abomasal displacements and volvulus
DESCRIPTION
Abomasal Displacments and VolvulusTRANSCRIPT
![Page 1: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/1.jpg)
Abomasal Displacments and Volvulus
Dr. Satyajeet Singh
![Page 2: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/2.jpg)
Greater Omentum
Consists of 2 leaves Superficial leaf (1)
Left longitudinal groove of rumen
Greater curvature of abomasum and duodenum (2)
Deep leaf (3) Right longitudinal groove of rumen
Decending duodenum
Both leaves form sling for intestine
1 3
2
2
2
![Page 3: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/3.jpg)
Lessor Omentum (1)
Connects peritoneum between Liver (2) Lesser curvature of abomasum (3) Cranial duodenum (4)
Covers right side of omasum Key to other structures
Mesoduodenum (5) Greater omentum (6)
2
3
4
1
5
6
![Page 4: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/4.jpg)
Normal Anatomy – Left Flank
![Page 5: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/5.jpg)
Normal Anatomy – Right Flank
![Page 6: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/6.jpg)
Normal Anatomy - Ventral
![Page 7: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/7.jpg)
Incidence of Abomasal Displacement 10% RDA
90% LDA
91% occur within first 6 weeks of calving
Most likely to occur
Adult diary cattle in early postpartum period
Prevalence in well managed herd varies
0.2 – 2.5%
![Page 8: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/8.jpg)
Predisposing Factors
Abomasal atony High grain/low roughage diets
[VFA] Gas accumulation Distention
Roughage (large particles)
Stimulates rumination via touch receptors
Increases salivary buffer action
Hypocalcemia Milk fever
smooth muscle tone and motility
4.8 x risk of developing LDA than normocalcemic
![Page 9: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/9.jpg)
Predisposing Factors
Abomasal atony
Metritis, retained placenta, severe mastitis Endotoxins and endogenous pyrogens (IL-1) depress motility
Result in hypocalcemia
Electrolyte disturbances Lack of exercise/confinement
High producing diary cows
Large abdominal cavities more room for displacement
Genetic selection
![Page 10: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/10.jpg)
LDA Clinical Signs
Anorexia
fecal output
rumen motility
milk production
2o ketosis
Sunken left paralumbar fossa
![Page 11: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/11.jpg)
LDA Clinical Signs
Percussion left paralumber fossa Above/below line from point of
elbow to tuber coxae
Ping over gas filled portion of abomasum
![Page 12: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/12.jpg)
LDA Differential Diagnosis
Rumen tympany
Peritonitis
Pneumoperitoneum
Physometra
![Page 13: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/13.jpg)
LDA Diagnosis
Clinical signs
Percussion
Liptak test
Centesis area below gas ping in “abomasum”
Fluid pH < 4.5 Abomasum
Burnt almond odor of gas Abomasum
![Page 14: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/14.jpg)
Normal Transit
Simple LDA cases normal serum electrolyte
levels Normal acid/base balance
Anion Gap
H2CO3
-
Cl-
K+
Na+
![Page 15: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/15.jpg)
Normal Transit
Not a complete obstruction Chloride secreted in
abomasum Absorbed in small intestine
+ Mild hypochloremia
+ Mild metabolic alkalosis
![Page 16: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/16.jpg)
LDA – Right Flank
![Page 17: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/17.jpg)
LDA – Left Flank
![Page 18: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/18.jpg)
LDA - Ventral
![Page 19: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/19.jpg)
LDA Treatment
Medical techniques
Cast in right lateral recumbency Roll into dorsal recumbency/shake legs Roll over to left lateralrecumbency Stand
Surgical techniques
Right paralumbar fossa omentopexyLeft paralumbar fossa abomasopexyRight paramedian abomasopexyPercutaneous abomasopexy
![Page 20: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/20.jpg)
LDA Prevention
Diet
Prepartum introduction of ensiled/concentrate feeds
Slowly introduce concentrates post-calving
