Page 164 - Clinical Manual of Small Animal Endosurgery

152 Clinical Manual of Small Animal Endosurgery

approximately 4–5 cm aborad to the first. An incision is then made
between the two sutures through the skin, subcutaneous tissue and body
wall until the gastric surface is seen. A 3–4 cm incision is then made
through the gastric serosa and muscularis down to the level of, but
excluding, the gastric mucosa. Like the laparoscopy-assisted gastropexy,
the seromuscular layer of the stomach is then sutured to the transversus
abdominis muscle. The external fascia, subcutaneous tissue and skin are
closed routinely. The stay sutures are removed and final endoscopic
inspection is performed.
The surgeon occasionally encounters an animal with a pre-existing
partial twisting of the stomach. Using the laparoscopic approach this is
easily recognised and grasping forceps can be used to reposition the
stomach to its normal anatomic location prior to gastropexy. A twist can
also be recognised endoscopically and can potentially be repositioned
using the endoscope, although this is somewhat difficult. The endoscopic
techniques have the potential for unrecognised trapping of omentum or
other abdominal contents between the gastric and abdominal walls so
careful palpation and repositioning of the animal may be required prior
to stay-suture placement.
With each of these procedures, following surgery the animals are given
a lidocaine patch and postoperative analgesics, which usually consist of
parenteral opiod medication and non-steroidal anti-inflammatory drugs
for 3–4 days. Owners are instructed to limit activity for 2–3 weeks while
the adhesion forms. In animals that are very active after surgery the most
common postoperative complication is seroma formation along the gas-
tropexy incision site, which resolves with conservative therapy.

Laparoscopic cryptorchid castration
If physical examination does not reveal one or both testicles in the
scrotum or inguinal area, laparoscopic visualisation of inguinal rings and
peritoneal cavity can assist with definitive identification and location of
retained testicles. In addition, this technique is associated with less tissue
trauma, postoperative pain and wound complications. If the spermatic
cord is visualised entering the inguinal ring, the testis is located outside
the peritoneal cavity or just inside the inguinal ring (the so-called peeping
testicle) (Freeman, 1999). If only the gubernaculums is seen entering the
inguinal ring, the testis is located inside the abdominal cavity. It can be
found by tracing the gubernaculum from the inguinal ring, the ductus
deferens from the prostate, or by identifying and tracing the pampini-
form plexus to the testicle.
A laparoscopic or laparoscopy-assisted technique can be performed,
depending on available equipment. If an energy modality such as LigaS-
ure, ENSEAL or Harmonic Scalpel is available the laparoscopic approach
is performed. If not, the laparoscopy-assisted technique is easiest and
quickest.