Surgical Principles and Instrumentation - … PRINCIPLES OF THORACIC SURGERY IN SMALL ANIMALS T....

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PRINCIPLES OF THORACIC SURGERY IN SMALL

ANIMALS

PRINCIPLES OF THORACIC SURGERY IN SMALL

ANIMALS

T. Németh, DVM, PhDT. Németh, DVM, PhD

Surgical Principles and Instrumentation


• Surgical handling- manipulations effect respiratory and cardiovascular function

- contents of thoracal cavity are intolerant of crushing or clamping

- minimise pleural irritation in order to avoid po. adhesion

- surfaces should be kept moist with warm sterile solutions

- gentle handling of intrathoracic structures and surfaces

- careful hemostasis- suction rather than wiping

• Surgical handling- manipulations effect respiratory and cardiovascular function

- contents of thoracal cavity are intolerant of crushing or clamping

- minimise pleural irritation in order to avoid po. adhesion

- surfaces should be kept moist with warm sterile solutions

- gentle handling of intrathoracic structures and surfaces

- careful hemostasis- suction rather than wiping



• Surgical instrumentation- special thoracic set- retractors - self retaining retractors (Finochietto)- hand-held retractors- vascular (atraumatic) clamps

("de Bakey")- fine sharp instruments

(Metzenbaum scissors)- cutting and coagulating electrocautery - surgical suction device- moistened hemostatic gauze sponges and laparotomy pads

• Surgical instrumentation- special thoracic set- retractors - self retaining retractors (Finochietto)- hand-held retractors- vascular (atraumatic) clamps

("de Bakey")- fine sharp instruments

(Metzenbaum scissors)- cutting and coagulating electrocautery - surgical suction device- moistened hemostatic gauze sponges and laparotomy pads

Anaesthesia for Thoracic SurgeryAnaesthesia for Thoracic Surgery

• Instrumentation- manually and mechanically controlled

IPPV (intubation)- closed or semiclosed system- laryngeal suction unit- ECG- pulsoxymetry- capnography

• Instrumentation- manually and mechanically controlled

IPPV (intubation)- closed or semiclosed system- laryngeal suction unit- ECG- pulsoxymetry- capnography

Anaesthesia for Thoracic SurgeryAnaesthesia for Thoracic Surgery

• Preparation for anaesthesia- stabilisation of curculation, respiration,

acid-base and electrolyt status- remove any free gas or fluid from the

pleural space- remove hair from thoracotomy field

before anaesthesia- circulating warm water blanket or bottle

• Preparation for anaesthesia- stabilisation of curculation, respiration,

acid-base and electrolyt status- remove any free gas or fluid from the

pleural space- remove hair from thoracotomy field

before anaesthesia- circulating warm water blanket or bottle

Anaesthesia for Thoracic SurgeryAnaesthesia for Thoracic Surgery• Premedication

- sedation (benzodiazepines, 2 agonists)- analgesia (opiates: butorphanol,

buprenorphine, nalbuphine)• Induction

- iv. induction (thiopentone, ketamine, propofol)

- "mask" induction (isoflurane)• Maintenance

-isoflurane, sevoflurane/oxygene- nitrous oxide to be avoided

• Premedication- sedation (benzodiazepines, 2 agonists)- analgesia (opiates: butorphanol,

buprenorphine, nalbuphine)• Induction

- iv. induction (thiopentone, ketamine, propofol)

- "mask" induction (isoflurane)• Maintenance

-isoflurane, sevoflurane/oxygene- nitrous oxide to be avoided

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Surgical Approaches to the Thoracic Cavity


• Lateral thoracotomy

• Median sternotomy

• Lateral thoracotomy

• Median sternotomy

Surgical anatomyLeft side




Surgical anatomyRight side

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Surgical anatomyRight side



• Lateral Thoracotomy (right or left sided)- exposes one half of the thoracal cavity- can be performed with or without rib resection- determine the location of the approach- intercostal, transmuscular incision and sharp

dissection- retractor placement- closure with suture around the surrounding ribs

- Polyglactin, Polydioxanone, Stainless steel- chest drainage (Heimlich-valve, one-way-suction drain)