Increase particle size of forage
Prevent hypocalcemia
Manage periparturient inflammatory diseases
![Page 21: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/21.jpg)
RDA Clinical Signs and DDx
Clinical signs similar to LDA Differential diagnosis
Cecal dilitation or volvulus Gas in spiral colon Small intestinal obstruction or volvulus Torsion about root of mesentery Pneumorectum Pneumoperitoneum Physometra Abomasal volvulus
![Page 22: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/22.jpg)
RDA Diagnosis
Clinical signs
Precussion
Ping under last 5 ribs in dorsal abdomen
Rectal palpation
![Page 23: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/23.jpg)
Slow Transit
Potential for sequestration of HCl in abomasum Hyochloremia (loss of anions)
Obstruction
Reabsorption of Cl- by small intestine
![Page 24: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/24.jpg)
Slow Transit
Metabolic alkalosis Compensate for loss of Cl- kidney produces H2CO3
-
Hypokalemia Stabilize blood pH
K+ (extracellular) H+ (intracellular)
Paradoxic aciduria Perfusion in peripheral tissue
Aldosterone Reabsorb Na+ Secrete K+
Deplete K+ Reabsorb Na+ Secrete H+
![Page 25: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/25.jpg)
RDA – Right Flank
![Page 26: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/26.jpg)
RDA Treatment
Medical techniques
Rolling contraindicated
Progression to Abomasal volvulus
Surgical techniques
Difficult to distinguish RDA vs. AV
Right paralumbar fossa omentopexy or abomasopexy
Right paramedian abomasopexy
![Page 27: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/27.jpg)
AV Clinical Signs
Colic
Tachycardia (> 100 bpm)
Dehydration
Bilateral abdominal distention
Feces abscent or watery but scant
AV Compete obstruction of flow of ingestia through duodenum
![Page 28: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/28.jpg)
AV Differential Diagnosis
Cecal dilitation or volvulus
Gas in spiral colon
Small intestinal obstruction or volvulus
Torsion about root of mesentery
Right abomasal displacement
![Page 29: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/29.jpg)
AV Diagnosis
Clinical signs
Precussion
Ping
Extends from 8th rib to middle of right paralumbar fossa
Ventral border is horizontal
Fluid in abomasum
Ballottement
Rectal palpation
![Page 30: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/30.jpg)
AV Clinical Pathology
Similar to RDA but more severe
Hypochloremia
Hypohalemia
Metabolic alkalosis Metabolic acidosis
More chronic cases
Dehydration
Poor peripheral perfusion
Shock
![Page 31: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/31.jpg)
AV – Right Flank
Typical orientationCounterclockwise viewed from right flank
![Page 32: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/32.jpg)
AV - Ventral
![Page 33: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/33.jpg)
AV - Cranial
Typical orientationClockwise viewed from cranial
![Page 34: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/34.jpg)
RDA Treatment
Surgical Emergency
Preoperative
IV fluids with KCl
Hypertonic saline
Normasol
0.9% NaCl
NSAIDs
Broad spectrum antibiotics
![Page 35: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/35.jpg)
RDA Treatment
Surgical techniques
Right paralumbar fossa omentopexyBest choice Integrity of abomasum often compromisedAbomasopexy procedures do not work well
Progniosis
Depends on degree of damage to abomasal mucosa
Vagal indigestion syndrome common
![Page 36: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/36.jpg)
Proximal Paravertebral Nerve Block
T13, L1, and L2
Sensory and motor to Skin Fascia Muscle Peritoneum
![Page 37: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/37.jpg)
Proximal Paravertebral Nerve Block
Nerve most localized Intervertebral foramen Walk needle of caudle edge of transverse process Single site rather than dorsal and ventral branches
individually Transverse process slopes forward
Technique Injection site 3 – 4 cm from midline Local bled of 2% lidocaine hydrochloride Use 1 in 16-ga needle as trocar for 10 cm 20-ga needle
![Page 38: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/38.jpg)
