Lecture 6: Rumenotomy and laparotomy

Indications for rumeostomy

• Chronic bloat

• Feeding mechanism (tetanic cattle, severe oral damage)

• Rumen fistula placement

Indications for rumenotomy

• Hardware to remove wires

• Dumping contents for acidosis

• Choke retrograde retrieval of items

• Removing fiber in hay belly cases

General considerations for rumenotomy

• Standing surgery

• If possible withhold food for 24-48 hours and water for 12-24 hours

• Butorphanol/xylazine/ketamine used for standing sedation

• Pre-op/ post-op antibiotics

• Assistance usually needed depending on urgent nature

• NSAID pre-op

• May need to pass kingman tube before surgery to relieve pressure or use needle to deflate

What side to you perform rumenotomy?

Left flank

What are the flank anesthetic options for rumenotomy?

• Line block

• Inverted L or reverse 7

• Proximal paravertebral

• Distal or transverse paravertebral

• High volume caudal epidural or lumbosacral epidural

• General anesthesia

What block is shown in the picture?

Paravertebral

What block is being shown?

Inverted L/Reverse 7

What block is being shown?

Line block

What should you keep in mind with location of stoma?

• Consider if bloated where it will be when its deflated

• Fit rumen cannula in it

Steps for rumenostomy

1. Aseptic prep (clip/prep). Draping and gowning.

2. Skin incision in dorsal 1/3. SQ tissues removed and disposed of. Muscle griddled, sharply incised, circle removed.

3. Go through the muscle layers: External abdominal oblique,internal abdominal oblique, transversus

4. Incise peritoneum ONLY. Suture peritoneum and transversus to deep dermis. Seal it shut. Use absorbable suture on cutting needle. Tack first at 0, 3, 6, 9 o’clock. Simple continous to make a circle.

5. Tack rumen to skin at 0,3,6,9 o’clock. Use simple continuous to create seal. Insert rumen cannula. Use stay sutures.

Postop care of rumenostomy

• Daily cleaning

• Post-op medications (PPG and NSAIDs)

Rumenostomy post op complications

• Incisional infection

• Peritonitis

• Continues primary problems

How do you close a stoma?

• Remove the cannula

• Freshen edges and 2 layer closure if chronic fistula

What are you at risk with complete stoma closure?

Peritonitis

What can you used to close the rumen?

• Taper needle

• Absorbable suture monofilament (Monocryl, PDS)

• Urecht, Lembert, Cushings

• May need double layer

How do you close the skin for an rumenotomy?

• 1-3 muscle layers (peritoneum and transversus, internal abdominal oblique, external abdominal oblique)

• Reverse cutting needle and absorbable suture (Vicryl, monocryl, PDS, chromic gut)

• Non-absorbable (Nylon) for skin

What approach is used for exploratory laparotomy?

Right sides into abdomen same as rumenotomy. Location found at the paralumbar fossa.

Indications for exploratory laparotomy

• Intestinal disease (SI disease)

• Cecal disease

• Liver disease

• No US

• Unexplained pings

• Type 3 or 4 vagal indigestion

• Peek and shriek

Compare a standing vs. recumbent exploratory laparotomy

• Standing gives you best approach and visualization. UNLESS YOU ARE GOING TO MANIPULATE SI

• Recumbent is better for tugging on

If you want to open rumen, remove contents and close, which surgery will you do?

A. Rumenotomy

B. Rumenostomy

A. Rumenotomy

Which sided approach will you do in case of TRP?

A. Left

B. Right

A. left

Which is the correct order you will cut through from external to internal

A. Skin, external abdominal oblique, internal abdominal oblique, transverse

B. Skin, transverse, external abdominal oblique, internal abdominal oblique

C. Skin, internal abdominal oblique, external abdominal oblique, transverse

A. Skin, external abdominal oblique, internal abdominal oblique, transverse

What is one indication for performing a rumenotomy?
a. Chronic bloat
b. Severe oral damage
c. Liver disease
d. Intestinal disease

1. a. Chronic bloat

Which of the following is a step in performing a rumenotomy?
a. Incise the skin in the ventral 1/3
b. Close the stomach with non-absorbable suture
c. Suture the peritoneum and transversus to deep dermis
d. Use a right-sided approach

1. c. Suture the peritoneum and transversus to deep dermis

What type of anesthesia is commonly used for a standing surgery?
a. General anesthesia
b. Local anesthesia
c. Standing sedation
d. Epidural anesthesia

1. c. Standing sedation

Which of the following is NOT an indication for rumenostomy?
a. Hepatic lipidosis
b. Hardware disease
c. Feeding mechanism failure
d. Cecal disease

1. b. Hardware disease

What is a common postoperative care step for rumenostomy?
a. Immediate feeding
b. Daily cleaning
c. Withhold water for 48 hours
d. No medication needed

1. b. Daily cleaning

During a rumenotomy, which layer is the surgeon NOT supposed to incise?
a. Skin
b. Peritoneum
c. Rumen
d. Transversus

1. c. Rumen

What complication is associated with rumenostomy?
a. Incisional infection
b. Abdominal distension
c. Hemorrhage
d. Anemia

1. a. Incisional infection

Which anesthetic technique involves a line block?
a. Inverted L block
b. Proximal paravertebral block
c. Distal paravertebral block
d. All of the above

1. d. All of the above

Which structure is checked first during an exploratory laparotomy?
a. Gall bladder
b. Rumen
c. Omentum
d. Liver

1. c. Omentum

What is the purpose of rinsing the abdomen during rumenotomy closure?
a. To remove excess blood
b. To prevent contamination
c. To enhance the healing process
d. To reduce pain

1. b. To prevent contamination

What is the recommended size of the skin incision for a rumenostomy?
a. 1 cm
b. 2 cm
c. 4 inches
d. 5 cm

1. c. 4 inches

What is a common postoperative medication for rumen surgeries?
a. NSAIDs
b. Corticosteroids
c. Vaccines
d. Antihistamines

1. a. NSAIDs

Which surgical approach is used for exploratory laparotomy?
a. Left-sided
b. Right-sided
c. Ventral midline
d. Parametrial

1. b. Right-sided

What type of suture is typically used for skin closure in rumenotomy?
a. Non-absorbable
b. Absorbable
c. Silk
d. Nylon

1. a. Non-absorbable

Which of the following is a possible postoperative complication of exploratory laparotomy?
a. Coughing
b. Peritonitis
c. Vomiting
d. Constipation

1. b. Peritonitis

What is a key consideration when performing a rumenostomy?
a. The location of the stoma
b. The size of the incision
c. The type of anesthesia
d. The age of the animal

1. a. The location of the stoma

Which block would you use for pain relief in rumen surgery?
a. Epidural block
b. Inverted L block
c. Intramuscular block
d. Topical anesthetic

1. b. Inverted L block

When should the pre-op antibiotics be administered?
a. 12 hours before surgery
b. 24-48 hours before surgery
c. After the surgery
d. During the surgery

1. b. 24-48 hours before surgery

Which of the following is a reason to perform an exploratory laparotomy?
a. Hardware disease
b. Unexplained pings
c. Chronic bloat
d. Severe oral damage

1. b. Unexplained pings

What is the purpose of using absorbable suture for closing the rumen?
a. To allow for future surgeries
b. To avoid the need for suture removal
c. To minimize scarring
d. To enhance cosmetic appearance

1. b. To avoid the need for suture removal