LDA surgery

Re: LDA surgery

Sara Pedersen — Fri, 06 Aug 2010 20:23:53 GMT

A large bore giving set does the trick as you can screw the needle onto the end with no risk of it detaching.

Re: LDA surgery

Phil Elkins — Mon, 02 Aug 2010 11:41:08 GMT

[quote user="Fiona Dale"]I did drop the needle once or twice, but quickly found it again without doing any damage - not sure if this was luck or if there is only so far they can go![/quote]

I've generally felt very lucky when this has happened!! I now have a needle taped to a flutter valve for DAs only. It gets flushed with hibi and sits in my prep bucket until I need to use it, which is generally not very often. At a previous practice, I rigged up a Dectomax gun to the back of the flutter valve which allows you to pump the air out much quicker.

Re: LDA surgery

Phil Elkins — Mon, 02 Aug 2010 11:36:04 GMT

[quote user="Martin Jones"]

We also used to do an extra little flourish - not mine, but a colleague's - where about 2-3" down and cranial of the main wound, we'd make a little skin incision. Find the pylorus and put a big cruciate stitch or a ford interlocking pattern through it, with long ears on both sides, and then using a needle, draw them one at a time through the small incision, so you have two ends on which you can pull to bring the pylorus right up against the body wall, and then tie a big knot that is then just under a small skin wound. In the (unlikely) event of any problems post-op, you can snip this stitch without having to open the cow right up. As it's not in the wound, you also have freedom to feel from the back to ensure that everything is sitting just right. Closing up is a relative doddle, and the abomasum is nice and low in the abdomen.

[/quote]

Mmmmmm, I wondered where that little gem came from. I've been doing this for 2 years now and think it is a really good idea.

Re: LDA surgery

Fiona French — Thu, 04 Feb 2010 08:40:05 GMT

I used to do a lot of LDA ops from the right flank and generally found them to be quick and straightforward. I am slightly built and 5'5", and found that deflating them made it much easier to reposition them, I would then use my left arm to sweep it under the rumen, and then reach down the right body wall and grasp the pylorus and sweep it up. I have to admit I used the needle and flutter valve technique - never found anything else suitable. I did drop the needle once or twice, but quickly found it again without doing any damage - not sure if this was luck or if there is only so far they can go!

Re: LDA surgery

Michael Woodhouse — Wed, 03 Feb 2010 23:34:22 GMT

[quote user="Vikki Halliday"]

[quote user="Michael Woodhouse"]Be quick and get the cow dropped on her RHS and upside down ASAP![/quote]

I'm assuming you advise this because of the escape of gas and therefore the subsequent difficulty in locating the abomasum, however if you have an assistant kneel and put pressure in the lower right abdominal quadrant, this forces the abomasum to the peritoneum, and will usually give you more than enough time to place the toggles.[/quote]

That is the exact reason!

I always kneel in the cows abdomen in front of the udder when I am placing the toggles!

Seems to be a lack of assistance on some farms!

Re: LDA surgery

Vikki Halliday LLB — Fri, 29 Jan 2010 09:09:39 GMT

[quote user="Michael Woodhouse"]Be quick and get the cow dropped on her RHS and upside down ASAP![/quote]

I agree with the placement of the second toggle, but have found on some occasions the second one has to be almost lateral to the first due to subcutaneous vessels and proximity to the costal arch.

Re: LDA surgery

Michael Woodhouse — Thu, 28 Jan 2010 23:22:45 GMT

I assisted with right flanks as a student (and a left flank/Utrecht) and when I started in practice we did the paramedian. I was stunned how easy it was compared to the other techniques - once the cow is upside down it's straight forward.

My boss wrote his technique up in the UK Vet Volume 4 issue 4 if you want a blow by blow account (also see the giant, ancient suction machine!).

Funnily enough I toggled a cow today! My top tip is first toggle 1 hand breath behind ziphoid 1 hand breadth to right of mid-line, stab toggle, then insert second toggle IN FRONT of first! Not too much tension on string. Be quick and get the cow dropped on her RHS and upside down ASAP!

Re: LDA surgery

Martin Foster — Thu, 28 Jan 2010 20:02:01 GMT

thanks for that, Michael. As it happens , I had never got round to reporting back on the case in question, but now that the thread is open again anybodies comments would be much appreciated. When I opened up this cow on the right flank, I found a sea of dilated viscus on the right side- most of which appeared to gas filled small intestine. I was able to locate and deflate the abomasum over the top of the rumen, buit every time I reached under or behind the rumen to grab it I found I was holding intestine. Eventually I gave up , and had to go back 3 days later to do the left sided (utrecht ) method. This seems to have worked ,but the cow wasn't helped by being opened up twice, and the farmer and my colleagues unimpressed by my new 'better' technique. Obviously that has made me reluctant to try it again- so I toggled one this week.

