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This Concept Map, created with IHMC CmapTools, has information related to: Exploratory Laparotomy, Repeat the procedure with the needle on the caudal end of the suture note that Avoid crossing sutures or perforating other viscera, Procedure Exploratory Laparotomy Equipment, Procedure Exploratory Laparotomy Relevant Anatomy (Mouse Over), Place a simple continous suture line(8-12cm) through the seromuscular layers of the parietal surface of the abomasum, 5-7cm from the attachement of the greater omentum note that 1-2meters of monofilament nonabsorbable suture should extend from each end of the suture line, Place a simple continous suture line(8-12cm) through the seromuscular layers of the parietal surface of the abomasum, 5-7cm from the attachement of the greater omentum note that Hemostats should be placed on the suture ends to easily identify the cranial and caudal ends, Manually push the abomasum to the ventral body wall (normal position). When the sutured area of the abomasum is lying against the floor of the abdomen the assistant should tie the suture ends together note that The retention suture should be tied with appropriate tension. The surgeon should be able to have one finger snuggly between the abomasum and body wall when tied. If the suture is too loose intestines can be entrapped. Too tight suture may lead to tearing of the suture out of the abomasum, Make a 20-25cm skin incision in the left paralumbar fossa 8cm caudal and parallel to the last rib and 8cm ventral to the transverse processes of the lumbar vertebrae note that The greater curvature of the abomasum should be visible through the incision and the rumen should be displaced medially, Make a 20-25cm skin incision in the left paralumbar fossa 8cm caudal and parallel to the last rib and 8cm ventral to the transverse processes of the lumbar vertebrae note that The incision should be extended more ventrally if the surgeon is appendicularly limited in a large cow, Place a simple continous suture line(8-12cm) through the seromuscular layers of the parietal surface of the abomasum, 5-7cm from the attachement of the greater omentum Step 3 Attach the cranial end of the suture to a large, straight cutting needle Carry this needle along the internal body wall 3-4cm to the right of the midline and 4-5cm caudal to the sternum, Repeat the procedure with the needle on the caudal end of the suture Step 6 The assistant should then grasp the two suture ends with a hemostat and apply gentle traction. At the same time the surgeon can decompress the gas from the abomasum with a 10-14 gauge needle with attached tubing, Manually push the abomasum to the ventral body wall (normal position). When the sutured area of the abomasum is lying against the floor of the abdomen the assistant should tie the suture ends together Step 8 Close the incision routinely, Close the incision routinely This is done in 3 layers Layer 1 Suture of the peritoneum and transverse and internal oblique abdominal muscles using a simple continous pattern, Attach the cranial end of the suture to a large, straight cutting needle Carry this needle along the internal body wall 3-4cm to the right of the midline and 4-5cm caudal to the sternum note that An assistant can apply upward pressure on the abdominal wall in the area where the needles are to be inserted through the body wall (empty syringe case can be used), Close the incision routinely This is done in 3 layers Layer 3 Suture the skin using a continous interlocking pattern, Insert the needle quickly through the ventral body wall An assistant should grasp the needle with a hemostat and the caudal suture pulled through the ventral body wall 8-12cm caudal to the cranial suture Step 5 Repeat the procedure with the needle on the caudal end of the suture, The assistant should then grasp the two suture ends with a hemostat and apply gentle traction. At the same time the surgeon can decompress the gas from the abomasum with a 10-14 gauge needle with attached tubing Step 7 Manually push the abomasum to the ventral body wall (normal position). When the sutured area of the abomasum is lying against the floor of the abdomen the assistant should tie the suture ends together, Attach the cranial end of the suture to a large, straight cutting needle Carry this needle along the internal body wall 3-4cm to the right of the midline and 4-5cm caudal to the sternum note that The forefinger should be used to protect the end of the needle Use the lateral fingers to reflect the viscera away from the wall and ahead of the needle, Make a 20-25cm skin incision in the left paralumbar fossa 8cm caudal and parallel to the last rib and 8cm ventral to the transverse processes of the lumbar vertebrae Step 2 Place a simple continous suture line(8-12cm) through the seromuscular layers of the parietal surface of the abomasum, 5-7cm from the attachement of the greater omentum, Attach the cranial end of the suture to a large, straight cutting needle Carry this needle along the internal body wall 3-4cm to the right of the midline and 4-5cm caudal to the sternum Step 4 Insert the needle quickly through the ventral body wall An assistant should grasp the needle with a hemostat and the caudal suture pulled through the ventral body wall 8-12cm caudal to the cranial suture, Close the incision routinely This is done in 3 layers Layer 2 Suture of the subcutaneous tissue and external oblique abdominal muscle using a simple continuous pattern