7. Once the whole of the intestinal tract has been checked and the foreign body has been located, the section of the intestine containing the foreign body can be separated from the other abdominal contents by placing laparotomy swabs around it, to reduce the risk of GI contents leaking into the abdomen.
8. The scrub nurse can use their fingers or Doyen clamps placed either side of the foreign body to minimise GI leakage.
9. If an enterotomy is performed, an incision is made into the intestine distal to the foreign body, which can then be milked out through the incision [ 2 ].
10. If an enterectomy is performed, incisions are made at either side of the devitalised tissue, with the foreign body in the middle.
11. Once the foreign body has been removed, the incision into the intestine is closed. This can be done using an absorbent monofilament suture with a simple continuous pattern [ 2 ]. If a section of the intestine has been removed, an end-to-end anastomosis can be performed with suture or a stapler such as the GIA stapler.
12. Once the incision has been closed or the end-to-end anastomosis has been performed, a leak test is sometimes performed using a small-gauge needle and a syringe of sterile saline [ 2 ].
13. If GI contents have leaked, warm sterile saline may be used to lavage the abdominal cavity.
14. Once the VS has confirmed the intestinal closure and all the foreign bodies have been removed, a swab, sharps and instruments count is performed before abdominal closure is started.
15. The scrubbed personnel should change their sterile gloves for a new pair and use clean instruments and swabs for closure, to prevent contamination of the abdomen with any GI contents.
16. The VS will close each layer of the abdomen, starting with the linea alba, with a strong, absorbable monofilament suture such as PDS( Ethicon).
17. The subcutaneous tissue and fat are closed with another absorbable monofilament suture, such as Monocryl( Ethicon), before closing the skin incision with either intradermal sutures, skin sutures or a skin stapler.
Conclusions
Overall, there are many ways in which VNs can assist the VS when an ex-lap needs to be performed. Their responsibilities, spanning preoperative preparation, intraoperative support, maintenance of asepsis and adherence to established safety protocols, directly influence surgical efficiency and patient outcomes. Learning and performing these skills enable VNs to contribute to the prevention of complications such as contamination, haemorrhage and postoperative infection.
As ex-laps are often high-risk emergency procedures, the combined efforts of the veterinary nursing team and VSs are essential to ensuring the success of the procedure and optimising patient recovery. Continuing professional development in surgical nursing practices is therefore fundamental to advancing standards of care within veterinary soft tissue surgery, ensuring that the best care is given to patients and providing good job satisfaction to the team members.
REFERENCES
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