Bovine GI Surgery Flashcards
Abomasal surgical disorders.
LDA (left displaced abomasum).
RDA (right displaced abomasum).
RVA (right abomasal volvulus/torsion).
- Classical sound on abdominal auscultation of LDA.
- Methods of treatment of LDA.
- Ping.
- Conservative management e.g. casting and rolling.
Surgical management:
- open (conventional).
- closed.
- laparoscopic.
Considerations for treatment of LDA.
Return and stabilise abomasum in a normal anatomical position.
Manage concurrent abdominal pathology.
Minimise additional risk.
Practicality - available handling facilities and available labour.
Economic cost-benefit.
Surgeon experience and familiarity with technique.
Conservative management of LDA.
Casting and rolling.
Analgesia +/- spasmolytic.
Oral fluid therapy.
Calcium to improve motility.
Treatment of concurrent medical conditions:
- e.g.. metritis, ketosis.
Dietary management:
- High fibre, low starch.
Process of casting and rolling as treatment of LDA.
Attach ropes ready to cast.
Cast cow into right lateral recumbency.
Roll onto back so abomasum floats up.
Rock gently from side to side while on back to deflate abomasum and help movement of gas into the intestines.
Continue to roll cow into left lateral recumbency and remain there for a further few minutes to allow gases to continue to escape.
Return to sternal recumbency.
- can give supportive therapy while here.
Conservative management px.
40% success rate.
Monitor closely for return to function.
- signs will be more subtle than first time.
Open (conventional) surgical correction methods of LDA.
Right sided paralumbar fossa (common).
Double sided paralumbar fossa (still commonly used).
Left sided paralumbar fossa.
(“Utrecht”) (less common in UK but occasionally useful),
Right paramedian (fairly common).
Closed surgical correction methods of LDA.
Toggle-pin (common).
Blind fixation (not recommended).
Laparoscopy.
Right paralumbar laparotomy.
For LDA.
With pyloropexy or omentopexy.
Return LDA to RHS and suture to RHS abdominal wall, in the hope that it will stabilise and carry on with normal function.
- Advantages of a right paralumbar laparotomy.
- Disadvantages of rift paralumbar laparotomy.
- Good visualisation of right abdomen.
Low recurrence risk.
Animal standing.
Assistant not required. - Time.
Cost.
Requires arm long reach.
Difficult if abomasal adhesions to the left body wall.
Process of right paralumbar laparotomy.
Incise just caudal to last rib, at around middle of abdomen, incise the size of your bicep.
Reach caudally to the omental sling and dorsally, then cranially over the rumen to palpate the distended abomasum (like a balloon).
Insert 2 inch 14G needle attached to sterile tubing into the abomasum at the most dorsal point to remove gas. (Guarding as guiding through abdomen).
- takes time for gas to be removed.
Remove needle once all gas removed.
Reach across ventral body wall and grasp pylorus or lesser omentum on the midline then gently raise pylorus to the ventral margin of the incision, restoring near-ish normal anatomical position.
Exteriorise the abomasum through incision.
- “Sow’s ear” = lesser omentum.
- pylorus at the bottom.
Perform omentopexy or pyloropexy to anchor abomasum to right body wall.
- use thick dissolvable or non-dissolvable suture material e.g. vicryl size 0.
- suture pexy to peritoneum and transverse abdominal muscle at the cranial incision.
Perform routine abdominal and skin closure.
Double sided paralumbar fossa approach to LDA process.
With pyloropexy or omentopexy.
As for unilateral RHS paralumbar fossa approach
But have 2 surgeons - second surgeon performs a simiultaneous paralumbar incision on LHS.
- then push down distended abomasum to release gas.
- then hands lessee omentum to RHS surgeon.
- abomasum is anchored on the right as before.
- Double sided paralumbar fossa approach to LDA advantages.
- Double sided paralumbar fossa approach to LDA disadvantages.
- Advantages as with right sided paralumbar fossa approach.
Very good visualisation.