Proximal Paravertebral Nerve Block
Technique Once transverse process encountered
Needle walked off caudle border and advanced 0.75 cm
10 ml 2% lidocaine hydrochloride
Temporary lateral deviation of spine Lumbar muscle paralysis
![Page 39: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/39.jpg)
Distal Paravertebral Nerve Block
Branches of T13, L1, and L2 blocked at ends of transverse processes of L1, L2, and L4 (not L3)
Technique 25 ml 2% lidocaine hydrochloride per site 18-ga needle inserted under each transverse
process 10 ml 2% lidocaine hydrochloride
![Page 40: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/40.jpg)
Distal Paravertebral Nerve Block
Technique Withdrawn short distance and redirected craniad
and caudad 2% lidocaine hydrochloride
Infiltration of ventral branches
![Page 41: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/41.jpg)
Distal Paravertebral Nerve Block
Technique Needle redirected dorsal and caudal to transverse
process 2% lidocaine hydrochloride
Infiltration of dorsolateral branches
No deviation of spine No lumbar muscle paralysis
![Page 42: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/42.jpg)
Inverted L Nerve Block
Vertical line passes caudal to last rib Horizontal line passes ventral to transverse
processes 100 ml 2% lidocaine hydrochloride
![Page 43: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/43.jpg)
Right Paralumbar Fossa Omentopexy
Vertical incision in middle of paralumbar fossa 3 – 5 cm ventral to transverse processes 20 – 25 cm long
Skin SQ
![Page 44: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/44.jpg)
Right Paralumbar Fossa Omentopexy
External abdominal oblique muscle Internal abdominal oblique muscle Aponeurosis of transverse abdominal muscle Peritoneum
![Page 45: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/45.jpg)
LDA Decompression
14 gauge needle attached to sterile suction hose
![Page 46: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/46.jpg)
LDA Decompression
14 gauge needle attached to sterile suction hose
![Page 47: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/47.jpg)
LDA Manipulation
Abomasum returned to normal position Follow peritoneal surfaces ventrally Hand between rumen and body wall Elevate caudal ventral blind sac of rumen
![Page 48: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/48.jpg)
LDA Manipulation
Abomasum returned to normal position Follow peritoneal surfaces ventrally Hand between rumen and body wall Elevate caudal ventral blind sac of rumen
![Page 49: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/49.jpg)
Right Paralumbar Fossa Omentopexy Gently pull omentum out through incision Retract dorsad and caudad until pylorus is visualized
Omentum on both sides of pylorus Palpable firmness of torus pyloricus muscle
Omentopexy Close to pyloroduodenal
junction 3 – 4 cm caudal Appendage “sows ear”
6 – 8 cm vertical section of greater omentum
Distribute pexy of wide area
![Page 50: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/50.jpg)
Right Paralumbar Fossa Omentopexy #2 or #3 chromic gut Incorporate omentum in peritoneum and
transversus abdominal muscle closure
![Page 51: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/51.jpg)
Right Paralumbar Fossa Omentopexy External/internal abdominal oblique muscles
closure Single layer, simple continuous pattern, #2 - #3
chromic gut
Skin closure Ford interlocking pattern, #3 polymerized
caprolactam (Vetafil)
![Page 52: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/52.jpg)
AV Decompression
14 gauge needle attached to sterile suction hose
![Page 53: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/53.jpg)
AV Manipulation
Typical orientationCounterclockwise
Viewed from right flank
Viewed from rear
![Page 54: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/54.jpg)
Advantages and Disadvantages: Right Paralumbar Fossa Omentopexy
Prognosis LDA 86% - 90% Complications
Redisplacement 3.6% - 4.2% Incisional infection Peritonitis
Advantages Animal in standing position Surgeon can perform procedure alone Allows abdomial exploration Used to correct LDA, RDA, and AV
Disadvantages More skill
