By A.W. Kersjes, F. Nemeth
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Additional resources for Atlas of Large Animal Surgery
The Utrecht method (left flank laparotomy and omentopexy) and percutaneous abomasopexy using a bar suture are discussed here, (i) Utrecht method. In the standing animal left flank laparotomy (see 4-4) is carried out one handbreadth behind the last rib and about 20 cm ventral to the lumbar transverse processes. In most cases the abomasum appears directly in the laparotomy wound . With the right hand and forearm some pressure is applied on the greater curvature in the direction of the xiphoid to expel gas and achieve partial replacement.
After local infiltration analgesia or epidural analgesia a circular piece of skin is excised over the anal site. Ideally the rectum should be sutured to the skin before the rectum is opened but often faeces are discharged immediately following the skin excision . After sufficient evacuation of the bowel the rectal wall is apposed to the skin by interrupted sutures . If the distal portion of the rectum is also atretic, deeper dissection is required to locate the blind end of the rectum.
The ligatures of the remaining ends are invaginated after which closure of the ends is performed with a seromuscular purse-string suture . The ends of the gut are now laid side by side with their stumps either in the same direction (anisoperistaltic = functional end-to-end anastomosis) or in Chapter 4 THE A B D O M E N / Gastro-intestinal system 4-10 opposing directions (isoperistaltic). Intestinal content is milked back and isolated with intestinal clamps. The two apposed loops are sutured together with a continuous Lembert suture.