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Laparotomy: paramedian

ISSN 2398-2950

Contributor(s) :


Synonym(s): Celiotomy

Introduction

  • Access to caudal abdominal cavity (ventral midline more commonly used).

Uses

Disadvantages

  • Restricted access to contralateral organs.

Alternative techniques

Requirements

Materials required

Minimum equipment

Ideal equipment

  • Self-restraining retractor (Balfour or Gossett) Surgical instruments: self-retaining retractors - Balfour abdominal .

Preparation

Dietary preparation

  • Fast patient for 12 hours before to avoid reflux esophagitis Esophagitis.

Site preparation

  • Caudal ventral abdomen - lateral to midline (left or right according to exposure required).

Restraint

Technique

Approach

Step 1 - Position patient

  • Position in dorsal recumbency.

Step 2 - Incise skin

  • Incise through skin and subcutis parallel to midline.

Step 3 - Split muscles

  • Incise external rectus sheath and split rectus muscle (along fibers) .
  • Incise internal rectus sheath and peritoneum
    Carefully tent peritoneum to avoid damage to organs below.

Core procedure

  • Further surgery depends on core procedure.

Exit

Step 1 - Close muscle

  • Close internal rectus sheath with rectus muscle with simple continuous pattern Laparotomy: midline (simple interrupted if using chromic catgut ).
    Inclusion of peritoneum increases risk of adhesions.

Step 2 - Close external rectus sheath

  • Close external rectus sheath separately with simple continuous pattern (simple interrupted if using chromic catgut ).

Step 3 - Close skin and subcutis

  • Routine closure subcutaneous tissue and skin .

Aftercare

Immediate Aftercare

Analgesia

Antimicrobial therapy

  • Dependent upon core procedure.

Outcomes

Further Reading

Publications

Refereed papers