• Lateral Thoracotomy (right or left sided)- exposes one half of the thoracal cavity- can be performed with or without rib resection- determine the location of the approach- intercostal, transmuscular incision and sharp

dissection- retractor placement- closure with suture around the surrounding ribs

- Polyglactin, Polydioxanone, Stainless steel- chest drainage (Heimlich-valve, one-way-suction drain)



Target of surgery Intercostal spacethoracic trachea 3 (r)- oesophagus (cran.) 3-4 (r,l)- oesophagus (at heart base) 4-5 (r)- oesophagus (caud.) 7-8 (r,l)- PDA, PRAA 4 (l)- cran. lung lobe, pericardium 5 (r,l) - middle lung lobe 6 (r)- caud. and acc. lung lobe 5-6 (r,l)

Target of surgery Intercostal spacethoracic trachea 3 (r)- oesophagus (cran.) 3-4 (r,l)- oesophagus (at heart base) 4-5 (r)- oesophagus (caud.) 7-8 (r,l)- PDA, PRAA 4 (l)- cran. lung lobe, pericardium 5 (r,l) - middle lung lobe 6 (r)- caud. and acc. lung lobe 5-6 (r,l)

Lateral thoracotomy

Lateral thoracotomyLateral thoracotomy Lateral thoracotomyLateral thoracotomy

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Lateral thoracotomyLateral thoracotomy Lateral thoracotomy


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Lateral thoracotomyLateral thoracotomySurgical Approaches to the

Thoracic CavitySurgical Approaches to the

Thoracic Cavity

• Medial Sternotomy- ventral midline approach- gives access to both pleural spaces and the lungs, heart and mediastinum

- sternum is split with a power-driven oscillating saw

- closure with orthopaedic wire sutures


- sternum is split with a power-driven oscillating saw


Median SternotomyMedian Sternotomy Median SternotomyMedian Sternotomy

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Median SternotomyMedian Sternotomy Median SternotomyMedian Sternotomy

Median SternotomyMedian Sternotomy Surgical Approaches to the Thoracic Cavity



- sternum is split with a power-drivenoscillating saw



- sternum is split with a power-drivenoscillating saw


Median SternotomyMedian Sternotomy Surgical conditions requiring thoracic surgery

Surgical conditions requiring thoracic surgery

• Thoracic trauma

• Esophageal Obstruction

• Patent Ductus Arteriosus (elective course)

• Persistent Right Aortic Arch (elective course)

• Lung lobectomy

• Diaphragmatic hernia

• Thoracic trauma




• Lung lobectomy


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• Thoracic trauma




• Lung lobectomy


• Thoracic trauma




• Lung lobectomy


Introduction

• 15% of veterinary patients are traumatic (Kolata et al. 1974)

• 26 to 90% of traumatic cases are thoracic patients(Whitney & Mehlhaff 1987, Fullington & Otto 1997, Vnuk et al. 2004)

• Thoracic trauma = circulatory + respiratory distress(Kirby 2004)

Thoracic trauma

• „High rise syndrome”

Etiology

Thoracic trauma


• Car accident

Etiology

Thoracic trauma


• Car accident

• Bite

Etiology

Thoracic trauma


• Car accident

• Bite

• Shot

Etiology

Thoracic trauma

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• Car accident

• Bite

• Shot

Closed or openchest injury

Etiology

Thoracic trauma

Localisation

Thoracic trauma

• Upper airways (trachea, main stem bronchi)

Localisation

Thoracic trauma


• Lung parenchyma (contusion: edema, hemorrhage, laceration)

Localisation

Thoracic trauma



• Pleural space (PTX, hemothorax, diaphragmatic hernia)

Localisation

Thoracic trauma




• Chest wall (simple or multiplex rib fracture, open chest injury)

Localisation

Thoracic trauma

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• (Cardiologic sequelae: arrhytmias, hemopericardium)

Localisation

Thoracic trauma

ARD

• # Acute Respiratory Distress

Thoracic trauma

ARD


• Clinical signs (6 phases):

