with favourable survival rates. Individual case assessment is crucial, as delayed laparotomy may increase mortality rates. Suspicion of concurrent small intestinal volvulus or devitalised small intestine always warrants immediate laparotomy following MR.

Urolithiasis in a captive Siberian chipmunk (Eutamias sibiricus).

This clinical case describes struvite urolithiasis in a pet chipmunk. Physical examination revealed the presence of two ovoid palpable masses in the caudal part of the abdomen, which were later confirmed by radiography as urinary bladder stone. The animal underwent ventral midline laparotomy and uroliths were successfully removed. Uroliths analysis revealed the presence of struvite and bacteriology showed the presence of Proteus mirabilis. Little is known about aetiology and incidence of urolithiasis in chipmunks. Client education about husbandry, dietary needs, and animal behaviour is necessary, especially when dealing with less commonly kept exotic companion mammals. This is the first report of struvite urolithiasis in a pet chipmunk.

Single-Port Laparoscopic Treatment and Outcome of Dogs with Ovarian Remnant Syndrome: 13 Cases (2010-2018).

Ovarian remnant syndrome (ORS) is a condition resulting from incomplete removal of ovarian tissue during ovariectomy and/or ovariohysterectomy. Single-port laparoscopy (SPL) is an alternative to ventral midline laparotomy for treatment of ORS. Medical records of 13 client-owned female dogs who underwent SPL for the treatment of ORS were retrospectively reviewed to evaluate surgical technique and outcome. Dogs who had undergone a previous attempt at open ovariectomy or ovariohysterectomy were included. Major intraoperative complications did not occur and conversion to open laparotomy was not required. In 1 dog, an SPL + 1 technique was used, in which an additional port was placed cranial to the single-port device to aid in dissection and tissue manipulation. Median surgical time was 45 min (range, 30-90 min). Clinical signs related to estrus had resolved in 11 of 13 dogs with a median follow-up time of 18 mo. Two of 13 dogs were lost to follow-up at 3 mo postoperatively; however, signs of estrus had resolved at time of last follow-up. SPL treatment for ORS was feasible and successful in this cohort of dogs. Reduced surgical time was found in this study compared with previous reports investigating multiple-port laparoscopic treatment of ORS.

Standing flank laparotomy for the treatment of small colon impactions in 15 ponies and one horse

SummaryImpactions are the most common problem affecting the small colon in horses and are much more prevalent in ponies and miniature horses. Ventral midline laparotomy under general anaesthesia is the standard of care for this condition when medical management fails to resolve the impaction or when the impaction causes complete intraluminal obstruction and tympany. This case series reports the use of standing flank laparotomy (SFL) in 15 ponies with focal small colon impactions and one large breed horse with an elongated small colon impaction. All cases presented with signs of colic of 1–4 days' duration. The horses were initially vigorously treated with both enteral and parental fluids but failed to pass faeces, with no resolution of abdominal distention or pain. In all cases, a definitive diagnosis was made duringSFLand the small colon appeared to be viable. The impaction was resolved by extraluminal massage. In the horse and in one pony, in addition to extraluminal massage, high enema was administered during surgery. Routine perioperative treatment with fluids, analgesics, antimicrobials and wound care was provided. All animals survived to discharge. The time from surgical resolution of the impaction to passing faeces was less than 2 h in all but one case. Median duration of hospitalisation was 2 days and all animals returned to their original use by 2 months. The encouraging results of this case series suggest thatSFLis a viable alternative to ventral laparotomy for ponies and horses with either focalSCIor extensiveSCI.

Assessment of the analgesic potency of constant rate infusion of tramadol hydrochloride and as an adjunct to ketoprofen in laparotomized bitches

In this study, the analgesic potency of constant rate infusion of tramadol hydrochloride and as adjunct to ketoprofen on laparotomy-induced pain was evaluated. Dogs were randomly assigned to 4 groups (n=5). Groups 1, 2 and 3 received 0.5mg/kg/hr, 1.0mg/kg/hr and 2.0mg/kg/hr IV; CRI of tramadol hydrochloride respectively while group 4 which served as control received normal saline. Infusions were administered from 30 minutes before surgery and lasted for 105 minutes. All dogs underwent ventral midline laparotomy. Ketoprofen 50 mg/ml at the dose of 5mg/kg, SC was given at 1 hour post-surgery (hps) after pain assessment and on days 2 and 3 post-surgery (dps) to dogs in all the groups. Parameters determined were heart and respiratory rates, blood glucose level, pain score and body weight. Results showed that mean heart rate, respiratory rate and body weight were not differed significantly (p > 0.05) within and among the groups. Mean blood glucose level of group 4 was significantly higher (p < 0.05) than the other groups intra- and post-surgery. Mean blood glucose level of group 3 was significantly lower (p < 0.05) than that of group 1 at 1 hps. Group 4 dogs also had significantly higher mean blood glucose intra-surgery and at 1 hps than their baseline value. Group 4 dogs had significantly higher (p < 0.05) mean rank pain score than other dog groups on 0-3 dps while mean rank pain scores of groups 1 and 2 were significantly (p < 0.05) higher than that of group 3 on 0 dps. It was concluded that tramadol HCL at constant rate infusion doses of 0.5mg/kg, 1.0mg/kg/hr and 2.0mg/kg/hr were effective at managing laparotomy-induced pain up to one hour post-surgery. As an adjunct to ketoprofen, 2.0mg/kg/hr of tramadol hydrochloride offered better analgesia than the other doses studied during the post-surgical days. Keywords: Analgesia, Constant rate infusion, Ketoprofen, Laparotomy, Pain, Tramadol

