Anatomy of the rectus sheath.

CELIOTOMY

GENERAL INFORMATION

• Always prepare surgical site so that extension of the incision is possible.
• Once committed to exploratory laparotomy, obtain samples of all abnormal tissue for histopathologic analysis.
• The linea alba is easiest to find near the umbilicus because that is where it is thickest.
• The holding layer of the abdominal wall is not muscle but rather the fascia.
• Incorporate fascia into the suture close to prevent dehiscence.
• Never use chromic gut in a continuous fashion in the linea alba.

 

MOST COMMON COMPLICATIONS AND DIFFICULTY

• Inadequate incision length, making the exploration difficult.
• Mistaking the preputial fascia for the linea alba when closing male dogs.
• Close with care if the patient is debilitated or has been on long term corticosteroid therapy. Healing may be delayed in these patients.

"EXPERTS' ADVICE"

• Consistently use a standardized approach to explore the abdomen by organ system or anatomic region (usually quadrants).
• An adequate exploratory CANNOT be performed through a small incision. Xyphoid to pubis is recommended for an appropriate exploratory.
• Don’t be blinded by the obvious. Examine the remainder of the abdominal cavity, even when an obvious lesion is noted.

 

Use a continuous suture to close the linea. Use a strong, monofilament absorbable suture to close the linea alba.


CELIOTOMY:
SUTURE AND NEEDLE OPTIONS

	Brand		Needle Type	Needle Reference
	Main Choice	Also Possible		Main Choice	Also Possible
LINEA ALBA	PDS* II	VICRYL* PLUS	Taper Point	CT-2, CT-1	RB-1, SH-1, SH
SUBCUTANEOUS	MONOCRYL* VICRYL* PLUS	PDS* II VICRYL*	Taper Point	RB-1, SH, CT-2, CT-1
SKIN CLOSURE	ETHILON* PROLENE*	Silk	Reverse Cut	FS-2, FS-1, FS	FSL, CP-2, CP-1, KS

	Cat/Small Dog (20 lbs or less)	Medium Dog (20-45 lbs or less)	Large Dogs (50 to 75 lbs)	Giant Dog (75 lbs +)
LINEA ALBA	3-0	3-0 or 2-0 or 0	2-0 or 0	0 or 1
SUBCUTANEOUS	4-0	4-0 or 3-0	3-0 or 2-0	2-0
SKIN CLOSURE	4-0	4-0 or 3-0 or 2-0	3-0 or 2-0	2-0

 

Use the suture selection tool for specific product code recommendations.