Changes

Toggles are useful in low value animals as it is a cheap and fast technique.  The animal is cast and rolled onto her back. Two toggles are inserted through the ventral abdominal wall into the abomasal lumen. Once positioned the two toggles are tied together. Following this blind suture it is possible to toggle the incorrect area (e.g. rumen, reticulum) resulting in fatal complications. To avoid this complication a pH strip can be used to confirm the correct location following cannulation before the toggles are put in place.  

Toggles are useful in low value animals as it is a cheap and fast technique.  The animal is cast and rolled onto her back. Two toggles are inserted through the ventral abdominal wall into the abomasal lumen. Once positioned the two toggles are tied together. Following this blind suture it is possible to toggle the incorrect area (e.g. rumen, reticulum) resulting in fatal complications. To avoid this complication a pH strip can be used to confirm the correct location following cannulation before the toggles are put in place.  

*'''Right flank omentopexy'''

*'''Right flank (pyloro-)omentopexy'''

The right flank is incised one hands distance behind the last rib and the displaced abomasum is located. The organ is then deflated and repositioned in the correct location. The abomasum is sutured to the abdominal wall and the incision is closed in a routine manor.

The right flank is incised one hands distance behind the last rib and the displaced abomasum is located. The organ is then deflated and repositioned in the correct location. The omentum (+/- pylorus) is sutured to the abdominal wall and the incision is closed in a routine manor.

*'''Left flank omentopexy'''

*'''Left flank abomasopexy/Utrecht'''

The left flank is incised just caudal to the last rib and the omentum adjacent to the abomasum is located. A long nylon suture is passed through the fat a few times and then both ends through separate points on the ventral body wall. An assistant can help locate the correct position for the suture to be passed by palpating the region with a pair of artery forceps. The two pieces of suture are tied externally and hold the abomasum in the correct position whilst adhesions form.

The left flank is incised just caudal to the last rib and the omentum adjacent to the abomasum is located. A continuous, partial thickness nylon or absorbable suture line with long tails is placed in the body of the abomasum then both ends are passed through separate points on the ventral body wall. An assistant can help locate the correct position for the suture to be passed by palpating the region with a pair of artery forceps. The two pieces of suture are tied externally and hold the abomasum in the correct position whilst adhesions form.

*Right paramedian abomasopexy

*'"Right paramedian abomasopexy"'

For this technique the cow is sedated and cast onto her back. An incision is made to the right of midline caudal to the most posterior part of the sternum. The abomasum is located, repositioned and sutured to the body wall.  

For this technique the cow is sedated and cast onto her back. An incision is made to the right of midline caudal to the most posterior part of the sternum. The abomasum is located, repositioned and sutured to the body wall.

 

Two general laparoscopic techniques have been developed, the two-step (Janowitz) and the one-step (Christianssen/Barisani) procedures. Both 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 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 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. Advantages include a more rapid procedure, faster recovery to milk and gastrointestinal motility and lower postoperative morbidity/mortality (compared with right paralumbar fossa omentopexy), and validation of toggle placement, lower morbidity/mortality, visualisation of concurrent pathology, and a lower redisplacement rate (vs blind toggle placement). The prime disadvantage is the cost of the equipment required. Laparoscopic techniques for correction of right-sided displacements and cases of abomasal volvulus have also been developed.

   

   

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.