Surgical Correction of Abomasal Displacements

Question 1

2 step toggle pin placement Step 1: standing (insertion of toggle pins) Step 2: dorsal recumbency (toggle pins are tied to gauze roll)

Answer 1

janowtiz technique

Question 2

what method is used to cast cow into right lateral?

Answer 2

Rueff’s method

Question 3

layers you close when doing a flank laparotomy (3)

Answer 3

1. peritoneum and transverse abdominus (incorporate greater omentum if you did a pexy) 2. close internal and external oblique mm 3. skin

Question 4

pyloropexy site

Answer 4

1 cm cranial to ventral end of right flank laparotomy incision

Question 5

what type of suture pattern do you use for omentopexy and pyloropexy?

Answer 5

mattress sutures; incorporate peritoneum and all muscular layers, just NOT skin

Question 6

what closed technique can be used for abomasal displacements

Answer 6

roll +blind tack or toggle pin can NOT be used for volvulus

Question 7

how to decrease the risk of herniation when doing a paramedian laparotomy?

Answer 7

make the incision LEFT paramedian, but do the abomasopexy RIGHT paramedian

Question 8

what do you see when you open left flank to correct an LDA?

Answer 8

lesser omentumj

Question 9

christiansen technique

Answer 9

1 step STANDING toggle pin placement using Spieker and lancet

Question 10

which laparotomy is the only one you can use for volulus?

Answer 10

right flank laparotomy

Question 11

which way do you turn a abomasal volvulus to correct?

Answer 11

clockwise

Question 12

Answer 12

Question 13

omentopexy involves…

Answer 13

suturing the GREATER omentum to the the body wall (ALL muscular layers just not skin) using mattress sutures Use during a right flank laparotomy

Question 14

post op laparoscopic correction of displacements

Answer 14

-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

Question 15

what to remember when doing a paramedian laparotomy?

Answer 15

-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

Question 16

prognosis for laparoscopic correction of displacements?

Answer 16

95-98%

Question 17

Newman technique

Answer 17

1 step DORSAL toggle pin placement

Question 18

Janowitz technique

Answer 18

2 step toggle pin placement Step 1: standing (insertion of toggle pins) Step 2: dorsal recumbency (toggle pins are tied to gauze roll)

Question 19

contraindications for roll +blind tack or toggle pin approach (4)

Answer 19

-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

Question 20

contraindications for paramedian laparotomy (3)

Answer 20

-unstable/shock (VOLVULUS, pneumonia, hypotension) because in dorsal -if you need to do exploratory -brisket edema

Question 21

how to correct an LDA via left flank laparotomy

Answer 21

1. 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

Question 22

prognosis for roll + blind tack or toggle pin approach

Answer 22

good (80-90%) BUT when there are complications they are usually super serious

Question 23

what direction do you roll cow?

Answer 23

1. right lateral 2. dorsal 3. left lateral 4. ventral

Question 24

Babkin laparoscopic technique

Answer 24

hospital setting ONLY 1 step dorsal abomasopexy abomasopexy done in dorsal recumbency without no toggle pin

Question 25

indication for left flank laparotomy

Answer 25

LDA ONLY

Question 26

where does the laparoscopic and instrument portals go when cow is standing?

Answer 26

laparoscopic portal: caudal to last rib (13) instrument: cranial to 12th rib

Question 27

which laparotomy approach is more cosmetic?

Answer 27

paramedian laparotomy

Question 28

prognosis for LDA/RDA

Answer 28

90-95%

Question 29

indications for using a paramedian laparotomy

Answer 29

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

Question 30

prerequisites for using the rolling + blind tack or toggle pin approach (3)

Answer 30

-must have sufficient gas in abomasum (PING) -no adhesions -NO volvulus

Question 31

what is the preferred method for fixing a failed omento/pyloropexy?

Answer 31

paramedian laparotomy

Question 32

layers closed when doing a paramedian laparotomy

Answer 32

1. peritoneum + internal rectus sheath with simple continuous 2. rectus abdominis + external rectus sheath: interrupted 3. skin MUST be closed with INTERRUPTED

Question 33

negative and positive prognostic indicator for RVA

Answer 33

(-): L-lactate > 6 mmol (+): L-lactate < 2 mmol

Question 34

Rueff’s method

Answer 34

used to cast cow into right lateral

Question 35

which two pexy options can you use with a right flank laparatomy?

Answer 35

omentopexy or pyloropexy (used when omentum is fatty or friable)

Question 36

where does the laparoscopic and instrument portals go for the Newman method (and second half of Janowtiz method)?

Answer 36

-laparoscopic portal: near umbilicus -instrument portal: RIGHT paramedian

Question 37

prognosis for RVA

Answer 37

30-75% negative prognostic indicator: L-lactate > 6 mmol positive prognostic indicator: L-lactate < 2 mmol

Question 38

which laparoscopic technique uses a spieker and lancet?

Answer 38

christiansen 1 step standing toggle pin placement

Question 39

right flank laparotomy can be used for which types of displacement?

Answer 39

ANY type. But ideal for volvulus

Question 40

this technique involves insufflating abdomen while cow is standing, but the technique itself is completed in dorsal recumbency

Answer 40

newman technique