1. Hyperventilation / hyperpnoe

Thoracic trauma

ARD




2. Tachypnoe

Thoracic trauma

ARD




2. Tachypnoe

3. Dyspnoe

Thoracic trauma

ARD




2. Tachypnoe

3. Dyspnoe

4. Breathing relieving posture

Thoracic trauma

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ARD




2. Tachypnoe

3. Dyspnoe


5. Labial breathing (cat!)

Thoracic trauma

ARD




2. Tachypnoe

3. Dyspnoe


5. Labial breathing (cat!)

6. Cyanosis

Thoracic trauma

ARD (cont’)

• Oxigenisation

Thoracic trauma

ARD (cont’)

• Oxigenisation

• Hypoxemia

Thoracic trauma

ARD (cont’)

• Oxigenisation

• Hypoxemia

• Tissue hypoxia

Thoracic trauma

ARD (cont’)

• Oxigenisation

• Hypoxemia

• Tissue hypoxia

• Respiratory acidosis

Thoracic trauma

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ARD (cont’)

• Oxigenisation

• Hypoxemia

• Tissue hypoxia


• Asphyxia

Thoracic trauma

ARD (cont’)

• Oxigenisation

• Hypoxemia

• Tissue hypoxia


• Asphyxia

SHOCKARD +

Thoracic trauma






Localisation

Thoracic trauma

Upper airway injuries

• Larynx, trachea

– Rupture

– Hematoma

– Laceration

Thoracic trauma

• Physical signs

– Open wound

– Stridor/stretor

– Subcutaneous emphysema

– Inspiratory dyspnoe: larynx and/or upper tracheal injury

– Expiratory dyspnoe: lower tracheal or main stem bronchial injury

Upper airway injuriesThoracic trauma

• Radiography

– Emphysema

– Pneumomediastinum

– Pneumoperitoneum

SHOCK


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• Radiography

– Emphysema



SHOCK


• Radiography

– Emphysema



SHOCK


• Tracheobronchoscopy (!)

Dr. Psáder Roland gyűjteményéből


• Conservative therapy

– oxigenisation (mask, nasotracheal tube, tracheostomy)

– sedation (ACE, benzodiazepine)

– iv. steroid (edema!)

– iv. furosemide

– analgesia (NSAID, opiate agonists/antagonists)


• Surgery

– Surgical reconstruction

» debridement

» suturing

» tracheostomy


• Surgery

– Surgical reconstruction

» debridement

» suturing

» tracheostomy


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Localisation

Thoracic trauma

Injuries of the lung parenchyma

• Lung contusion

– edema

– hemorrhage

– laceration

Thoracic trauma

• Physical signs

– ARD

– Varied according to…

» severity (laceration+hemorrhage)

» extent (No of lung lobes)

» lateralisation (uni- or bilateral)

Injuries of the lung parenchymaThoracic trauma

• Radiology

– edema No 1

SHOCK

Interstitial pattern


• Radiology

– edema No 2

– 2.

SHOCKAlveolar pattern


• Radiology

– hemorrhage

SHOCK Interst.-alveol.pattern


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• Radiology

– laceration (atelectasia+PTX)


• Conservative therapy– oxigenisation (mask, nasotracheal tube, tracheostomy)– sedation (ACE, benzodiazepine)– iv. steroid (edema!)– iv. furosemide– analgesia (NSAID, opiate agonists/antagonists)– hypotensive resuscitation (infusion) therapy

» slow, low dose colloid+cristalloid» syringe pump

– therapy of the pleural space(see later)


• Surgery

– ideal: unilateral, 1-2 lung lobe

» hemorrhage

» laceration

– thoracotomy/sternotomy

– partial lobectomy


• Surgery


» hemorrhage

» laceration


– total lobectomy


• Surgery


» hemorrhage

» laceration


– total lobectomy


• Surgery


» hemorrhage

» laceration


– total lobectomy


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Localisation

Thoracic trauma

Injuries of the pleural space

• PTX

• Traumatic hemothorax

• Traumatic diaphragmatic hernia

Thoracic trauma

Injuries of the pleural space

• PTX

• Traumatic hemothorax

• Traumatic diaphragmatic hernia

Thoracic trauma

• PTX

– 20 to 63% of closed chest injuries (Vnuk et al. 2004, Whitney & Mehlhaff 1987)

