Right flank omentopexy vs Utrecht (left flank)

Re: Right flank omentopexy vs Utrecht (left flank)

David Mills — Fri, 02 Mar 2012 15:26:34 GMT

I don't like 'nevers' and dogma so I would say try the different ones out for yourself. As far as published evidence goes, there seems to be little to choose between Utrecht and R approach, so I suppose it's like doing a cat spay flank or midline - each have their pros, cons and their place. An underestimated aspect can be the size of the cow and the area you work in and even the farm - for some peculiar reason, some farms have recurrence with one not t'other and some toggle 100% without issue. As Mr Woodhouse has expounded, it is better to have competence in at least two lest one proves tricky - hence why the 'never had to do xyz' is unhelpful because one size doesn't fit all.

As to two sided approach I really struggle to see a justification for this apart from during learning. The increase in morbidity for the cow is unjustifiable I think for a routine procedure when others are available that are equally effective and places less post-op stress on the animal.

As an aside, I do shake my head at this avoidance and condemnation of toggling - as Mr Woodhouse says it you're going to struggle with a cow on her back then you may as well, if it doesn't hold then you can always proceed to an op later on.

Re: Right flank omentopexy vs Utrecht (left flank)

Michael Woodhouse — Fri, 02 Mar 2012 14:18:37 GMT

Hello,

I have done DA's by every recognised method that I know of. My invasive surgical approach of choice is a paramedian. Now you need a bit of help and muscle to get them upside down but the surgery is very easy and I personally believe the pexy is in the most anatomically correct place. I have had very very few problems, but occasionally find something wired when I get in (yellow fatty liver, ulcers and once a huge abscess from a traumatic reticulitis). I'd guess 95% success rate (in uncomplicated cases).

I only do the right flank approach for RDAs and claim a 50:50 success rate.

Toggling I reserve for low value cows that the owner doesn't want to pay for surgery. IF I am going to the trouble of rolling the cow I will toggle at the same time. I do it without any sedation and is very quick (and I'm sure more profitable!). We charge about half what we do for the op. In my hands I would guess 80% success rate but some farms very much better and some farms very much less. You can always go in and operate if the toggle 'fails'. I suspect the lower success reflects the fact that you can't see what is going on and some are complicated cases that you just don't appreciate. I do think it has its place.

I have also done ~30 cows using the laproscope (kit sold in the UK by Vet Instrumentation). My old boss went to BCVA when the Dutch gentleman spoke about it and bought the kit. There is a knack to it but it's quite fast and the cows tolerate it very well. Been into a couple of cows and there has been another obvious problem (peritonitis mainly, but you can see ulcers etc). If all goes well you can be packing stuff back in your car in 30 minutes. The main problem was too many cows died for no apparent reason (I'm guessing 5 out of 50, so 10%). I'd put the overall success in uncomplicated cases at 85%+. Now that I own my own practice not sure I can spent nearly 6 grand on the kit, or I would have one now.

So my 'gold standard' is the paramedian followed by a toggle for low value animals. The only cases I treat medically are those with a screaming obvious other condition - raging metritis is the usual one.

Re: Right flank omentopexy vs Utrecht (left flank)

Emma Drinkall — Fri, 02 Mar 2012 13:50:20 GMT

I've seen bilateral flank 2 vet (which does seem a good way to start!) and the vets I've worked with have been keen to get me doing a standing right flank (slightly challenging at 5ft 2", but manageable if prepared for a past shoulder scrub and adapted incision site) but I've also been with vets who prefer the Utrecht.

This is more of an academic question really - the utrecht and right flank seem most comparable methods, so I wondered if anyone found any difference in complications of one over the other - eg omental break downs with right sided, or fistula formation...

Cheers

Re: Right flank omentopexy vs Utrecht (left flank)

karen jones — Fri, 02 Mar 2012 13:25:06 GMT

There was a great article in In Practice a few months ago detailing all different techniques. We do 2 sided 2 vet approach with good success, doesn't take long and we have few complications. Usually one vet starts , puts in local scrubs etc and the other vet arrives does op on l side, stitches up and can then leave leaving other vet to finish right side which is usually longer to do.

Karen

Re: Right flank omentopexy vs Utrecht (left flank)

james herriot lied — Fri, 02 Mar 2012 12:37:06 GMT

Tried a number of standing left flank techniques over the years (and two-sided) - don't like toggling, and feel it's one of those things we oughtn't to have gone with (bring on the red stars, I'm sure).

For me, right sided approach. You can see everything, put it all in the right place, and if you make a nick through the skin cranioventral to your main wound, you can stitch through the body wall there. Easy and makes closing easier. Never, ever had to deflate one prior to reduction - take the abomasum slightly backwards and down, rather than trying to pull it straight down, and you'll find you can get past the caudal pole of the rumen fairly easily - and I'm a short little fat person.

Funnily enough, I seem to have more luck with rolling these days than I used to - the dreaded steroid and buscopan, spend quite a bit of time when they're on their backs 'jiggling' the abdomen and LISTEN to where the gas cap is. Can't really ascribe it to skill, but spending a couple more minutes on their back does seem to help.

But don't be afraid to start with two-sided and a boss - you can always try from one side, and if you can't do it, there's another set of hands on tap.