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Exploratory Laparotomy

What is an Exploratory Laparotomy?

The exploratory laparotomy, often referred to as the Ex Lap, is a diagnostic tool. The surgery is performed when the diagnostic tests readily available to a practitioner do not provide an explanation for the patient’s abdominal clinical signs. The ex lap can help you get answers and solve a problem.

Situational Awareness

The Ex Lap can be both lifesaving and money sparing when used appropriately and timely. The difficulty associated with this surgery is the level of associated uncertainty. Some questions you may be asking yourself are:
  1. Will I find the foreign body (FB)? What if I don’t?  
  2. What if I find a tumour?  What if I don’t? 
  3. Will the problem be beyond my skill level?
The key is for you and your client to be prepared, clearly there is no possible way to be prepared to surgically manage every possible scenario, but you can prepare for how you will handle different types of situations. You will either come out of the ex lap with the FB, with the diagnostic biopsies, maybe with pictures, samples and recommendation for referral or maybe a recommendation for euthanasia, but you will have an answer and a plan. You, your patient and your client will no longer be stuck in the ‘not knowing’.


Get ready to perform an Ex Lap

All the information you need. Fully narrated surgical videos. In depth guide and more.
Pre-Surgical Considerations
  • Indications for performing an Ex Lap:

    • Suspected FB that can not be confirmed with available diagnostic tools.
    • Scope of injuries need to be determined (and treated) after abdominal trauma has been sustained.
    • Unresolvable GI/abdominal issues (chronic diarrhea/vomiting) with symptomatic treatment.
    • Advanced diagnostic tests not available in a timely fashion.
  • Pre-operative preparations:

    • Bloodwork (including electrolytes) and urinalysis to determine metabolic status of the patient.
    • Ensure the patient is hydrated and stable for general anesthesia
What the client needs to know:
  • This is a diagnostic tool
  • There is a good chance we will find something that we can solve
  • Biopsies will help us get to a diagnosis even if the problem is not grossly evident
  • The scope of the problem is beyond repair/ability – we will get biopsy and call to re-assess
  • The alternative is to get an ultrasound (timing, availability, costs)

Step by Step Ex lap

Liver Biopsy: Create a loop with the suture material (3-0 monofilament will work well). Ensnare the tip of a liver lobe with the suture loop.
Liver Biopsy: Pull the suture loop tight around the liver lobe tip, thereby strangulating the parenchyma and vessels. Cut the liver tissue leaving the suture material in situ. Place the liver sample in formalin.
Intestinal biopsy: With a #15 blade make a small incision (about 1cm long) along the mesenteric border of the loop of bowel.
Intestinal biopsy: Using Metzenbaum scissors excise a FULL thickness strip of tissue, about 1mm wide, along one edge of the incision. Place the sample in the formalin jar.
Intestinal biopsy: Close the biopsy site with a simple interrupted, full thickness, apposing (not crushing) pattern. I like to start the closure in the centre of the enterotomy and I use a 3-0 or 4-0 shorter acting monofilament suture material.
Intestinal biopsy: When the closure is complete, do a leak test before moving on.

Get ready to perform an Ex Lap

Preferred instrumentation:

Post-operative Considerations:

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Q & A

How long is the recovery from a cystotomy?

Most pets will recover quite quickly from this surgery, however, it is an abdominal surgery. The abdominal incision should be allowed to heal properly. This usually takes about 2 weeks.

What happens after a cystotomy?

The pet may have blood in its urine for a few days after surgery and he/she may feel the need to urinate frequently in the first 24-48 hours after surgery, even though the bladder is empty. Many will show no signs of having any urinary issues after the surgery. The appropriate diet will be recommended once the type of stone has been determined.