Preoperative and intraoperative ultrasound aids removal of migrating plant material causing iliopsoas myositis via ventral midline laparotomy: a study of 22 dogs

BackgroundMigrating plant material is often suspected clinically to be the underlying cause of iliopsoas myositis in the dog, but cannot always be found pre- or intraoperatively. In most cases, recurrence of clinical signs is related to failure to remove the plant material. Preoperative ultrasonography can be useful to visualize migrating plant material and to determine anatomical landmarks that can assist in planning a surgical approach. The purpose of the present study was to report the role of intraoperative (intra-abdominal) ultrasonography for visualizing and removing the plant material from iliopsoas abscesses using a ventral midline laparotomy approach.ResultsA retrospective case series of 22 dogs with iliopsoas muscle abnormalities and suspected plant material was reported. Preoperative visualization and subsequent retrieval of the plant material was performed during a single hospitalization. In all 22 dogs, the plant material (including complete grass awns, grass awn fragments and a bramble twig) was successfully removed via ventral midline laparotomy in which intraoperative ultrasonography was used to direct the grasping forceps tips to the foreign body and guide its removal. In 11 of these 22 dogs, the plant material was not completely removed during prior surgery performed by the referring veterinarians without pre- or intraoperative ultrasonography. Clinical signs resolved in all dogs and all dogs resumed normal activity after successful surgical removal of the plant material.ConclusionIntraoperative ultrasonography is a safe and readily available tool that improves success of surgical removal of plant material within the iliopsoas abscesses via ventral midline laparotomy. Moreover, ultrasonographic findings of unusual plant material can be useful in planning and guiding surgical removal, by providing information about the size and shape of the foreign body.

Single‐port laparoscopic incisional hernia repair in a horse

SummaryA 16‐year‐old Italian Saddle Horse gelding was referred for treatment of an incisional hernia that developed 7 months after a ventral midline laparotomy for treatment of acute abdominal pain. Physical examination revealed a hernia approximately 20 cm long and 15 cm wide on the ventral aspect of the abdomen. Ultrasonography revealed the dimensions of the hernia ring to be approximately 15 cm in length and 10 cm in width. A single‐port laparoscopic incisional hernia repair using an operating 0° laparoscope was performed with an appropriately sized (24 × 18 cm) piece of mesh fixed in place with simple interrupted transabdominal sutures. At 4 weeks post operatively, follow‐up physical examination and ultrasonography confirmed healing of the surgical site with no evidence of hernia recurrence. The same evaluation was done 6 months post operatively, and the horse returned to its previous level of activity 8 months post operatively. In horses, laparoscopic application of mesh should be considered among the treatment options for incisional hernia. In the present case, this technique was performed with a single port using an operative laparoscope, in contrast to the multiportal techniques reported previously. The case presented here demonstrates that single‐port laparoscopic herniorrhaphy is feasible, and allows proper placement of an expanded polytetrafluoroethylene intraperitoneal mesh in horses

Use of micro-lightguide spectrophotometry for evaluation of microcirculation in the small and large intestines of horses without gastrointestinal disease.

To evaluate the use of a micro-lightguide tissue spectrophotometer for measurement of tissue oxygenation and blood flow in the small and large intestines of horses under anesthesia. 13 adult horses without gastrointestinal disease. Horses were anesthetized and placed in dorsal recumbency. Ventral midline laparotomy was performed. Intestinal segments were exteriorized to obtain measurements. Spectrophotometric measurements of tissue oxygenation and regional blood flow of the jejunum and pelvic flexure were obtained under various conditions that were considered to have a potential effect on measurement accuracy. In addition, arterial oxygen saturation at the measuring sites was determined by use of pulse oximetry. 12,791 single measurements of oxygen saturation, relative amount of hemoglobin, and blood flow were obtained. Errors occurred in 381 of 12,791 (2.98%) measurements. Most measurement errors occurred when surgical lights were directed at the measuring site; covering the probe with the surgeon's hand did not eliminate this error source. No measurement errors were observed when the probe was positioned on the intestinal wall with room light, at the mesenteric side, or between the mesenteric and antimesenteric side. Values for blood flow had higher variability, and this was most likely caused by motion artifacts of the intestines. The micro-lightguide spectrophotometry system was easy to use on the small and large intestines of horses and provided rapid evaluation of the microcirculation. Results indicated that measurements should be performed with room light only and intestinal motion should be minimized.