– 100% of open chest defects

– closed vs. open vs. tension

– ARD

– tympanic percussion sound

– decreased respiratory sounds

Injuries of the pleural spaceThoracic trauma

• PTX

– Radiography

SHOCK


• PTX

– „tap before rad” vs. „rad before tap”


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• PTX


– recommended therapeutic protocol:

1.thoracocentesis - tapping- recheck (rad)


• PTX




2. chest drainage - intermittent/constant suction- recheck

...if fails…


• PTX

SHOCK

Injuries of the pleural spaceThoracic trauma Thoracic trauma

Chest drainageThoracic trauma

Chest drainage

Thoracic traumaChest drainage




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• PTX




2. chest drainage - intermittent/constant suction- recheck

3. thoracotomy / sternotomy – lobectomy – chest drainage

...if fails…

...if fails…







Localisation

Thoracic trauma

Chest wall injuries

• Bite !!! – Shamir et al (JSAP, 2002)

– 185 biten dogs, 11 biten cats

– Most relevant: male, 10 kg dogs with chest wall defect

• Shot

• Stab

Thoracic trauma

• Physical signs

– ARD + SHOCK

– Closed or open injury

– Skin defect chest status!!!

(Davidson 1998)

– Mortality = chest status!!!

(McKiernan et al 1984, Davidson 1998, Shamir

2002)

Chest wall injuriesThoracic trauma

• Radiology

– Double projection


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• Radiology

– Double projection

Dr. Péter Csébi’s cortesy


• Surgery

– „Triad”:

» ARD

» Chest wall defect

» Radiological signs

– Thoracotomy

– Lobectomy

– Chest wall reconstruction

– Chest-drainage

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• Thoracic trauma




• Lung lobectomy


• Thoracic trauma




• Lung lobectomy


Esophageal ObstructionEsophageal Obstruction

Definition partial or complete blockage of esophageal

passage usually caused by foreign body localisation: pharyngeal, cervical and thoracal

• Incidence- dogs, cats, horses, cattles- young puppies, playful, greedy animals- bone, stone, potato, bolus

Definition partial or complete blockage of esophageal

passage usually caused by foreign body localisation: pharyngeal, cervical and thoracal

• Incidence- dogs, cats, horses, cattles- young puppies, playful, greedy animals- bone, stone, potato, bolus


• History- apathy

- vomiting, regurgitation just aftereating in undigested form

- constant attemp to eat and drink- cough, aspiration

• History- apathy

- vomiting, regurgitation just aftereating in undigested form

- constant attemp to eat and drink- cough, aspiration


• Diagnostics- anamnesis

- direct visualisation or palpation of theobstruction (pharyngeal, cervical)

- orogastric tube- X-ray (plain, contrast)- oesophagoscopy

• Diagnostics- anamnesis

- direct visualisation or palpation of theobstruction (pharyngeal, cervical)

- orogastric tube- X-ray (plain, contrast)- oesophagoscopy

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Esophageal ObstructionPlain esophagography

Esophageal ObstructionPlain esophagography

Esophageal ObstructionPositive contrast esophagography

Esophageal ObstructionPositive contrast esophagography


• TherapyPharyngeal: - oral removalCervical: - push back to the pharynx

or- endoscopic removal

or- surgical exploration

pushing backor

esophagotomy

• TherapyPharyngeal: - oral removalCervical: - push back to the pharynx

or- endoscopic removal

or- surgical exploration

pushing backor

esophagotomy

Esophageal ObstructionSurgery - Esophagotomy






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• Thoracic trauma




• Lung lobectomy


• Thoracic trauma




• Lung lobectomy


LobectomyLobectomy

surgical removal of (a) lung lobe(s) surgical removal of (a) lung lobe(s)