Any comments gratefully received- was I unlucky or somehow under prepared-were there any anatomical guides I could have used. It was a slightly atypical cow in that it had been calved c4 mths and was already 5 weeks in calf, and did feel v full on the right side on rectal exam.

cheers, Martin

Re: LDA surgery

Michael Woodhouse — Wed, 27 Jan 2010 23:01:08 GMT

Sorry to drag up an old thread.

I prefer the paramedian approach, once the cow is upside down it is easy surgery and the poition of the abomasum is much more 'physiological'.

We used to take an old medical suction machine onto farms with us and deflate any remaining gas in the abomasum via a 16G or 14G needle. The motor broke and we got a simple pump off ebay for draining fluid from a car (like a big baloon pump) and it is just as effective!

(looks like this, but is double action so can dump the fluid or gas on the floor if required http://www.machinemart.co.uk/shop/product/details/cgg500-500cc-oil-suction-gun)

I would use it on 1 in 3 cases. Every now and again you get an abomasum like a medicine ball so full of fluid and gas that you can't pick it up to place your sutures and in this case suction is invaluable!

Re: LDA surgery

Sarah Wheeler — Sat, 09 Jan 2010 21:20:44 GMT

If I need to deflate (about 1/4 of cases) I just use a 16 ga 1 inch needle with no tubing.

In my previous practice we did the ventral paramedian aprroach with the cow on her back and it worked really well, apart from the fact you needed 3 or 4 people to help you. Where I work now, most times you're left on your own with the cow or just have 1 person to nose her so it's not really possible.

Re: LDA surgery

Martin Foster — Thu, 03 Dec 2009 20:08:13 GMT

Thanks both of you for that advice- I will try the right sided op without deflation- thanks for explaining it so well.

Cheers, Martin

Re: LDA surgery

Martin Jones — Thu, 03 Dec 2009 16:36:13 GMT

In fairness, Wynne, I found that right sided approach was easier, better and less stressful to the cow (one wound, easier immobilisation, actually quicker). I too started off with the shaking-hands-in-the-middle approach, and was never that fussed with it. When I was in Oz, I learned to do it one-sided and never looked back.

Yes, it was also cheaper, which meant that we were more likely to do them. Win-win, I'd say

Martin

Re: LDA surgery

Hannah Wynne Richards — Thu, 03 Dec 2009 16:30:16 GMT

Martin I couldn't understand why you had probs deflating with a needle and flutter valve until I realised from the R or L debate that you're doing LDAs single-handed Back when I did them we always had 2 veterinary surgeons, 1 working from R, 1from L I suppose it's a sign of the greater economic stringency of cattle practice that you now only have 1

Wynne

Re: LDA surgery

Martin Jones — Tue, 01 Dec 2009 23:20:47 GMT

Yep, always used to do them right flank (I should explain that I was a cattle vet for 10 years before coming over to the Light). However, my answer may not be what you're looking for...........

I never once found that I actually needed to deflate an abomasum. I know this is one of those arguments that can run and run, but I think it really is down to technique - I'm only about 5'10, and my knuckles don't drag on the floor as I walk, and we always had plenty of giant Holsteins and grotesquely wide Friesians coming through the doors (although obviously more of the former).

People talk about going underneath the rumen and either tugging on the pylorus (my advice, not ever) or reaching over the top of the abomasum and pulling it back under - which in a big cow does mean that you need massively long arms. My approach was always to go across the back of the rumen with the left hand, then kind of force it forwards with the whole arm, so that you're not putting point pressure on it, reach between abomasum and rumen with palm facing left, until you have your whole hand around the front, and then bring it backwards before going downwards. You create a natural path for it to follow across the back of the rumen, and then as it passes down through the midline, it gurgles like mad and floats up on the right, minus a lot of gas.

Hope this helps - sorry if it doesn't, but I honestly think that you can do LDAs without deflating.

Martin

Re: LDA surgery

Martin Foster — Tue, 01 Dec 2009 21:59:50 GMT

Hi Martin- I used to do a left flank- now a right flank approach.

Martin

Re: LDA surgery

Martin Jones — Tue, 01 Dec 2009 17:45:03 GMT

Martin

One question: what approach are you using (it may obviate the need for air drainage at all)?

Martin