surgical approach to forestomach surgery

Question 1

what is the approach to a left flank laparotomy?

Answer 1

Clip, block and prep
- Remember to “sweep” off transverse processes

• Incise in paralumbar fossa
  
  • 4cm caudal to ribs
• Incise skin, external and internal abdominal oblique muscles, transversus abdominis and peritoneum
• Sheep = same but lateral recumbency

Question 2

what are you able to explore in a cranial abdomial exploration
what are you able to explore in a caudal abdomen exploration?

Answer 2

Cranial abdomen exploration
* Pylorus
* Abomasum
* Omasum
* Reticulum

Caudal abdomen exploration
* Bladder
* Uterus
* Left kidney
* Intestines

on the left the rumen stops everything from falling out

Question 3

what are the indications, approach, other approach options and peri-op considerations for rumenotomy?

Answer 3

Indications
- Adhesions suspected
- TRP, foreign body, toxins, frothy bloat
- Access to rumen and reticulum

Approach
- Same as laparotomy
- Suture rumen to body wall before you open it!
- Partial thickness - Short runs of Cushing pattern (3, tieing off each time (if not will constrict)

Other approach possibilities:
- Stay sutures
- Weingarth apparatus
- Wound edge protector

Peri-op considerations
- Clean contaminated surgery
- Perioperative antimicrobials and NSAIDs
- Restraint!

Question 4

what is the most common reason for a rumenostomy?
what is the approach?

Answer 4

Recurrent bloat?
- Self retaining trocar preferrable - But peritonitis risk

• Similar to laparotomy except only small circle of skin incised
  
  • Rumen stay sutured to body wall
  • Small circle of rumen mucosa removed
  • Rumen wall sutured to body wall in everting pattern
    
    • Horizontal/vertical mattress
• When trocar is removed tissue will gradually granulate and close