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Bovine practitioners are often presented with dystocias that require a cesarean section. Many practitioners perform this surgery using the same approach each time due to their comfort with one specific approach or lack of familiarity of other available options. The goal of this article is to explain the advantages, disadvantages, and indications fo...
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... placed, the only body wall layers incised are the skin, subcutis, and the linea alba. Additional assistance is required to cast and position the cow for this approach. The cow is typically positioned in dorsal recumbency, leaning toward the surgeon at a 45 degree angle (Figure 2). Both front and hind feet are tied to a gate or wall. This positioning is critical. If the cow is positioned either in exact dorsal recumbency or leaning away from the surgeon, exteriorization of the uterus becomes problematic, if not impos- sible. Once the peritoneal cavity has been opened, it may be necessary to pull the greater omentum cranially to expose the uterus. Exteriorizing the uterus is facilitated by untying the hind feet only and temporarily laying the hind limbs flat on the ground. After removal of the fetus and closure of the uterus, the cow is repositioned in dorsal recumbency and the linea alba is closed. Closure of the abdominal wall is often difficult. The authors typically close the linea with polyglactin 910 (#3 Vicryl, Ethicon; Johnson & Johnson, New Brunswick, New Jersey, USA) in an everting interrupted horizontal mattress pattern. Eversion of the linea permits the surgeon to oversew the linea with relative ease and safety. Other appositional suture patterns, including simple continuous, may be used. Some practitioners may choose to close the linea alba with a braided nonabsorbable suture; however, this choice will cause carcass contamination with foreign material. A surgeon’s knot, 2 overhand knots on the 1st throw, facilitates appositional closure of the linea alba. In cases where closure of the abdomen wall is difficult, loosen- ing the back legs and using Bachaus towel clamps to appose the 2 sides of the incision will help to relieve the tension prior to tying the knots. Integrity of abdominal wall closure is critical. Less than optimal closure may result in either abdominal wall herniation or, in severe cases, evisceration of the cow. The ease with which the uterus is exteriorized with this approach makes it optimal for exteriorizing the uterus, a critical issue when the surgeon is attempting to remove an emphysematous fetus. This approach is also ideally suited to 1st calf heifers of the beef breeds, because the incision is somewhat hidden and does not involve retail cuts, suggesting that this approach would be pref- erable, if the producer is likely to sell the animal for slaughter soon after the procedure. This approach should be used when the large udder of older beef and dairy cows precludes extending the incision sufficiently caudad to permit ready exteriorization of the uterus, and when udder edema and the increased ventral vasculature make this approach more complicated. This approach is similar in most respects, including the advan- tages and contraindications, to the ventral midline approach (1,12). The abdominal wall incision is placed parallel and approximately 5 cm lateral to the linea alba (Figure 2). Some authors have postulated that the abdominal wall closure of the paramedian approach is more secure than that of the ventral midline approach. This makes little sense. Neither the internal sheath of the rectus abdominis muscle, nor the rectus abdominis muscle has substantial holding properties and it would seem that a 1-layer abdominal closure is easier and, hence, preferable to a 3-layer closure. This approach is similar to the other ventral approaches, but it may be better suited for the older dairy or beef cow (1,12). The cow is positioned in right lateral recumbency. The hindlimbs should be extended caudally and the upper limb abducted for the best exposure to the incision site (Figure 3). This approach uses a curvilinear incision that is roughly parallel to the last rib; it starts approximately 5 cm lateral to the umbilicus and courses caudodorsally toward the inguinal area (Figure 3). This approach readily permits exteriorization of the uterus, making it suitable for removal of a large emphysematous fetus. In cattle with a large udder, the incision is more readily extended caudally than when the ventral midline or ventral paramedian approach is used. Consequently, this approach may have utility in dairy cows and older beef cows. In addition, this incision is not read- ily visible in a standing cow, which may be an advantage if the cow is going to be sold soon after the operation. Closure of the incision is often more difficult than with the other approaches, as more tension is placed on the muscle layers. The integrity of the abdominal wall closure is less secure than that of either the ventral midline or ventral paramedian approaches and therefore, more prone to herniation and evisceration of the cow. This described variation of the left paralumbar celiotomy approach has distinct advantages (4,13). In this approach, the incision starts 4 to 6 cm ventral and cranial to the tuber coxae, extends cranioventrad at a 45 degree angle to the ground, and terminates at the last rib (Figure 4). This incision extends further cranially and more ventrally than the traditional left paralumbar incision; it can also be used in the recumbent left approach. The external abdominal oblique muscle is incised in the same direc- tion as the skin. The internal abdominal oblique and transversus abdominus muscles can then be gridded parallel to the incision using a combination of sharp and blunt dissection. Herniation is less problematic than with the ventral approaches; however, the apex of the gravid uterus is far more readily exteriorized in this procedure compared with the other standing procedures. This approach holds distinct advantages for surgeons with either smaller stature or less physical strength. The patient must be adequately restrained and must be able to remain standing, but as with the other standing procedures, minimal assistance is needed. Most surgeons use a standing left paramedian celiotomy to perform cesarean section in the cow. The left oblique approach is preferable under most circumstances, because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Alternative approaches are available that will further limit the potential for contamination. Practitioners are encouraged to consider alternate approaches for certain conditions. Drs. Schultz, Tyler, and Moll collaborated in the writing of the manuscript and Dr. Constantinescu provided editing and the illustrations. ...
