Introduction in Large

Animal Surgery
drh. M. Arfan Lesmana, M.Sc.
Fakultas Kedokteran Hewan, Universitas Brawijaya
Email: arfan142002@yahoo.com
Introduction in Large Animal Surgery
• Laparotomy
• Ruminotomy
• Penanganan LDA/RDA
• Trokarisasi
Laparotomy
Laparotomy
• for exploratory purposes when a clinical diagnosis is still uncertain
• for a specific purpose when a clinical diagnosis has already been
made
Method:
• Left fossa paralumbar
• Right fossa paralumbar
• Ventral midline/paramedian
Laparotomy
• Flank laparotomy on the standing animal under local anesthesia 
most common technique

Flank Laparotomy through the left paralumbar fossa

• if problem suspected in the left side (specifically indicated for left-
sided abomasopexy, rumenotomy, cesarean section)
Laparotomy
Flank Laparotomy through the right paralumbar approach
• used for exploratory laparotomy if a problem is suspected on the right
side
• specifically indicated for surgical conditions of the abomasum,
including right-sided pyloro-omentopexy or abomasopexy, small
intestine, cecum and colon
Laparotomy
Laparotomy via ventral midline or paramedian approach
• is an alternative that necessitates the animal being cast and/or
sedated and placed in dorsal recumbency
Indications:
• offers andvantages in the delivery of oversized or emphysematous
fetuses and in complicated deliveries, including uterine tears, less-
visible postoperative scarring in feedlot heifers
• may also be useful for cesarean section in heifers that have a
relatively small paralumbar fossa
Laparotomy
Anesthesia and Surgical Preparation
• Animal standing
• Anesthesia using line block, L block or a paravertebral block
• Small and large intestinal tract, pain and shock associated with both
the condition itself and the tension on the mesentery created by
surgical manipulation may cause the animal go down during surgery
Laparotomy
Surgical technique
• A vertical incision is made in the middle of the paralumbar fossa
extending from 3 to 5 cm ventral to the transverse processes of the
lumbar vertebrae for a distance of 20 to 25 cm
• For cesarean section, the incision may begin 10 cm ventral to the
transverse processes and may extend 30–40 cm
• Separation of the skin and subcutaneous tissue reveals fibers of the
external abdominal oblique muscle and fascia
• This layer is incised vertically to reveal the internal abdominal oblique
muscle, and aponeurosis transverse abdominal muscle
Laparotomy
Laparotomy
Laparotomy
Laparotomy
Laparotomy
Postoperative Management
• Antibiotic
• Supportive accordance with the animal condition
• Suture may be removed 2 – 3 weeks after surgery
• At 10 – 14 days the incision is still vulnerable to trauma
Laparotomy
Complications and Prognosis
• Complications such as peritonitis and adhesions may arise following
abdominal exploration
• Cattle in particularly may be prone to incisional dehiscene and wound
infection when house together
• The incidence of incisional infection can be greatly reduced when
antibiotics are given preoperatively
Rumenotomy
Indication:
• for the removal of metallic foreign bodies, whose presence may cause
traumatic reticulitis or traumatic reticuloperitonitis
• materials such as baling twine or plastic bags that are obstructing the
reticulo-omasal orifice
• foreign bodies lodged in the distal esophagus or over the base of the
heart
• for evacuation of rumen contents in selected cases of rumen overload
or following ingestion of toxic plants, spoiled roughages, or chemicals
Rumenotomy
Anesthesia and Surgical Preparation
• The left-flank area is prepared for aseptic surgery in a routine manner,
and local anesthesia is instituted by line block, inverted L block, or
paravertebral block
Rumenotomy
Surgical Technique
• Rumenotomy is performed through a left paralumbar incision (a 20-
cm incision generally is sufficient) with the animal standing
• The technique for left-flank laparotomy has been described previously
• In large cows, the flank incisions for rumenotomies sometimes are
made just caudal and parallel to the last rib, to place the incision
closer to the reticulum. It is essential, however, to leave sufficient
tissue caudal to the last rib for suturing. (The incision should be
approximately 5 cm [2 inches] caudal to the last rib.)
Rumenotomy
• Following opening and systematic exploration of the peritoneal cavity
it is necessary to anchor the rumen to the incision to avoid
contamination of the abdominal musculature and peritoneum during
the rumenotomy procedure
• A continuous inverting suture pattern (similar to a Cushing pattern) is
used, to pull the rumen over the edge of the skin incision
• This suture should be of heavy-gauge material such as nylon or
polypropolene (Surgipro, Prolene)
• The rumen is incised with a scalpel taking care to leave enough room
dorsally and ventrally for closure at the end of the procedure
Rumenotomy
• To reach the reticulum from the rumenotomy incision, the dorsal wall
of the rumen should be followed until it becomes the ventral wall, at
which point one is in the reticulum
Surgical Corrections of Abomasal
Displacements and Torsion
• Dilation or displacement of the abomasum is considered to be one of
the most common surgical conditions in bovine patients
• Abomasal displacement is believed to occur secondarily to
abnormally high volatile fatty acid levels and excessive fermentation
that lead to gas accumulation and distention
• Although less common, right torsion of the abomasum (RTA) may
occur to varying degrees
• If the torsion exceeds 180°, it is termed a volvulus. Abomasal volvulus
is a serious condition that leads to complete obstruction of the
outflow of ingesta to the duodenum
• The etiology of RTA is not completely understood, but the condition is
thought to occur secondary to some cases of right-sided displacement of the
abomasum
• Both LDA and RDA may be treated with right-flank omentopexy, with or
without pyloropexy, and right paramedian abomasopexy
• Right-flank omentopexy was developed when the only alternative was
paramedian abomasopexy, which required the patient to be in dorsal
recumbency.
• Recumbency should be avoided in animals with compromised systemic
conditions, respiratory distress, distended rumens, or those that are
pregnant
• Right paramedian abomasopexy has several advantages: the
abomasum is brought into position more easily in most cases, and
instantaneous repositioning commonly occurs; the abomasum is
easily viewed for detailed examination and detection of ulcers; and
strong, positive, long-lasting adhesions can be anticipated
• Another disadvantage is the possible formation of an abomasal fistula
if the retaining suture penetrates the lumen of the abomasum
• Right-flank omentopexy involves suturing the superficial layer of the
greater omentum in the region of the pylorus to the abdominal wall in
the right flank
• Right-flank omentopexy has a high reported success rate for the
treatmen
• A disadvantage to this approach is that the surgeon’s access to a left-
sided displaced abomasum is more limited than with the ventral
paramedian approach of LDA
• maintenance of longterm fixation of the abomasum can be
questioned, particularly with inexperienced surgeons
Anesthesia and Surgical Preparation
• Right-flank omentopexy, right-flank pyloropexy (pyloroomentopexy), and right-
and left-flank abomasopexies are performed with the animal standing
• Local anesthesia is instituted by performing a paravertebral block, inverted L
block, or a line block
• Right paramedian abomasopexy is performed in dorsal recumbency
• The cow is sedated (xylazine HCl 15–30 mg IV) and is cast in dorsal recumbency
• Acepromazine or butorphanol tartate are also appropriate sedatives.
• Local anesthesia is administered by local infiltration along the proposed
incision or an inverted L block of the right paramedian area