Stephen J. Birchard DVM, MS, Diplomate ACVS

Sunday, March 3, 2019

How to Perform a Colopexy in Dogs and Cats

How to Perform A Colopexy in Dogs and Cats

Colopexy is a surgical procedure in dogs and cats intended to produce a permanent adhesion between the descending colon and the interior of the left abdominal wall. The procedure is indicated in animals with conditions such as rectal prolapse that is not responsive to other treatment methods, in selected cases of perineal hernia with rectal sacculation, and in dogs with colonic volvulus. In rectal prolapse the colopexy prevents recurrence of the prolapse since the colon is fixed to the body wall, preventing the rectum from prolapsing through the anus. In some dogs with severe rectal sacculation secondary to perineal hernia, primary herniorrhaphy may not sufficiently ameliorate the rectal pathology. Colopexy in these dogs can help straighten the rectum, reduce the size of the sacculation, and improve rectal function. Finally, colopexy can be used to prevent recurrence of colonic volvulus. Since the proximal portion of the descending colon becomes displaced to the right side of the abdominal cavity in colonic volvulus, colopexy of the descending colon to the left abdominal wall prevents that displacement and therefore prevents recurrence of the volvulus.

Surgical Technique

In the following series of step by step figures using a surgical model, colopexy of the descending colon to the interior of the left abdominal wall is demonstrated. After placing the animal under general anesthesia, the ventral abdomen is clipped and prepared for aseptic surgery. A ventral midline abdominal approach is performed. After a complete abdominal exploratory is performed, the descending colon is identified and placed adjacent to the interior of the abdominal wall at the proposed site of the pexy.

Place towel clamps on the left side of the linea alba incision and retract dorsally to better expose the interior of the abdominal wall. Make a 6-10cm (depending on the size of the animal) in the peritoneum and transversus abdominus muscle from cranial to caudal. (Fig. 1) 

Fig. 1: Make the initial incision in the abdominal wall through the peritoneum
and transversus abdominus muscle from cranial to caudal. (Cr-cranial, Ca-caudal)

The anti-mesenteric aspect of the descending colon is scarified with a scalpel to encourage a better adhesion to the abdominal wall. An incision is not made in the seromuscular layer of the colon to avoid accidental perforation of the colonic lumen.

Place the colon near the abdominal wall incision. Using gentle traction of the colon in a cranial direction, determine the optimal location of the colon on the abdominal wall to accomplish the desired goal. Suture the dorsal side of the abdominal wall incision to the seromuscular aspect of the colon in a simple continuous pattern with 2-0 PDS. (Fig. 2, 3)
Fig. 2: Suture the dorsal aspect of the abdominal wall(A) incision to the
descending colon. (DC) Note that needle direction is always from abdomen
to the colon. 
Fig. 3: Completed closure of dorsal abdominal incision to the colon.
Suture the ventral aspect of the abdominal wall incision to the colon is a similar fashion to complete the colopexy. (Fig. 4, 5)
Fig. 4: Beginning the closure of the ventral abdominal incision to the colon.
Fig. 5: Completed closure of the ventral abdominal incision to the colon. 

Postoperative Care

The abdominal incision is closed routinely and the animal is recovered from anesthesia. Supportive care consisting of intravenous fluids and analgesics is given. Monitor for postoperative pain and infection. Also monitor for normal colorectal function. Stool softeners such as Miralax or canned pumpkin can be given if constipation due to abnormally hard stool occurs. Most dogs and cats do well after colopexy with improvement of their condition and low risk of recurrence of rectal prolapse or colonic volvulus. Dogs with perineal hernia will also require primary herniorrhaphy in addition to the colopexy.


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