TECHNIQUE

Laparotomy in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description
Preparation
  • Anaesthetise the rabbit. See: Treatment and Care - Anaesthesia and Chemical Restraint - Lagomorph Anaesthesia
  • Clip and scrub from the xiphoid process of the sternum to the pubis, and extending laterally to a few centimetres lateral to the nipples (from the inguinal to midthoracic area) for laparotomy. (B601.17.w17, B602.22.w22)
Incision
  • Make a midline incision through the skin from just caudal to the xiphoid down to the pubis (or from the umbilicus to the pubis). (B601.17.w17, J29.16.w3)
    • A shorter incision is preferable. (V.w140)
  • Incise the thin subcutaneous tissue to expose the linea alba. (B601.17.w17)
  • Isolate the linea alba and use fine toothed thumb forceps to tent it away from the abdominal viscera. (B601.17.w17)
  • Using an inverted number 10 or number 15 scalpel blade (cutting edge of the blade directed upwards), make a stab incision through the linea alba, parallel to the linea alba. (B601.17.w17)
    • Care is required to avoid damaging the caecum, which has a thin wall, is usually distended with ingesta, and lies directly under the abdominal wall. (B601.17.w17)
    • Or use Metzenbaum scissors to enter through the linea alba. (B534.43.w43f)
  • Place a small thumb forceps into the abdomen and directed parallel to the linea alba; use this to lift the linea alba away from the underlying viscera. (B601.17.w17)
  • Using a scalpel, cut cranially and caudally along the linea alba between the jaws of the forceps.(B601.17.w17)
    • Or use blunt-topped fine tissue cutting scissors, with one blade inserted into the abdomen parallel to the linea alba and used to lift the abdominal wall away from the viscera while cutting cranially and caudally. (B601.17.w17)
Exploration
  • Place moistened laparotomy sponges or moistened gauze squares along both edges of the incision, between the body wall and the viscera, along the whole length of the incision and covering the edges. (B601.17.w17)
  • Place a Lonestar Veterinary Retractor or small Balfour retractor to provide increased exposure to the abdomen. (B601.17.w17)
  • For exploration, start with non-gastro-intestinal tract (GIT) structures, before exploring the GIT from the abdominal oesophagus through to the descending colon. (B601.17.w17)
  • Note: handling of the viscera in general and the gastro-intestinal tract in particular should be minimized. As handling of the viscera increases the risk of post-operative ileus and post-operative adhesions increases. Gentle handling of tissues is essential. (V.w140)
Closure
  • Close the linea alba in a simple continuous or interrupted pattern. (B601.17.w17, B534.43.w43f))
    • Use a synthetic monofilament absorbable suture material. (B601.17.w17)
    • Make sure to bring the cut peritoneal surfaces into apposition, to re-establish continuity of the non-adherent peritoneal surface; this minimises the risk of adhesions developing between the muscle-fascia layer and any abdominal organs. (B534.43.w43f)
    • Visualisation can be improved and time reduced if the muscle-fascia layer is elevated by use of a towel clamp at each end of the incision. This also reduces the risk of accidental suturing of underlying organs to the muscle-fascia layer, and assists in ensuring that the two edges of the peritoneum are brought into apposition with each suture. (B534.43.w43f)
    • Check the suture line by gently probing between sutures with closed Brown-Adison thumb forceps; if the forceps can enter the abdomen easily, an extra suture is needed at this potential herniation point. (B534.43.w43f)
  • If there is enough subcutaneous tissue available, close this in a simple continuous suture pattern. (B601.17.w17)
    • Use a synthetic absorbable suture material, monofilament or braided. (B601.17.w17)
    • Braided material is easier to handle but has more drag, so causes more tissue damage, and may allow bacterial growth. (B601.17.w17)
  • Close the skin using a simple continuous subcuticular suture. (B601.17.w17, (B534.43.w43f))
    • Use a synthetic monofilament absorbable suture material. (B601.17.w17)
  • OR use surgical staples. (B534.43.w43f)
Appropriate Use (?)
  • Exploratory laparotomy is suitable for use when physical examination and non-surgical exploration (e.g. radiographic and ultrasonographic imaging) have failed to produce a diagnosis.
  • The general laparotomy described above is suitable for access to any part of the abdominal viscera.
Notes
  • Gentle handling of tissues is essential. (V.w140)
Complications/ Limitations / Risk
  • The caecum has a thin wall, is usually distended with ingesta, and lies directly under the abdominal wall. Considerable care is needed to ensure this is not damaged when the linea alba is incised. (B601.17.w17)
  • NOTE: handling of the viscera in general and the gastro-intestinal tract in particular should be minimized. As handling of the viscera increases the risk of post-operative ileus and post-operative adhesions increases. Gentle handling of tissues is essential. (V.w140)
Equipment / Chemicals required and Suppliers
  • Standard anaesthetic equipment for rabbits.

  • Surgical kit suitable for rabbits, including:

    • Laparotomy sponges or gauze squares.

    • Lonestar Veterinary Retractor or small Balfour retractor .

  • Suture materials.

    • Synthetic monofilament absorbable suture material. (B601.17.w17)

    • Surgical staples if preferred for skin closure. (B534.43.w43f)

Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience; this would usually be someone with a veterinary degree.
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Frances Harcourt-Brown BVSc FRCVS (V.w140)
References B534.43.w43f, B601.17.w17, B602.22.w22, J15.30.w1, J29.16.w3, V.w140

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