Left dorsal displacement of the large colon in the horse

SummaryLeft dorsal displacement of the large colon is a condition unique to the horse that results in an obstruction of the colon and signs of colic. This condition may be successfully treated medically with analgesia, i.v. or oral fluids and feed restriction, exercise with or without administration of phenylephrine, or rolling under general anaesthesia with or without administration of phenylephrine, or a combination of these conservative options. Surgical correction via standing left flank laparotomy or, more commonly, ventral midline laparotomy under general anaesthesia, is required in cases where conservative therapy is unsuccessful. Recurrence rates range from 3.2% to 21%. Surgical attempts to prevent recurrence of this condition include large colon resection, colopexy, and ablation of the nephrosplenic space.

The influence of suture pattern on the incidence of incisional drainage following exploratory laparotomy

Incisional complications following exploratory celiotomy increase morbidity, extend hospitalisation and increase cost. Retrospective studies seek to identify risk factors and measures for prevention of surgical site infection. The relatively high incidence of incisional complications following exploratory laparotomy necessitates identification of ideal surgical closure methods. The study sought to identify the incidence of incisional drainage within our hospital population, and to identify risk factors for incisional complications while determining surgical practices that reduce the incidence of incisional drainage. Retrospective cohort study. A retrospective study, with telephone follow-up, was performed on 199 horses that underwent exploratory laparotomy at the University of Georgia from 2 January 2008 to 31 December 2010, examining associations between case background, lesion type, access to the lumen of the bowel, and closure methods and incisional draining. The linea alba incisions were closed by the primary surgeon and junior house officers closed the subcutaneous tissues and skin. The incidence of purulent or persistent serosanguinous incisional drainage in 142 horses with complete follow-up information was 21.8%. Background, lesion type, and enterotomy or enterectomy were not associated with a significantly increased likelihood of incisional drainage. However, closure of the subcutaneous tissues and skin in a 2-layer, modified subcuticular pattern was associated with a significantly lower incidence of post operative incisional drainage. Follow-up information identified subsequent episodes of colic in 28.9% of horses. However, 80.3% of horses had returned to their previous level of work. Incisional drainage is common following ventral midline laparotomy. The use of a 2-layer, modified subcuticular closure was associated with a significant reduction in the incidence of incisional drainage compared with closure performed with skin sutures, but not closure performed with staples.

Criptorquidectomía laparoscópica en dos perros utilizando bisturí ultrasónico

RESUMENTradicionalmente, los perros con testículos retenidos abdominales son remitidos para orquiectomía a través de laparotomía media ventral o paraprepucial. Sin embargo, las técnicas mínimamente invasivas realizadas a través de equipos endoscópicos, son una alternativa excelente para efectuar el procedimiento, debido a las ventajas en la reducción del trauma tisular y un menor dolor posoperatorio, además de la reducción de complicaciones posquirúrgicas entre otras ventajas. A continuación se presentan dos casos de pacientes caninos criptórquidos intervenidos quirúrgicamente mediante laparoscopia, para la extracción de los testículos retenidos en las que además se utilizó un bisturí ultrasónico. En Colombia, el desarrollo de las técnicas endoscópicas en cirugía de pequeños animales aún se encuentra muy limitado, y probablemente esta sea la primera publicación en el país acerca del uso de laparoscopia en casos de orquiectomía en pacientes con testículos retenidos en la cavidad abdominal.

Puerperal development of ewes following dystocia: a retrospective analysis of two approaches to caesarean section

The objective of this study was to retrospectively analyse the puerperal development of ewes referred to a veterinary teaching hospital following caesarean section in comparison with assisted parturition. Laparotomy was performed either via left flank incision (group 1, n=86) or ventral mid-line approach (group 2, n=33). Both groups were compared with ewes following non-surgical intervention (group 3, n=73). The overall fetal death rate was 41 per cent. There was no significant difference in fetal deaths between groups 1 and 2, but assisted delivery led to a higher number of liveborn lambs compared with caesarean section (P<0.05). Seven ewes (3.6 per cent) died or were euthanased on welfare grounds during caesarean surgery, and the overall maternal mortality rate following dystocia in the postpartum period was 10.9 per cent. While there was no significant difference between groups 1 and 2 in the percentage of ewes developing healing disorders, the complications that occurred were more severe after the left flank approach (P=0.04), and the mean hospitalisation period was significantly longer in group 1 than in group 2 (P<0.05), leading to the conclusion that ventral mid-line laparotomy has some advantages over a left flank approach.