LobectomyLobectomy

• Indication- circumscribed neoplasia, abscess,

foreign body of a lung lobe- severely injured and collapsed

lung lobe- spontaneous pneumothorax

causing pulmonary lesion - lung lobe torsion

• Indication- circumscribed neoplasia, abscess,

foreign body of a lung lobe- severely injured and collapsed

lung lobe- spontaneous pneumothorax

causing pulmonary lesion - lung lobe torsion

LobectomyLobectomy

• Diagnosis- respiratory symptomes - laterolateral and ventrodorsal X-ray

projection- bronchoscopy

• Diagnosis- respiratory symptomes - laterolateral and ventrodorsal X-ray

projection- bronchoscopy

LobectomyPulmonary neoplasia

LobectomyPulmonary neoplasia

LobectomyLobectomy

• Surgery- right or left sided lateral thoracotomy- isolation of the affected lung lobe- partial lobectomy V-shaped

resection on the edge- lobectomy ligature of accompaning

pulmonary vessels closure with double layer

of continuous sutures- chest drainage





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Partial lobectomyInjured lung lobe

Partial lobectomyInjured lung lobe LobectomyLobectomy









LobectomySurgery

LobectomySurgery

LobectomySurgery

LobectomySurgery

LobectomyLobectomy

• Postoperative care- monitoring of respiration

- postoperative analgesia

- check-up X-ray

• Postoperative care- monitoring of respiration

- postoperative analgesia

- check-up X-ray



• Thoracic trauma




• Lung lobectomy


• Thoracic trauma




• Lung lobectomy


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Diaphragmatic HerniaDiaphragmatic Hernia

• Diaphragm: - a musculotendinous wall - separates the abdominal and

the thoracal cavities- contributes to respiration,

abdominal press (excretion, partus)

- develops from 6 embryonic segments

• Diaphragm: - a musculotendinous wall - separates the abdominal and

the thoracal cavities- contributes to respiration,

abdominal press (excretion, partus)

- develops from 6 embryonic segments

Diaphragmatic HerniaDiaphragmatic Hernia• Definition:

abnormal dislocation of abdominalorgan(s) into the thoracal cavity through acongenital or acquired, normal or abnormaldefect of the Diaphragm clinical consequences due to the

compression of the intrathoracal organs and themorphological as well as functional disorder ofthe affected abdominal structures

• Definition: abnormal dislocation of abdominal

organ(s) into the thoracal cavity through acongenital or acquired, normal or abnormaldefect of the Diaphragm clinical consequences due to the

compression of the intrathoracal organs and themorphological as well as functional disorder ofthe affected abdominal structures


• Classification:a.,Congenital (abnormal development of

segments) - pleuroperitoneal diaphragmatic hernia

(hereditary)- peritoneopericardial hernia(PPDH - defect of septum transv.)

- hiatal hernia (sliding/axial orrolling/paraoesophageal)

- diaphragmatic eventrationb., Acquired, traumatic ( 90-95 %)

- left / right sided or bilateral- circular, radial or combined hernial gate







Peritoneopericardial Diaphragmatic Hernia(PPDH)


↓↓ ↓↓ ↓

↓↓ ↓↓

Definition- abnormal opening between the peritoneal and the pericardial

sac- dislocation of abdominal organs to the pericardium



↓



• Definition- abnormal opening between the peritoneal and the pericardial sac

- dislocation of abdominal organs to the pericardium

• Definition- abnormal opening between the peritoneal and the pericardial sac

- dislocation of abdominal organs to the pericardium

Bojrab: Current Techniques of Small Animal Surgery

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Hiatal Hernia(HH)

Hiatal Hernia(HH)

• Definition- displacement of the abdominal esophagus, esophagogastricjunction and/or part of the stomach into the thorax


Hiatal Hernia(HH)

Hiatal Hernia(HH)

Axial or sliding HHAxial or sliding HH

Hiatal Hernia(HH)

Hiatal Hernia(HH)


Hiatal Hernia(HH)

Hiatal Hernia(HH)


Hiatal Hernia(HH)

Hiatal Hernia(HH)

Rolling or Paraesophageal HHRolling or Paraesophageal HH

↓↓ ↓↓ ↓

↓ ↓

↓



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Hiatal Hernia(HH)

