Madback and Dangleben 2015).
At the end of a laparotomy a 2‐0 monofilament nonabsorbable suture is placed loosely across the linea alba (Figure 5.4a). The linea alba should be maintained open on the entire length of the incision. Several loops of sutures are placed 3–5 cm from the edges of the skin incision and 3–4 cm from each other. Loop areas are placed at the cranial and caudal ends of the incision (Figure 5.4a see arrow).
The laparotomy incision is then covered with two to three layers of sterile laparotomy sponges. Umbilical tape is then laced through the loop of suture over the laparotomy sponges. A sterile sticky plastic drape is then placed over the bandage and the skin to isolate the bandage from the environment (Figure 5.4b and c). If the patient is a male dog, a urinary catheter should be placed to prevent contamination of the bandage with urine.
Bandage is changed on a daily basis in the operating room. At each bandage change the abdominal cavity is flushed with sterile saline. A cytology is performed daily, and when cytology is improved, with a reduction of the number of bacteria and degenerative neutrophils, the abdominal cavity is closed over a closed suction drain.
5.2.4 Vacuum‐Assisted Drainage of the Abdominal Cavity
Vacuum‐assisted bandage has been used instead of an open abdomen drainage technique to actively drain the peritoneal space (Hondt et al. 2011; Buote and Havig 2012; Cioffi et al. 2012; Spillebeen et al. 2017).
The linea alba is partially closed. Foam used for vacuum‐assisted wound therapy is then applied on the part of the incision left open. A drain and sticky bandage are applied over the foam to establish a water and airtight seal. The drain is connected to the vacuum generator. A negative pressure of 75–125 mmHg is generated through the catheter in the foam in a continuous fashion. Fluids drained out of the peritoneal cavity is collected in a reservoir and the bandage does not need to be changed daily.
5.3 Tips
It is paramount to keep any of those drains well protected from the environment to prevent ascending infection. Sticky drapes can be used to cover the exit site of the closed suction drain. It should also be well covered to prevent any accidental removal by the patient. An E collar should be placed on the patient.
Cytology of the abdominal fluid should be performed daily basis to follow the progression of the disease process in the abdominal cavity. Fluid can be collected from the reservoir if a closed suction drain has been used, or at each bandage change if the abdomen has been left open. Measurement of lactate and glucose from the abdominal fluid can help determine if septic peritonitis is still present. If septic peritonitis is present, the difference between the concentration of glucose in the fluid and blood is more than 20 units or the difference between the concentration of lactate in the fluid and blood is more than 2 units. Those results are 100% sensitive and specific in dogs and 86 and 100% respectively in cats (Bonczynski et al. 2003). However, if the fluid is collected from the closed suction drain and the reservoir and not the abdomen, those differences are not accurate (Szabo et al. 2011).
With an open abdomen, it is paramount that the bandage change and the lavage of the peritoneal space are performed under anesthesia in an operating room (Staatz et al. 2002). The surgical site is inspected at each bandage change. If needed, the additional sutures can be added to an enterotomy, or a resection anastomosis. Also it is important to perform enteral feeding for dogs and cats with open abdomen. A gastrostomy feeding tube is used to aspirate stomach content to prevent reflux, vomiting, and aspiration pneumonia. A jejunostomy feeding tube is used to feed the patient while under heavy sedation with an open abdomen. Enteral feeding is an efficient technique to maintain protein and albumin levels. Open abdomen drainage is usually used for 24 or 48 hours. The abdomen is then closed on a closed suction drain. Negative pressure therapy might be superior to passive abdominal drainage because the abdominal fluid is better contained (Spillebeen et al. 2017).
5.4 Complications and Aftercare
Since patients with abdominal drainage have some form of peritonitis, it is important to monitor those patients with electrocardiogram and arterial pressure measurement.
Hypovolemia, hypotension, arrhythmias, and disseminated intravascular coagulation are the common complications related to abdominal drainage and peritonitis. Monitoring urine production with a urinary catheter and a close collection system is important to adjust fluid therapy. Evaluation of electrolytes, glucose, and lactate are paramount to monitor and support the patients.
During abdominal drainage it is important to replace the losses to prevent hypovolemia. It is then important to add either synthetic colloids or plasma to maintain oncotic pressure.
Intra‐abdominal compartment syndrome affects cardiac function, respiratory function, kidney function, and intracranial pressure (Diebel et al. 1992; Schein et al. 1995; Ivatury et al. 2001; Madback and Dangleben 2015). Abdominal drainage should therefore help to prevent this syndrome, which aggravates the clinical status of the patient. Monitoring intra‐abdominal pressure is possible with a urinary catheter and a water manometer (Way and Monnet 2014; Madback and Dangleben 2015).
Septic peritonitis in dogs and cats is associated with a 30% mortality rate (Ludwig et al. 1997; Staatz et al. 2002; Davis et al. 2018). However, this prognosis is greatly affected by the underlying condition causing the peritonitis. Septic bile peritonitis carries a worse prognosis, with a mortality rate as high as 73% mortality, and the utilization of an open abdomen did not improve outcome (Ludwig et al. 1997).
References
1 Adams, R.J. et al. (2014). Closed suction drainage for treatment of septic peritonitis of confirmed gastrointestinal origin in 20 dogs. Vet. Surg. 43 (7): 843–851.
2 Bonczynski, J.J. et al. (2003). Comparison of peritoneal fluid and peripheral blood pH, bicarbonate, glucose, and lactate concentration as a diagnostic tool for septic peritonitis in dogs and cats. Vet. Surg. 32 (2): 161–166.
3 Buote, N.J. and Havig, M.E. (2012). The use of vacuum‐assisted closure in the management of septic peritonitis in six dogs. J. Am. Anim. Hosp. Assoc. 48 (3): 164–171.
4 Cioffi, K.M. et al. (2012). Retrospective evaluation of vacuum‐assisted peritoneal drainage for the treatment of septic peritonitis in dogs and cats: 8 cases (2003–2010). J. Vet. Emerg. Crit. Care 22 (5): 601–609.
5 Davis, D.J. et al. (2018). Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs: a retrospective review of 210 anastomoses. Vet. Surg. 47 (1): 125–129.
6 D'Hondt, M. et al. (2007). Systemic peritoneal cavity lavage: a new strategy for treatment of the open septic abdomen. Acta Chir. Belg. 107 (5): 583–587.
7 Diebel, L.N. et al. (1992). Effect of increased intra‐abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J. Trauma 33 (2): 279–282; discussion 282–273.
8 Hondt, M. et al. (2011). Can vacuum‐assisted closure and instillation therapy (vac‐instill therapy)
