Align-ju STUDENT
Introduction
Laparotomy is defined as an incision through the flank and is sometimes used as a synonym for coeliotomy, a surgical incision into the abdominal cavity [ 1 ]. Coeliotomies or laparotomies are commonly performed in veterinary practice for a variety of reasons, such as neutering, prophylactic treatments such as gastropexy, therapeutic procedures such as enterotomy and diagnostic procedures for collecting tissue samples [ 1 ].
Exploratory laparotomies( ex-laps) are often emergency procedures, where the animal is either acutely or chronically unwell, which can increase the risk of intraoperative and postoperative complications. Therefore, consideration should be taken to stabilise the patient and diagnose the condition before surgery. For example, in cases of a gastrointestinal( GI) foreign body, a sound diagnosis is essential. This is often achieved with diagnostic imaging methods such as radiography and ultrasonography.
When performing an ex-lap for a GI foreign body, the veterinary surgeon( VS) makes a ventral midline incision from the xiphoid process to just cranial to the pubic symphysis [ 1 ]. Once the abdominal cavity is open, its contents can be examined for pathologies such as a foreign body. When the foreign body has been identified, it can be removed. Table 1 provides definitions of the terms used to describe the different surgical procedures that may be used in foreign body removal from the intestine or stomach.
Table 1. Definitions of surgical terms.
Term Enterotomy Enterectomy Gastrotomy Gastrectomy
Definition Incision into the intestine Removal of a part of the intestine Incision into the stomach Removal of part or all of the stomach
There are two surgical approaches depending on the condition of the GI tract: enterotomy and enterectomy( Table 2)( or gastrotomy and gastrectomy, in the case of foreign bodies in the stomach). For both techniques, the affected area is exteriorised where possible and isolated with swabs to prevent contamination of the abdominal cavity with GI contents.
An enterectomy may be performed instead of an enterotomy if part of the intestine is ischaemic or necrotic due to damage caused by the GI foreign body. If the foreign body is linear, multiple enterotomies may be needed to remove it entirely. Linear foreign bodies are also often adhered to the intestinal wall proximally, and the peristalsis of the intestines can cause the intestinal loops to bunch up around the foreign body, leading to multiple GI perforations [ 2 ]. If left untreated, this can lead to septic peritonitis, which can make treatment very difficult.
Table 2. Comparison of enterotomy and enterectomy. GI, gastrointestinal.
Enterotomy
Bowel clamps, for example, Doyen clamps, or an assistant can be used to hold the intestine on either side of the foreign body and prevent leakage of GI contents [ 2 ]
An incision is made through the intestinal wall, distal to the foreign body
The foreign body can then be‘ milked’ out through the incision
Veterinary nurses( VNs) play an essential role in the surgical management of patients that require an ex-lap for a GI foreign body. They prepare the patient for surgery by clipping and cleaning the surgical site, act as the circulating nurse by preparing the theatre and equipment, monitoring consumables and blood loss, or act as the scrub nurse. In this latter role, they can assist the VS, monitor swab counts, and keep the surgical instruments clean and organised on the kit trolley.
Preparing the patient
Enterectomy
Forceps can be used on either side of the foreign body to hold the intestine [ 2 ]
The damaged part of the intestine is resected
The two ends are then anastomosed with suture or a GI stapler [ 2 ]
Preparing the patient for surgery is the first step in any surgical procedure. This involves removing the hair over and around the incision site and cleaning the skin with a suitable solution to create an aseptic area. Creating an aseptic area with minimal contaminants before surgery is essential to reduce the risk of surgical site infections( SSIs).
Two categories of contaminants should be considered when preparing a patient for surgery.
• Endogenous bacteria come from the patient, and are also called the resident flora [ 3 ]. They are usually found residing on the patient ' s skin and have functions that help to protect the patient. These bacteria cannot be entirely removed during surgical preparation, meaning they can cause wound contamination leading to an SSI.
• Exogenous bacteria come from the environment and are also called transient flora [ 3 ]. They are not normally found on the skin and are removed during the patient ' s surgical preparation.
Volume 41( 5) • October 2026
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