RIGHT FLANK ABOMASOPEXY

By: Occeña, Pitonang, Morales, Tulba

INDICATIONS:

TREATMENT OF RIGHT-SIDED DISPLACEMENT AND DILATATION OF THE ABOMASUM OR RIGHT SIDED TORSION OF THE ABOMASUM

Site of incision…

LOCAL ANESTHESIA IS INSTITUTED BY PERFORMING A PARAVERTEBRAL BLOCK, INVERTED L BLOCK, OR A LINE BLOCK

LINE BLOCK…

ADDITIONAL INSTRUMENTATION

STERILE, MEDIUM SIZED STOMACH TUBE, 12 GAUGE NEEDLE AND STERILE TUBING, AND A LARGE, STRAIGHT, CUTTING, NEEDLE OR S-SHAPED CURVED CUTTING NEEDLE.

A 20-25cm INCISION IS MADE

THE COLOR OF THE ABOMASAL SEROSA IS ASCERTAINED BEFORE ONE ATTEMPTS TO DEFLATE THE ABOMASUM OR CORRECT ITS POSITION

A 12-GAUGE NEEDLE WITH RUBBER TUBING ATTACHED IS INSERTED TO RELIEVE THE GASEOUS PRESSURE AND TO FACILITATE FURTHER EXPLORATION AND MANIPULATION THE NEEDLE IS PLACED IN THE DORSAL PORTION OF THE ABOMASUM AND IS INSERTED AT AN ANGLE TO OBVIATE LEAKAGE WHEN THE NEEDLE IS WITHDRAWN

IT IS EASIER TO REMOVE GAS AND FLUID BEFORE DETORSION BECAUSE THE ABOMASUM IS

CLOSER TO THE INCISION

A 8- TO 12-CM SIMPLE CONTINOUS OR INTERLOCKING SUTURE LINE OF HEAVY POLYMERIZED CAPROLACTAM IS PLACED IN THE GREATER CURVATURE OF THE ABOMASUM 5 TO 7CM FROM THE ATTACHMENT OF THE GREATER OMENTUM (Fig. 1).

Fig. 1

THE SUTURE BITES PASS THROUGH THE SUBMUCOSA, AND A METER OF SUTURE MATERIAL SHOULD EXTEND FROM EACH END OF THE SUTURE LINE. HEMOSTATS ARE PLACED ON THESE SUTURE ENDS IN SUCH A FASHION THAT THE CRANIAL AND CAUDAL ENDS ARE EASILY IDENTIFIED

IT IS IMPORTANT THAT THE ABOMASUM NOT BE DEFLATED PRIOR TO THE INSERTION OF THE SUTURE; OTHERWISE, THE SITE FOR SUTURE PLACEMENT MAY BE RETRACTED AWAY FROM THE INCISION

THE CRANIAL END OF THE POLYMERIZED CAPROLACTAM IS ATTACHED TO A LARGE, STRAIGHT, CUTTING NEEDLE OR TO AN S-CURVED CUTTING NEEDLE; THIS NEEDLE IS CARRIED ALONG THE INTERNAL BODY WALL TO A POSITION RIGHT OF MIDLINE, BUT MEDIAL TO THE SUBCUTANEOUS VEIN AND 15CM CAUDAL TO THE XIPHOID PROCESS. THE FOREFINGER PROTECTS THE END OF THE NEEDLE, AND THE LATERAL FINGERS REFLECT THE VISCERA AWAY FROM THE BODY WALL AND AHEAD OF THE NEEDLE

AN ASSISTANT CAN APPLY UPWARD PRESSURE ON THE ABDOMINAL WALL IN THE AREA WHERE THE NEEDLES ARE TO BE INSERTED THROUGH THE BODY WALL. AN EMPTY SYRINGE CASE WORKS WELL FOR THIS PURPOSE.THE NEEDLE IS INSERTED THROUGH THE VENTRAL BODY WALL (Fig 2).

Fig 2 (applicable also to RDA)

THE ASSISTANT GRASPS THE NEEDLE , AND THE CAUDAL SUTURE IS PLACED THROUGH THE BODY WALL 8 TO 12CM CAUDAL TO THE CRANIAL SUTURE. THE ASSISTANT THEN GRASPS THE TWO SUTURE ENDS AND APPLIES GENTLE TRACTION; AT THE SAME TIME, THE SURGEON PUSHED THE DEFLATED ABOMASUM INTO ITS NORMAL POSITION. WHEN THE SUTURED AREA OF THE ABOMASUM IS LYING AGAINST THE FLOOR OF THE ABDOMEN, THE ASSISTANT TIES THE SUTURE ENDS TOGETHER (Fig 3). THE SUTURE IS LEFT IN PLACE FOR FOR 4 WEEKS; THE ENDS ARE THEN CUT AS CLOSE TO THE SKIN AS POSSIBLE

Fig 3

Incision is sutured routinely…

ANIMALS WITH RDA NEED INTENSE FLUID THERAPY WITH PARTICULAR EMPHASIS ON REPLACEMENT OF THE CHLORIDE DEFICIT

FOR THIS PURPOSE, 0.9% SODIUM CHLORIDE SOLUTION IS GENERALLY APPROPRIATE

SUPPLEMENTATION WITH POTASSIUM CHLORIDE MAY ALSO BE INDICATED. WITH ADEQUATE FLUID AND ELECTROLYTE THERAPY

ANTIBIOTICS ARE ADMINISTERED POSTOPERATIVELY

The End…(^_^)