Hiatal Hernia(HH)



Hiatal Hernia(HH)

Hiatal Hernia(HH)
















Traumatic Diaphragmatic HerniaTraumatic Diaphragmatic Hernia

• Incidence: - cat dog

• Aethiology:- car accident- falling down- penetrating wound

• Incidence: - cat dog

• Aethiology:- car accident- falling down- penetrating wound

Traumatic Diaphragmatic HerniaTraumatic Diaphragmatic Hernia• Pathogenesis:

depens on time of anamnesis

size of hernial gate (incarceration) dislocated organs (omentum, liver etc) status of intrathoracal organs

(lungs)

systemic alteration- shock- ARD

• Pathogenesis: depens on time of anamnesis

size of hernial gate (incarceration) dislocated organs (omentum, liver etc) status of intrathoracal organs

(lungs)

systemic alteration- shock- ARD

Traumatic Diaphragmatic HerniaTraumatic Diaphragmatic Hernia• Pathogenesis (cont.)

intrathoracal alterations- thoracic contusion

- pulmonary oedema/hemorrhage- pneumothorax, hemothorax

abdominal disorders- hepatic contusion,

congestion, rupture- splenic congestion/rupture- gastrointestinal laceration,

obstruction

• Pathogenesis (cont.) intrathoracal alterations

- thoracic contusion- pulmonary oedema/hemorrhage

- pneumothorax, hemothorax

abdominal disorders- hepatic contusion,

congestion, rupture- splenic congestion/rupture- gastrointestinal laceration,

obstruction

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• Diagnosis–general assessment–detailed examination–supplementary examination–differential diagnosis

• Diagnosis–general assessment–detailed examination–supplementary examination–differential diagnosis

Traumatic Diaphragmatic HerniaGeneral assessment

Traumatic Diaphragmatic HerniaGeneral assessment

• weakness, apathy• lying or sitting position• cyanotic, pale mucous membranes• prolonged CRT• tachypnoe, dyspnoe

• weakness, apathy• lying or sitting position• cyanotic, pale mucous membranes• prolonged CRT• tachypnoe, dyspnoe

Traumatic Diaphragmatic HerniaDetailed examination


• Circulation:- shock- tachycardia- dislocation or lack of heart sounds

• Circulation:- shock- tachycardia- dislocation or lack of heart sounds



• Thorax: Auscultation - increased respiratory sounds

(pulm. oedema)- lack of resp. sounds (liver,

spleen or PTX)- gastrointestinal sounds

(stomach, intestine)

• Thorax: Auscultation - increased respiratory sounds

(pulm. oedema)- lack of resp. sounds (liver,

spleen or PTX)- gastrointestinal sounds

(stomach, intestine)



• Thorax: Percussion- dislocated diaphragmatic

line- decreased resonance (liver,

spleen, omentum)- increased resonance

(stomach, intestine, PTX)- fluid line (hemothorax)

• Thorax: Percussion- dislocated diaphragmatic

line- decreased resonance (liver,

spleen, omentum)- increased resonance

(stomach, intestine, PTX)- fluid line (hemothorax)



• Abdomen: Palpation- abnormal, "empty" feeling

• Abdomen: Palpation- abnormal, "empty" feeling

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Traumatic Diaphragmatic HerniaSupplementary examination


X-ray: - plain laterolateral and dorsoventral projection

- line of Diaphragm - position of intrathoracal organs- lung pattern (oedema, hemorrhage,

contusion)- free contents of thoracal cavity

(fluid, gas) - position of liver and stomach- positive contrast examination (Ba)

X-ray: - plain laterolateral and dorsoventral projection

- line of Diaphragm - position of intrathoracal organs- lung pattern (oedema, hemorrhage,

contusion)- free contents of thoracal cavity

(fluid, gas) - position of liver and stomach- positive contrast examination (Ba)

