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Laparotomy refers to a procedure in which an incision is made under surgically sterile conditions, in order to gain access to the abdomen.
A laparotomy may be undertaken for a number of different reasons, including neutering female cats, to take biopsy samples from the organs, removing bladder stones, or as a means of inspecting the abdomen when there is a high suspicion of a problem that needs surgical correction, such as a foreign body stuck in the gut.
A laparotomy is a common procedure both in first opinion practice and at referral centers. In itself, laparotomy is not inherently dangerous however, by its very nature exploratory surgery is often undertaken on sick, high-risk patients.
Laparotomy is performed with the patient under full general anesthetic and under sterile surgical conditions. In the case of exploratory surgery or when the cat is already sick, careful attention is given to stabilizing the patient prior to anesthesia. This may involve blood tests, pain relief, intravenous antibiotics, and intravenous fluids.
The time taken to perform a laparotomy depends on the purpose of the procedure. For neutering, the surgical time is around 10 - 20 minutes, whilst complex exploratory surgery that requires bowel resection could take a couple of hours.
Once the patient is anesthetized, the belly is clipped, the cat positioned on their back on the operating table and the skin sterilized with surgical scrub. The surgeon scrubs and gowns, then uses a scalpel to make an incision into the abdomen. They then perform an organized inspection of each abdominal organ in turn to locate any issues. Biopsy samples are collected as necessary.
The surgeon then closes the abdomen in using three layers of stitches (the inner two rows are absorbable).
In many circumstances, laparotomy is essential to a successful outcome as it is the only way to gain sufficient surgical access for procedures such as neutering or foreign body removal.
In first opinion practice, laparotomy is used to aid diagnosis, when samples need to be collected. In a referral setting this can sometimes be avoided and the samples collected by ultrasound guided needle biopsies or by endoscopy. However, even these sophisticated techniques have drawbacks because of the small sample sizes collected, and full laparotomy may still be advised in order to get a large enough sample to be diagnostic.
This is a significant invasive procedure, only undertaken when the patient is likely to benefit. Surgeons do not undertake laparotomy lightly, and will have accrued evidence to suggest that the procedure is both necessary and the most likely route to a successful outcome. Indeed, there is a tipping point, beyond which postponing laparotomy could adversely affect recovery.
The typical recovery time from surgery to suture removal is 10 days. To a certain extent, this depends on the size of the incision, with a small laparotomy incision for spaying causing less discomfort that a major incision to remove a portion of bowel.
It is recommended the patient stays indoors until suture removal, 10 days post surgery. In addition, a light meal the evening of surgery is advised, if this is appropriate given the reason for the operation.
Some surgeons use intradermal sutures, which makes it more difficult for the cat to disrupt the wound. Where skin sutures or staples are used, the cat may need to wear a cone to prevent them prematurely removing the sutures.
During the recovery period, it is a good idea to provide a litter tray containing shredded newspaper rather than cat litter. This is because the cat litter may stick to the wound, increasing the risk of infection or complications.
The cost varies widely depending on the reason for the laparotomy. For example, the laparotomy cost is often absorbed into the cost of spaying, at around $80- $110 as an average total cost.
If exploratory surgery is performed, you may find the laparotomy listed as an item on an invoice, along with multiple other costs such as the anesthetic, drugs, fluids, blood tests, and histology fee. Expect the package to cost anywhere from $400 to $2,000 depending on how involved the surgery was and other procedures that were necessary.
Perhaps ironically, alternative methods of harvesting biopsy samples, are not necessarily less expensive as the equipment involved is expensive to purchase.
Laparotomy in itself is not complex, although it is invasive as it involves entering the abdomen. When the vet suggests an exploratory laparotomy, they will have balanced up the risks of this surgery against the risks of not doing it. For example, if the vet was suspicious of a foreign body stuck in the gut and did not operate, the consequences could include bowel perforation, peritonitis, septicaemia, and death. This is balanced against the scenario of finding nothing and the discomfort of entering the abdomen and stitching back up again.
The vet will discuss with you the evidence behind their decision, the risks of laparotomy, and the worst case scenario if surgery is declined.
In the majority of cases, avoiding laparotomy depends on keeping the cat in good health. This means being vigilant for swallow hazards around the home, such as ribbon or tinsel, which could be problematic if swallowed.
It also means feeding a good quality, balanced diet, and allowing the vet to investigate at an early stage should your cat have urinary issues. This reduces the risk of bladder stones, which need removal.
Keeping your cat indoors also reduces the risk of injury as a result of dog bites or from malicious intent by people.
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