Can break down adhesions - Requires 2 surgeons.
Cost.
Time.
Left paralumbar laparotomy (Utrecht method) approach to LDA.
With abomasopexy.
Left flank paralumbar approach.
Decompress abomasum.
Exteriorise an area of abomasal fundus via incision.
Place 2 large stay sutures in dorsocranial aspect of abomasal fundus.
Take needles and abomasum right down to caudal abdomen of body wall.
Pass needles ventrally in abdomen to exit body wall to right of midline, caudal to sternum, avoiding veins.
Tie the two ends together with a surgeon’ knot.
- Left paralumbar laparotomy (Utrecht method) approach to LDA advantages.
- Disadvantages for left paralumbar laparotomy (Utrecht method) approach to LDA disadvantages.
- Good visualisation of abomasum.
Can break down adhesions.
Low recurrence.
Animal standing.
Useful in cows in late gestation.
- uncommon.
Useful if had surgery on LHS already and scar tissue an issue. - Cost.
Time.
Poor abdomen visualisation.
Right paramedian laparotomy and abomasopexy approach to LDA process.
Fairly common.
Cast cow into right lateral recumbency.
Roll into dorsal recumbency, so abomasum floats to caudal abdominal wall.
Make a paramedian incision a hands breadth to the right of midline and a hands breadth caudal to the xyphisternum.
Identify abomasum.
Form an abomasopexy - suture abomasal fundus to the internal layer of the rectus sheath and peritoneum.
- Right paramedian laparotomy and abomasopexy approach to LDA advantages.
- Right paramedian laparotomy and abomasopexy approach to LDA disadvantages.
- Allows visualisation of abomasal fundus and some other abdominal viscera.
Adhesions with left body wall can be managed.
More rapid than other closed procedures.
Surgeon arm length not restrictive.
Low risk of recurrence.
Appropriate for any size of displacement. - Requires cow to be rolled.
Cost.
Time.
Poor abdomen visualisation.
Closed approach toggle pin suture approach to LDA process.
Common.
Use of a toggling kit.
Similar to casting and rolling.
Cast cow into right lateral recumbency and then rolled onto back.
- abomasum floats up to ventral body wall of cow.
- locate abomasum with ping. If absent. Abort procedure and continue the roll.
- if located, apply pressure to caudal abdomen to push abomasum cranially and ventrally.
- place trocar into abomasum, hands breadth to right of midline and hands breadth caudal to xiphisternum — must be performed quickly to be successful.
Push through toggling pin and suture line to pexy abomasum to ventral body wall.
- location confirmed by acidic smell of abomasal gas.
- first toggle quickly inserted using cannula and trocar removed before abomasum decompressed fully.
Grasp free end of suture securely with haemostats.
Re-insert trocar approx. 5cm cranial to the first toggle suture.
Second toggle suture put in place.
Gas can be allowed to escape through trocar.
Needle can be removed once fully decompressed.
2 suture ems secured together by a surgeon’s knot, leaving approx. Hand width thickness between tightened suture and body wall.
Cow then rolled onto left side and finally allowed to stand.
Leave in place for 10-14 days and then cut the string, releasing the toggles into the digestive tract to be passed in faeces by the cow.
- Closed toggle pin approach to LDA advantages.
- Closed toggle pin approach to LDA disadvantages.
- Quick.
Cheaper compared to open surgery. - Blind.
Can’t visualise abdomen viscera.
Potential risk of trauma to personnel and cow.
Requires rolling (space and man power).
*pick your cases well!
- classical signs.
- within 2-3 weeks of calving.
- off-colour and dropped milk yield.
- but otherwise well.
- Laparoscopic correction methods of LDA.
- Advantages.
- Disadvantages.
- Two-step method:
- place toggle sutures on displaced abomasum through keyhole incisions, followed by rolling and retrieving sutures through ventral incision.
One-step method. - Minimally invasive.
Visual control.
Quick.
Minimal antibiotics required. - Requires ability to use laparoscope.
Expensive equipment.