Proper position of abomasum Proper area for fixation
Abomasum position less anatomically correct than abomasopexy Not good if suspect adhesions beteen abomasum and left body wall
![Page 55: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/55.jpg)
Left Paralumbar Fossa Abomasopexy
Identify abomasum
![Page 56: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/56.jpg)
Left Paralumbar Fossa Abomasopexy Well distented abomasum Along greater curvature
2 – 3 cm from attachment of greater omentum
Ford interlocking pattern 5 – 7 cm Bites through submucosa
#2 - #3 monofilament, non-absorbable 2 m long 2 long tags with straight needles
Decompress abomasum
![Page 57: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/57.jpg)
Left Paralumbar Fossa Abomasopexy Anchor suture tags
Cranial site 10 cm caudal/right of xiphoid process
Pass cranial suture through ventral abdomin
Assistant applies pressure of site with hemostats
Assistant pulls needle through skin
Repeat with caudal suture
![Page 58: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/58.jpg)
Left Paralumbar Fossa Abomasopexy Reduction of abomasum Each suture is placed through a sponge
before being tied
![Page 59: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/59.jpg)
Advantages and Disadvantages: Left Paralumbar Fossa Abomasopexy
Prognosis 83.5% - 94%
Complications
Entrapment of small intestine between abomasum and body wall
Abomasal fistula formation if
Suture penetrates abomasal mucosa
Suture not removed in 2 – 3 weeks
Advantages Animal in standing position Best choice for cows in advanced pregnancy (> 7 months) Best choice for rumenotomy with concurrent TRP
Disadvantages Only for LDA not for RDA or AV Requires assistant to guide needle placement
![Page 60: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/60.jpg)
Percutaneous Abomasopexy
Toggle 5 cm long plastic rod
30 cm long nylon suture
Trocar with stylet Used to place toggle in the
abomasum
![Page 61: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/61.jpg)
Percutaneous Abomasopexy
Abomasum repositioned Position of abomasum
identified
![Page 62: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/62.jpg)
Percutaneous Abomasopexy
Trocar with stylet inserted into abomasum Stylet removed
Abomasal odor confirmed
First toggle passed through cannula to abomasum
![Page 63: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/63.jpg)
Percutaneous Abomasopexy
Trocar with stylet inserted into abomasum Stylet removed
Abomasal odor confirmed
Second toggle passed through cannula to abomasum
![Page 64: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/64.jpg)
Percutaneous Abomasopexy
Ends of suture tied around a sponge
![Page 65: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/65.jpg)
Advantages and Disadvantages: Percutaneous Abomasopexy
Prognosis 80% - 88%
Complications
Pexy viscera or omentum
Abomasal rupture at suture site
Peritonitis
Abomasal obstruction
Advantages Quick, inexpensive, easy to perform
May be good choice for cows that are poor surgical candidates
Disadvantages Requires dorsal recumbency
Only for LDA not for RDA or AV
Requires assistants
Abomasum must be distended with gas
![Page 66: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/66.jpg)
Laparascopic Assisted Abomasopexy Minimally invasive technique for surgical correction of LDA
Developed to reduce incidence of complications
Traditional laparotomy
Percutaneous toggle placement
![Page 67: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/67.jpg)
Laparascopic Assisted Abomasopexy Advantages
Reduced surgical time and cost
Reduced healing time
Can immediately go back into production
Reduced milk discarding
Antibiotics not required
Allows abdominal exploratory
Any degree of gas distention
Even minimally dilated
![Page 68: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/68.jpg)
Laparascopic Assisted Abomasopexy Two-step technique
Toggle placement – standing
Suture retrieval – dorsal recumbency
One-step technique
Dorsal resumbency
One-step technique
Standing
![Page 69: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/69.jpg)
Laparascopic Assisted Abomasopexy Single toggle
Toggle bar
