Endoscopy: displaced abomasum

• With the aid of small incisions (portals), vets are able to visualize the displaced abomasum and correct this condition endoscopically.
• This minimally invasive technique also allows vets to carry out abdominal exploration and to identify concurrent disease, ie peritonitis, abscess, foreign bodies.
• Endoscopic corrective techniques can be classified into the following two categories:
  1. One-step (or standing) techniques: preparation and correction is performed on the standing animal. Techniques include:
     • Christiansen: with this LDA technique, the abomasopexy point lies caudal to the xiphoid process.  
     • Meyer: with this LDA technique, the abomasopexy point lies cranial to the navel.
  2. Two-step technique: preparation is undertaken on the standing animal, but surgical correction is performed with the animal in dorsal recumbency:
     • Janowitz: this technique may be used to correct LDA or RDA and is useful for general abdominal exploration. The abomasopexy point lies cranially to the navel.

Uses

Advantages

• Minimally invasive.
• Reduced risk of infection.
• Surgeon can fully visualize target organs.
• Patient can join the herd at the next milking.
• Research has indicated that LDA patients treated with endoscopic techniques, produced more milk post-operatively than their Grymer-Sterner corrected counterparts.
• One-step (standing) techniques require 1 assistant only.
• Unique selling point for veterinary practices that apply the technique.

Disadvantages

• Purchase cost of the kit is equivalent to a good quality ultrasound scanner.
• For a multi-branch practice with a limited number of surgeons trained on the technique, day to day management of the endoscopic equipment can present a challenge. Best results are achieved, when there is at least one endoscopic kit allocated per branch and a minimum of 2 trained surgeons in each branch.

Technical problems

• There are very few, if any, technical problems associated with the technique.
• The endoscopic equipment kit comprises of various trocar-cannula combinations. Intimate familiarity with the instruments and the order they are used in, is essential for a successful outcome.
• The LED re-chargeable light source used in endoscopic operations is shielded, but not fully water-proof. Covering it with a glove while in use, would reduce further the risk of water contamination.

Time required

Preparation

• This includes unpacking the endoscopic instruments, patient medication, surgical field and surgeon preparation.
• The preparatory time required is:
  • One-step techniques: 10-15 min.
  • Two step technique: total of 15-20 min.

Procedure

• In the author’s experience, in uncomplicated cases, the procedural time required is:
  • One-step techniques: 30-35 min.
  • Two step technique:
    • LDA Corrections: 45-50 min.
    • RDA Corrections (non-volvulated): 45-50 min.
    • RDA Corrections (volvulated):  2 visits 12 h apart, at 45-50 min each visit.

Decision taking

Criteria for choosing test

• Endoscopic correction can be applied to all LDA & RDA cases.
• Speed of recovery and return to anticipated milk yield will depend on patient's level of acetonemia Ketosis and fatty liver (as expressed by blood beta-Hydroxybutyrate levels) and other concurrent disease.

Risk assessment

• The animal needs to be restrained with a halter in the corner of an examination pen. No further handling facilities are required.
• For the one-step techniques, a 2 meter clearance above the animal is required for the Spieker use.
• For the two step technique, a wide pen is needed for the placing the animal in dorsal recumbency.