Surgical Correction of Abomasal Displacements Flashcards
2 step toggle pin placement Step 1: standing (insertion of toggle pins) Step 2: dorsal recumbency (toggle pins are tied to gauze roll)
janowtiz technique
what method is used to cast cow into right lateral?
Rueff’s method
layers you close when doing a flank laparotomy (3)
- peritoneum and transverse abdominus (incorporate greater omentum if you did a pexy) 2. close internal and external oblique mm 3. skin
pyloropexy site
1 cm cranial to ventral end of right flank laparotomy incision
what type of suture pattern do you use for omentopexy and pyloropexy?
mattress sutures; incorporate peritoneum and all muscular layers, just NOT skin
what closed technique can be used for abomasal displacements
roll +blind tack or toggle pin can NOT be used for volvulus
how to decrease the risk of herniation when doing a paramedian laparotomy?
make the incision LEFT paramedian, but do the abomasopexy RIGHT paramedian
what do you see when you open left flank to correct an LDA?
lesser omentumj
christiansen technique
1 step STANDING toggle pin placement using Spieker and lancet
which laparotomy is the only one you can use for volulus?
right flank laparotomy
which way do you turn a abomasal volvulus to correct?
clockwise
omentopexy involves…
suturing the GREATER omentum to the the body wall (ALL muscular layers just not skin) using mattress sutures Use during a right flank laparotomy
post op laparoscopic correction of displacements
-measure body temp 3x/day; if > 103.1 for more than 24 hours, then treat with antibiotics antibiotics are needed in 25% of cases cut toggle pin sutures after 4 weeks
what to remember when doing a paramedian laparotomy?
-make the incision LEFT paramedian, then do the abomasopexy on the RIGHT paramedian = less risk of herniation -skin MUST be closed with simple INTERRUPTED in case stepped on
prognosis for laparoscopic correction of displacements?
95-98%
Newman technique
1 step DORSAL toggle pin placement
Janowitz technique
2 step toggle pin placement Step 1: standing (insertion of toggle pins) Step 2: dorsal recumbency (toggle pins are tied to gauze roll)
contraindications for roll +blind tack or toggle pin approach (4)
-VOLVULUS -pre-existing respiratory condition because will be in dorsal -cows without a ping (NEED GAS IN ABOMASUM) -cows with concurrent abdominal disease or other gas filled structures like cecum
contraindications for paramedian laparotomy (3)
-unstable/shock (VOLVULUS, pneumonia, hypotension) because in dorsal -if you need to do exploratory -brisket edema
how to correct an LDA via left flank laparotomy
- get a hold of the abomasum using FORD INTERLOCKING pattern with SUPER LONG tags 2. partially deflate 3. feed tags to pexy site on right paramedian 4. push through wall with needle 5. push abomasum into position and suture ends around roll of gauze
prognosis for roll + blind tack or toggle pin approach
good (80-90%) BUT when there are complications they are usually super serious
what direction do you roll cow?
- right lateral 2. dorsal 3. left lateral 4. ventral
Babkin laparoscopic technique
hospital setting ONLY 1 step dorsal abomasopexy abomasopexy done in dorsal recumbency without no toggle pin
indication for left flank laparotomy
LDA ONLY
where does the laparoscopic and instrument portals go when cow is standing?
laparoscopic portal: caudal to last rib (13) instrument: cranial to 12th rib
which laparotomy approach is more cosmetic?
paramedian laparotomy
prognosis for LDA/RDA
90-95%
indications for using a paramedian laparotomy
done in dorsal recumbency -unable to stand/weak -ideal when adhesions (esp. ventral adhesions) **preferred method to fix a failed omento/pyloropexy -more cosmetic because scar hidden
prerequisites for using the rolling + blind tack or toggle pin approach (3)
-must have sufficient gas in abomasum (PING) -no adhesions -NO volvulus
what is the preferred method for fixing a failed omento/pyloropexy?
paramedian laparotomy
layers closed when doing a paramedian laparotomy
- peritoneum + internal rectus sheath with simple continuous 2. rectus abdominis + external rectus sheath: interrupted 3. skin MUST be closed with INTERRUPTED
negative and positive prognostic indicator for RVA
(-): L-lactate > 6 mmol (+): L-lactate < 2 mmol
Rueff’s method
used to cast cow into right lateral
which two pexy options can you use with a right flank laparatomy?
omentopexy or pyloropexy (used when omentum is fatty or friable)
where does the laparoscopic and instrument portals go for the Newman method (and second half of Janowtiz method)?
-laparoscopic portal: near umbilicus -instrument portal: RIGHT paramedian
prognosis for RVA
30-75% negative prognostic indicator: L-lactate > 6 mmol positive prognostic indicator: L-lactate < 2 mmol
which laparoscopic technique uses a spieker and lancet?
christiansen 1 step standing toggle pin placement
right flank laparotomy can be used for which types of displacement?
ANY type. But ideal for volvulus
this technique involves insufflating abdomen while cow is standing, but the technique itself is completed in dorsal recumbency
newman technique