Stainless steel with central recess
Epoxy filling recess securing suture to toggle
Suture
Twin 80cm strands
Marker 4.5 cm from toggle bar
Marker
![Page 70: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/70.jpg)
Two-Step Technique: Step 1 - Standing
Left paralumbar fossa and last 3 ribs aseptically preped
2 local blebs (5 ml) 2% lidocaine
2 stab incisions (1 cm)
Laparascope portal (I)
10 cm caudal to last rib 10 cm ventral to transverse process
Instrument portal (II)
11th intercostal space 20 cm ventral to spinous process
II I
![Page 71: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/71.jpg)
Two-Step Technique: Step 1 - Standing
Pneumoperitoneum
Left paralumbar fossa
Position I
Veress needle with silicon tubing
Insufflation pump
![Page 72: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/72.jpg)
Two-Step Technique: Step 1 - Standing
Trocar-cannula assembly inserted in left paralumbar fossa (I) through stab incision
Laparascope inserted into cannula
Abdominal exploratory
![Page 73: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/73.jpg)
Two-Step Technique: Step 1 - Standing
Endoscopic picture of LDA
![Page 74: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/74.jpg)
Two-Step Technique: Step 1 - Standing
Trocar-cannula assembly inserted in 11th ICS (II) through stab incision
Instrument portal
![Page 75: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/75.jpg)
Two-Step Technique: Step 1 - Standing
Toggle trocar passed through instrument portal and inserted into abomasum
Toggle bar passed through trocar into abomasal lumen
![Page 76: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/76.jpg)
Two-Step Technique: Step 1 - Standing
Abomasum decompressed Excess toggle suture fully
inserted into abdomen Toggle trocar & laparascope
removed Skin incisions closed
Single interrupted suture
![Page 77: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/77.jpg)
Two-Step Technique: Step 2 – Dorsal Recumbency
Right parameadian area aseptically preped 2 local blebs (5 ml) 2% lidocaine 2 stab incisions (1 cm)
Laparascope portal (III) 5 cm lateral from midline
20 cm distal to xyphoid
Instrument portal (IV) 5 cm lateral from midline
10 cm distal to xyphoid
![Page 78: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/78.jpg)
Two-Step Technique: Step 2 – Dorsal Recumbency
Laparascope and grasping forceps inserted through portals
![Page 79: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/79.jpg)
Two-Step Technique: Step 2 – Dorsal Recumbency
Abomasum and suture material identified
Suture retrieved using grasping forceps
![Page 80: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/80.jpg)
Two-Step Technique: Step 2 – Dorsal Recumbency
Excess suture withdrawn through instrument portal up to preset marker on suture
Abomasum in proper anatomical position
Remove laparasope and cannulas
Skin incisions closed Single interrupted suture
![Page 81: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/81.jpg)
Two-Step Technique: Step 2 – Dorsal Recumbency
Suture ends each passed through separate 14 ga needles inserted through gauze stent
Needles removed Suture tied over gauze stent
Leave 3 cm of play in suture
Suture removed after 3 – 4 weeks
![Page 82: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/82.jpg)
One-Step Technique - Dorsal Recumbency
Animal is sedated and placed in dorsal recumbency
Area aseptically prepared from
Xyphoid process to 10 cm caudal to umbilicus Width of 20 cm each side of ventral midline
![Page 83: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/83.jpg)
One-Step Technique - Dorsal Recumbency
3 local blebs (5 ml) 2% lidocaine 3 stab incisions (1 cm) Portal site I (laparoscope)
2 cm left of umbilicus
Portal site II (grasping forceps) 3 cm caudal and 7 cm right of xyphoid process
Portal site III (needle holder) 5 cm right and 3 cm cranial to umbilicus
![Page 84: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/84.jpg)
One-Step Technique - Dorsal Recumbency
Fixation site IV 10 cm long line block using 2% lidocaine 3 - 5 cm right of linea alba Centered between umbilicus and xyphoid
process Four 1-cm long skin incisions
Perpendicular to ventral midline
