Diagnostic usefulness of laparoscopy versus exploratory laparotomy for dogs with suspected gastrointestinal obstruction

Abstract

OBJECTIVE To evaluate the feasibility of laparoscopy versus exploratory laparotomy for the diagnosis of specific lesions in dogs with suspected gastrointestinal obstruction. DESIGN Controlled trial. ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with gastrointestinal obstruction. PROCEDURES Single-incision laparoscopy with intracorporeal and extracorporeal examination of the gastrointestinal tract was performed by 1 surgeon. Immediately afterward, exploratory laparotomy was performed by a second surgeon. Accessibility and gross appearance of organs, surgical diagnoses, incision lengths, procedure duration, and complications were compared between diagnostic techniques. RESULTS Mean (95% confidence interval) incision length was 4.9 cm (3.9 to 5.9 cm) for laparoscopy and 16.4 cm (14.0 to 18.7 cm) for exploratory laparotomy. Mean (95% confidence interval) procedure duration was 36.8 minutes (31.6 to 41.2 minutes) and 12.8 minutes (11.4 to 14.3 minutes), respectively. Diagnoses of the cause of obstruction were the same with both methods. In 13 dogs, the laparoscopic examination was successfully completed, and in the other 3, it was incomplete. In 4 dogs in which laparoscopy was successful, conversion to exploratory laparotomy or considerable extension of the laparoscopic incision would have been required to allow subsequent surgical treatment of identified lesions. No dogs developed major complications, and minor complication rates were similar between procedures. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopy was feasible and clinically applicable in dogs with suspected gastrointestinal obstruction. Careful patient selection and liberal criteria for conversion to an open surgical approach are recommended when laparoscopy is considered for the diagnosis of gastrointestinal lesions in dogs.

Intestinal surgery in small animals: historical foundations, current thinking, and future horizons

“…Conversion rates reported in these series ranged between 0% and 23% . Reported reasons for conversion include linear foreign bodies, foreign bodies involving the ileocecocolic and gastroduodenal regions, hemorrhage, peritoneal effusion, and requirement for additional surgical procedures . Low preoperative total solids, presence of a solitary liver tumor, and diagnosis of neoplasia were associated with a conversion rate of 21% in another study .…”

“…A number of recent reports describe the use of diagnostic and therapeutic laparoscopy‐assisted techniques in small animals to explore the GI tract and report excellent outcomes with few complications. Conversion rates reported in these series ranged between 0% and 23% . Reported reasons for conversion include linear foreign bodies, foreign bodies involving the ileocecocolic and gastroduodenal regions, hemorrhage, peritoneal effusion, and requirement for additional surgical procedures .…”

“…In addition to intestinal diameter, the anatomic region of the affected bowel also appears to be important. Dogs and cats with GI lesions affecting the stomach, orad duodenum, or bowel aborad to the ileocolonic junction (ICJ) were not initially thought to be good candidates for a laparoscopy‐assisted approach . However, a recent report describing the addition of a minilaparotomy after single‐incision laparoscopic exploratory may represent a compromise approach that may allow access to the stomach and duodenum as part of the extracorporeal assessment …”

“…Intracorporeal exploration of the liver, gall bladder, pancreas, stomach, descending duodenum, and colon is followed by extracorporeal evaluation of the jejunum, ileum, and ICJ. (Figure A‐C) Patient repositioning is required for intracorporeal evaluation of the descending duodenum and colon . Extracorporeal evaluation of the viscera is most often facilitated by the use of polyurethane wound retractors (Figure C), although small Gelpi retractors and absence of retractors has also been reported .…”

“…No significant operative complications occurred, and clinical outcome was excellent in both groups. The time required to explore the GI tract was compared by using a single‐port approach to laparotomy in 16 dogs in a recent prospective study . Average laparoscopic exploratory time was 36 minutes vs 12 minutes for the open exploratory technique, although exploratory time improved significantly over the course of the study, suggesting a learning‐curve effect.…”