Rolling LDA's

Re: Rolling LDA's

James Kerr — Wed, 03 Jul 2013 16:43:11 GMT

I do know what some farmers can be like! The point I would chip in with here is that, as far as I can see, by far the greatest benefit to the farmer is to have his cow back in full production as quickly as possible; over the course of the lactation this will dwarf the relative difference in cost between all these procedures. With this in mind, do whichever is most likely to have the cow up and running again ASAP. I find that if toggles work, the cow will be back milking within a day or two - brilliant, but success rate ~75%. Op (R flank for me) will work ~95% of the time, but will have longer recovery afterwards. So, pros and cons either way, take your pick! And if the farmer has an opinion, maybe indulge him within reason! Rolling fails so often I think it's a waste of time.

Re: Rolling LDA's

Gerbil — Tue, 02 Jul 2013 14:36:48 GMT

Thanks for your help people, I suppose I need to impress on farmers management of these cases in the dry period. I was sort of thinking of giving up offering rolling anyway. You know what some farmers can be like though!!!

Thanks.

Re: Rolling LDA's

mariette asselbergs — Tue, 02 Jul 2013 13:07:27 GMT

I find rolling a waste of time, if you roll then may just as well toggle which works well and is quick in uncomplicated cases. Always treat for ketosis and aggerpump fluids and diet advise. When operating I use the right flank approach with thorough deflating, sometimes I need to open up on left to have farmer in long glove help push the abomasum down. Big advantage of operating is that you can check for adhesions, abomasal ulcers, liver abscesses and wire disease and in one case found mesenterial TB!

Mariette

Re: Rolling LDA's

Sarah Wheeler — Tue, 02 Jul 2013 12:22:16 GMT

I roll very very few LDAs, the last one was probably two years ago and she ended up having an op the following week! Ten years ago, I always rolled LDAs and operated on very few. In that time our average herd size has probably doubled (with no increase in staff levels in most cases) and no one makes hay anymore! If the cow could stay in a box or a nice straw yard and eat hay for 3-4 days afterward I might roll more. I have gone through periods of doing the ventral paramedian approach but now find myself back to the right flank omentopexy; I am lucky to have one decent helper in most cases and often I'm shown a cow in a crush, there she is.

Re: Rolling LDA's

Alan Tevendale — Tue, 02 Jul 2013 07:33:56 GMT

I've always gone for toggle where possible. I find that we get excellent success rates.

I would generally recommend still giving a minimum of 20L of fluids at the same time. A talk at BCVA congress a few years ago by Nikolai Aggers (a little biased I would presume) suggested that giving 40L of fluids without any other treatment would be successful in many cases. Having said that if you can correct any underlying disease process which is likely to be the cause of the displacement then you should get resolution without the need for surgery at all.

I think it comes down to - do whatever technique you are happiest doing. You will get some failures. Especially if the abomasum has ulceration present.

Re: Rolling LDA's

Michael Woodhouse — Mon, 01 Jul 2013 23:06:46 GMT

I've only ever used the plastic toggles that I believe are supposed to snap before rupture. I am also very keen to allow the abomasum to fully reduce with the 2nd puncture.

[I did have 1 abomasal rupture during a stint with left flank laproscopic Sx - but that is a large metal toggle]

Re: Rolling LDA's

james herriot lied — Mon, 01 Jul 2013 21:38:37 GMT

[quote user="Michael Woodhouse"]

JHL - why not toggle?

[/quote]

I've seen the aftermath of a couple of catastrophic ruptures. Plus, I don't think the cost difference is cost effective for the failure rate (this as explained to me by someone who'd stopped toggling and gone for right flank).

Re: Rolling LDA's

Michael Woodhouse — Mon, 01 Jul 2013 20:09:38 GMT

My preference is the paramedian technique as I believe it to offer the best anatomical position of the abomasum. If the owner will pay I do this as first choice. Very good success rate - >95%. Following wind less than 1 hour.

If money an issue then I roll and toggle. 20 minute job and slightly less than half the cost. Doesn't r/o surgery if unsuccessful. I have failed to cure with toggling, but never made one worse! Success rate in my hands 75-80%.

Occasionally I have opened up surgically and found something else - peritonitis or ulcers mainly. These add into the 'failure' rate of toggling, but are discounted from the op group. Toggling blind you would never find them.

I tried rolling but to do a good job takes time and time costs money (~30 mins). To my mind that is better spent on the toggle or op. I'd say 25-33% success. Not good enough to justify the time investment IMO.

JHL - why not toggle?

Re: Rolling LDA's

james herriot lied — Mon, 01 Jul 2013 19:41:00 GMT

I think most of us go through runs with rolling LDAs, which then influences our general disposition towards the procedure. Until the last couple of years, I felt that I had decent success - above 50% - with rolling, but ironically since then I've worked at practices where surgery is the norm, and finances have improved slightly to make it more cost-effective.

There's a definite skill to rolling, but whether that skill influences overall result I couldn't even say - hardly EBM, this stuff. Presuming you're already fine with casting, tying feet together etc, I think what really matters is taking your time, and having the cow stop at 45 degrees, dorsal recumbency, 45 degrees on the other side and then in left lateral recumbency, having a good ballotment around each time and a listen to hear the stomach moving over.

These cows are either ketotic or going into clinical ketosis, so I always give steroid and a couple of bottles of glucose I/v beforehand. Those with aggers pumps also like to bung 30 litres of fluid into the rumen at the end, to 'block off' the path of the abomasum. Certainly, getting the rumen full of something in the aftermath helps enormously, but a gut full of fibre is the business.

Surgically, I go in on the right flank. Have a kind of modified approach where I make a small skin incision a few inches down and forwards from the main wound, through which I push my pexy (inwards to outwards). Never have to deflate, and generally with this method, get reasonable anatomical approximation.

Never, ever, ever toggle.