Spaced 2.5 cm apart
![Page 85: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/85.jpg)
One-Step Technique - Dorsal Recumbency
I
II III
IV
![Page 86: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/86.jpg)
One-Step Technique - Dorsal Recumbency
Grasping forceps used to locate abomasum
Grasp abomasum in middle of greater curvature
2 – 3 cm from greater omentum attachment Fixation site
![Page 87: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/87.jpg)
One-Step Technique - Dorsal Recumbency
2 PDS suture with curved needle (1/2, 40mm) is used Needle straightened to facilitate manipulation of
needle
Needle introduced into abdomen through one of cutaneous incisions
Needle grasped intra-abdominally using needle holder
![Page 88: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/88.jpg)
One-Step Technique - Dorsal Recumbency
Needle and suture passed through serous and muscular layers of abomasum Stitch measuring 2 cm Running perpendicular to greater curvature
Site inspected for gas or fluid leakage
![Page 89: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/89.jpg)
One-Step Technique - Dorsal Recumbency
18 G needle inserted through abdominal wall Used as guide to exteriorize needle and suture
Suture pulled out of abdominal cavity
![Page 90: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/90.jpg)
One-Step Technique - Dorsal Recumbency
3 other sutures are placed in similar fashion
Correct positioning of abomasum verified by pulling gently on sutures to approximate abomasum to body wall
![Page 91: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/91.jpg)
One-Step Technique - Dorsal Recumbency
Sutures are knotted
Cutaneous incisions closed
![Page 92: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/92.jpg)
One-Step Technique - Dorsal Recumbency
Adhesions 3 months post-operatively
![Page 93: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/93.jpg)
One-Step Technique - Dorsal Recumbency
Follows two-step technique Except once toggle bar inserted into abomasum,
suture ends not passed into abdominal cavity
Specially designed instrument is used to drive toggle suture from left flank to ventral abdomen
Suture is tied as in two-step technique
![Page 94: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/94.jpg)
Right Paramedian Abomasopexy Incision
15 – 20 cm long, parallel and 3 – 4 cm right of midline Extending caudal from a point 4 – 8 cm caudal to xiphoid
Six distinct layers Skin SQ fascia
Deep pectoral muscle in cranial 1/3 External rectus sheath Rectus abdominus muscle Internal rectus sheath Peritoneum
![Page 95: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/95.jpg)
Right Paramedian Abomasopexy Exploratory Decompress abomasum and
exteriorize Identify pylorus
Omentum on both sides of pylorus
Palpable firmness of torus pyloricus muscle
Identify greater omentum Greater curvature (arrow)
Sweeps to left side of rumen Covering ventral surface of rumen
![Page 96: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/96.jpg)
Right Paramedian Abomasopexy Abomasopexy
3 horizontal mattress sutures
Lateral aspect of greater curvature of abomasum free of omentum
Seromuscular layer
Peritoneum and internal rectus sheath #2 chromic gut
Simple continuous pattern Peritoneum and internal rectus sheath At least 6 bites incorporating abomasum
Seromuscular layer
![Page 97: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/97.jpg)
Right Paramedian Abomasopexy Closure
External rectus sheath Horizontal mattress pattern
#3 chromic gut
Skin Ford interlocking pattern
#3 polymerized caprolactam (Vetafil)
![Page 98: Abomasal displacements and volvulus](https://reader033.vdocuments.net/reader033/viewer/2022061607/5587ed24d8b42a7e4b8b463f/html5/thumbnails/98.jpg)
Advantages and Disadvantages:
Right Paramedian Abomasopexy
Prognosis 83.5% - 95% Complications
Incisional hemorrhage, dehiscence, herniation or fistulation
Advantages Strong adhesions develop between abomasum and body wall Abomasum returns near normal position during placing in dorsal recumbency Correct LDA, RDA or AV
Disadvantages Dorsal recumbency
Bloat, regurgitation, aspiration
Requires assistants