Traumatic Diaphragmatic HerniaPlain X-ray




Traumatic Diaphragmatic HerniaPositive contrast study

Traumatic Diaphragmatic HerniaPositive contrast study



• Ultrasonography:- line of Diaphragm- position of intraabdominal organs

• Laboratory examination- blood gas analysis- complete blood-count - biochemical parameters (ALT, AP,

lipase, amylase, urea, creatinine etc)- thoracocentesis

• Ultrasonography:- line of Diaphragm- position of intraabdominal organs

• Laboratory examination- blood gas analysis- complete blood-count - biochemical parameters (ALT, AP,

lipase, amylase, urea, creatinine etc)- thoracocentesis

Hernia diaphragmatica traumatica Ultrasonography

Hernia diaphragmatica traumatica Ultrasonography

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Traumatic Diaphragmatic HerniaDifferential Diagnosis

Traumatic Diaphragmatic HerniaDifferential Diagnosis

• Pleural effusion without herniation (hydro-, hemo-, chylo-, pyothorax)

• Pulmonary oedema, hemorrhage, pneumonia

• PTX• GDV, intestinal obstruction• Cardiac disorders

• Pleural effusion without herniation (hydro-, hemo-, chylo-, pyothorax)

• Pulmonary oedema, hemorrhage, pneumonia

• PTX• GDV, intestinal obstruction• Cardiac disorders


Therapy absolute indication of surgery! Therapy absolute indication of surgery!

Traumatic Diaphragmatic HerniaTherapy


1., Stabilisation of circulatory and respiratory status

- oxygenisation (mask, intubation, tracheostomy)

- shock management- diuretics (furosemide)- correction of acid-base and ionic

imbalance- sedation (diazepam, acepromasine)- thoracocentesis (7-8. intercostal space)

1., Stabilisation of circulatory and respiratory status

- oxygenisation (mask, intubation, tracheostomy)

- shock management- diuretics (furosemide)- correction of acid-base and ionic

imbalance- sedation (diazepam, acepromasine)- thoracocentesis (7-8. intercostal space)



2., Surgery - objective and subjective conditions- correct (inhalation) anaesthesia- monitoring (pulsoxymetry, capnogr.) - surgical approach (laparotomy,

laparotomy combined with partial sternotomy)

- detection of type and extension of hernia, affected organs

2., Surgery - objective and subjective conditions- correct (inhalation) anaesthesia- monitoring (pulsoxymetry, capnogr.) - surgical approach (laparotomy,

laparotomy combined with partial sternotomy)

- detection of type and extension of hernia, affected organs



2., Surgery (cont.)- reposition of abdominal organs- evaluation of the vitality of organs- removal of necrotic tissues

(lobectomy, resection)- restoration of the Diaphragm (one

or two layers, interrupted or continuous, absorbable or nonabsorbable)

- chest drain placement (?)

2., Surgery (cont.)- reposition of abdominal organs- evaluation of the vitality of organs- removal of necrotic tissues

(lobectomy, resection)- restoration of the Diaphragm (one

or two layers, interrupted or continuous, absorbable or nonabsorbable)

- chest drain placement (?)

Traumatic Diaphragmatic HerniaSurgery


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Traumatic Diaphragmatic HerniaSurgery Traumatic Diaphragmatic HerniaTraumatic Diaphragmatic Hernia

• Postoperative care- oxygenisation- intensive monitoring (blood gas

analysis)- infusion, diuresis- analgesia ( flunixin meglumine,

opiates)- mashy diet

• Postoperative care- oxygenisation- intensive monitoring (blood gas

analysis)- infusion, diuresis- analgesia ( flunixin meglumine,

opiates)- mashy diet


• Assessement of Prognosis- time of anamnesis- response to stabilisation therapy- status of lungs and the liver- return of spontaneous respiration

after surgery- survival of the first 24 hours postoperatively

• Assessement of Prognosis- time of anamnesis- response to stabilisation therapy- status of lungs and the liver- return of spontaneous respiration

after surgery- survival of the first 24 hours postoperatively

Thank You for Your Attention !Thank You for Your Attention !

Surgical Principles and Instrumentation - … PRINCIPLES OF THORACIC SURGERY IN SMALL ANIMALS T....

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Transcript of Surgical Principles and Instrumentation - … PRINCIPLES OF THORACIC SURGERY IN SMALL ANIMALS T....