Changes

Three general laparoscopic techniques have been developed, the two-step (Janowitz) <ref>Janovitz, H. (1998) Laparoskopische Reposition und Fixation des nach links verlagerten Labmagens beim Rind. Tierarztl Prax, 26 (G), 308-313</ref>, the one-step (Christiansen/Barisani) procedures<ref>Christiansen K. Laparoskopisch kontrollierte Operation des nach links verlagerten Labmagens (Janowitz-Operation) ohne Ablegen des Patienten. Tierärz Prax, 2004; 32(5):118-121.</ref><ref>Barisani C. Evoluzione della tecnica di Janowitz per la risoluzione della dislocazione abomasale sinistra secondo Barisani. Summa, 2004; 5:35-39.</ref>, and the recumbent one-step method (Newman) <ref>Newman KD, Anderson DE, Silveira F. One-step laparoscopic abomasopexy for correction of left-sided displacement of the abomasum in dairy cows. JAVMA, 2005; 227(7):1142-1147, 1090</ref>. Both the Janowitz and Christiansen/Barisani methods start with port placement in the left paralumbar fossa of the standing cow, followed by abomasal trocharisation under laparoscopic guidance, modified toggle placement and deflation of the displaced abomasum. Then, in the two-step Janowitz procedure, the cow is rolled, two more portals are placed ventrally, and the suture line of the preplaced toggle is retrieved and tied externally around a piece of gauze. In the standing one-step method, a special tool (spieker) is introduced through the left 11-12 intercostal space or through the paralumbar fossa and is used to push the toggle (and abomasum) ventrally and pierce the body wall in the desired location, where it is again tied externally. In the recumbent one-step method (Newman), the cow is anaesthetised in dorsal recumbency and an intracorporeal suture line is placed under laparoscopic guidance to anchor the abomasal body to the ventral abdominal wall, reducing the risk of abomasal fistula formation by avoiding perforation of the abomasal lumen.  

Three general laparoscopic techniques have been developed, the two-step (Janowitz) <ref>Janovitz, H. (1998) Laparoskopische Reposition und Fixation des nach links verlagerten Labmagens beim Rind. Tierarztl Prax, 26 (G), 308-313</ref>, the one-step (Christiansen/Barisani) procedures<ref>Christiansen K. Laparoskopisch kontrollierte Operation des nach links verlagerten Labmagens (Janowitz-Operation) ohne Ablegen des Patienten. Tierärz Prax, 2004; 32(5):118-121.</ref><ref>Barisani C. Evoluzione della tecnica di Janowitz per la risoluzione della dislocazione abomasale sinistra secondo Barisani. Summa, 2004; 5:35-39.</ref>, and the recumbent one-step method (Newman) <ref>Newman KD, Anderson DE, Silveira F. One-step laparoscopic abomasopexy for correction of left-sided displacement of the abomasum in dairy cows. JAVMA, 2005; 227(7):1142-1147, 1090</ref>. Both the Janowitz and Christiansen/Barisani methods start with port placement in the left paralumbar fossa of the standing cow, followed by abomasal trocharisation under laparoscopic guidance, modified toggle placement and deflation of the displaced abomasum. Then, in the two-step Janowitz procedure, the cow is rolled, two more portals are placed ventrally, and the suture line of the preplaced toggle is retrieved and tied externally around a piece of gauze. In the standing one-step method, a special tool (spieker) is introduced through the left 11-12 intercostal space or through the paralumbar fossa and is used to push the toggle (and abomasum) ventrally and pierce the body wall in the desired location, where it is again tied externally. In the recumbent one-step method (Newman), the cow is anaesthetised in dorsal recumbency and an intracorporeal suture line is placed under laparoscopic guidance to anchor the abomasal body to the ventral abdominal wall, reducing the risk of abomasal fistula formation by avoiding perforation of the abomasal lumen.  

Advantages of laparoscopic methods include a more rapid procedure, faster recovery to milk and gastrointestinal motility and lower postoperative morbidity/mortality (compared with right flank omentopexy)<ref>Wittek, T., Locher, L.F., Alkaassem, A., Constable, P.D. (2009) Effect of surgical correction of left displaced abomasum by means of omentopexy via right flank laparotomy or two-step laparoscopy-guided abomasopexy on postoperative abomasal emptying rate in lactating dairy cows. Journal of the American Veterinary Medical Association. 5, 652-657.</ref>, and validation of toggle placement, lower morbidity/mortality, visualisation of concurrent pathology, and a lower redisplacement rate (vs blind toggle placement). The prime disadvantages are the cost of the equipment required, and a steep learning curve for intracorporeal suturing (Newman method). Laparoscopic techniques for correction of right-sided displacements and cases of abomasal volvulus have also been developed <ref>Kümper H, Seeger T (2003) Labmagenverlagerung beim erwachsenen Rind. Teil 3: Therapie (Fortsetzung), prae- und postoperative Behandlung, Prognose. Tierärztliche Praxis, 31 (G), 224-230</ref>.

Advantages of laparoscopic methods may include a more rapid procedure, faster recovery to milk and gastrointestinal motility and lower postoperative morbidity/mortality (compared with right flank omentopexy) <ref>Wittek, T., Locher, L.F., Alkaassem, A., Constable, P.D. (2009) Effect of surgical correction of left displaced abomasum by means of omentopexy via right flank laparotomy or two-step laparoscopy-guided abomasopexy on postoperative abomasal emptying rate in lactating dairy cows. Journal of the American Veterinary Medical Association. 5, 652-657.</ref>, and validation of toggle placement, lower morbidity/mortality, visualisation of concurrent pathology, and potentially a lower redisplacement rate (vs blind toggle placement). The prime disadvantages are the cost of the equipment required, and a steep learning curve for intracorporeal suturing (Newman method). Laparoscopic techniques for correction of right-sided displacements and cases of abomasal volvulus have also been developed <ref>Kümper H, Seeger T (2003) Labmagenverlagerung beim erwachsenen Rind. Teil 3: Therapie (Fortsetzung), prae- und postoperative Behandlung, Prognose. Tierärztliche Praxis, 31 (G), 224-230</ref>.

   

   

It is important for all surgical techniques that post-operatively the cow is given a large amount of roughage and concentrates are introduced into the diet slowly.

It is important for all surgical techniques that post-operatively the cow is given a large amount of roughage and concentrates are introduced into the diet slowly.