Citations
... Following individual physical examination, parturition was induced in all dams with a combination of 20 mg of dexamethasone (Dexamethasone ® 2 mg/mL, Agrilabs, Schuyler, NE, USA) and 25 mg of dinoprost (Lutalyse ® , Zoetis, Parsipanny, NJ, USA), administered intramuscularly as previously described [23]. Two days following induction of parturition, elective left-flank C-sections were performed in all cows as previously described [24]. Immediately after delivery, newborn calves were placed in sternal recumbency and airway patency was established by removing fluid from the nasopharynx with a 60 mL bulb syringe (Blowout Medical, Cottonwood Heights, UT, USA). ...
Assistance during calving and cesarean section (C-section) are important risk factors for the failure of transfer of passive immunity (FTPI) in beef calves, which increases the risk of morbidity and mortality in beef calves during the preweaning period. Colostrum replacement recommendations for beef calves, and especially for those delivered by C-section, are unavailable. The objective of this study was to determine whether or not colostrum replacement or supplementation with a commercially available product could increase serum IgG concentrations in beef calves delivered by elective C-section, compared to beef calves that nursed colostrum naturally. An elective C-section was performed in 32 pregnant beef cows and first-calf heifers. Immediately after delivery, newborn calves were randomly assigned to one of three different treatment groups. Group A calves (n = 7) were fed one packet of a commercial colostrum replacer (CR) product providing 60 g of IgG within 30 min of life. A second packet of the same CR was fed at 6 h of life. Group B calves (n = 13) were fed the same CR at the same frequency as group A; however, these calves were reunited with their dams after the second CR feeding to allow additional nursing of maternal colostrum. Group C calves (n = 12) were united with their dams immediately after surgery without colostrum intervention. Serum IgG levels at 48 h of life were greater in group C calves and in calves born to multiparous cows. Based on the results of this study, neither colostrum replacement nor supplementation result in higher serum IgG concentrations in beef calves delivered by elective C-section compared with natural nursing.
... Because the fetus exhibited vital signs, the decision to perform a cesarean section was clear. Among the many surgical methods for a cesarean section, a left abdominal wall incision while the cow is in a standing position is the most commonly used (Schultz et al., 2008). This procedure not only saves time but also prevents the bowel from spilling out of the wound. ...
... There are three surgical paths for paralumbar fossa in the left flank: anterior incision, middle incision, and posterior incision. In general, an anterior or middle incision is used to remove foreign bodies in the reticulum, whereas a posterior incision is often used in the case of a cesarean section (Schultz et al., 2008). Due to the large size of the cow, a middle incision was selected in this case owing to the convenience of removing the foreign body from the reticulum. ...
Background: Traumatic reticulitis (TR) and abomasal obstruction are common digestive diseases in beef cattle. In
clinical practice, these two conditions are often detected alone and rarely occur at the same time. Surgical therapy
is an effective approach to treat both of these diseases. However, there are no reports on the treatment of abomasal
obstruction in cattle induced by TR.
Case Description: We here report a rare case of the diagnosis and treatment of TR associated with abomasal obstruction
in a beef cow during late pregnancy. The affected cattle had an iron wire that was piercing the wall of the reticulum,
but did not penetrate the wall; the abomasum was blocked and appeared solid; and the fetus survived well in utero (268
days gestation). To save the lives of the cow and fetus on the same day, a cesarean section was first performed, followed
by rumenotomy, the foreign body (wire) was removed, and abomasotomy was finally performed. The fetus removed by
cesarean section grew well, and the beef cow recovered and successfully became pregnant again.
Conclusion: This case thus offers guidance for the timely diagnosis, effective treatment, and postoperative management
of these digestive diseases in cattle to prevent progression and further complications
... As the procedure is done in standing position, animal should be able to stand throughout the entire procedure (Roberts, 2004) [7] . Source: (Schultz et al., 2008) [8] ...
... As the procedure is done in standing position, animal should be able to stand throughout the entire procedure (Roberts, 2004) [7] . Source: (Schultz et al., 2008) [8] ...
... As the left oblique incision is longer as compared to vertical flank incision, it may be of value to remove large fetus (Ajeel et al., 2019) [1] . For surgeons with either smaller stature or less physical strength, this approach is advantageous for them (Schultz, 2008) [8] . Another advantage is that the internal abdominal oblique and the transverse abdominis musles can be split in same direction of the muscle fibres making it easy to access genital tract and also suture comparatively easy (Cox, 1987) [3] . ...
In large animal practice, animals presented with dystocia, torsion, prolonged pregnancies who are unable to deliver fetus normally requires surgical approach. Many veterinary practitioners use a common approach they have practiced and are familiar with and also depending upon the condition of animal whether animal is recumbent or in standing position. This article shows various possible approaches for caesarean section along with merits and demerits of each.
... In practice, a unique rumenotomy method for small ruminants subjected to standing restraints has been lacking. Standing rumenotomy in the cattle have many advantages than in the lateral recumbency position in sheep and goats [8]. ...
Ruminant welfare post-surgery could be improved by employing a procedural technique that causes minimal surgical stress. A total of twenty-four (n = 24) Kano Brown goats (KBGs) aged 1–2 years, weighing an average of 15.52 kg, were recruited for the study. Rumen skin clamp fixation (RSCF) and a stay suture rumenotomy (SSR) in lateral recumbency while standing restraint rumenotomy was aided by a locally fabricated mobile small ruminant surgical chute (MSRSC) were performed in groups A, B, and D, respectively, as control group C had no surgery. Six goats were allocated to each group such that each group had 3 males and females that were positive for rumen foreign body impaction (RFBI), except goats in group C that were free of RFBI. Pre- and post-rumenotomy values of vital parameters did not differ significantly (P > 0.05). The group A serum IL-6 concentrations at 72 hours post-rumenotomy (61.21 ± 44.52 ng/L) were significantly higher (P < 0.05) than those in group D (15.24 ± 3.09 ng/L) among the female KBGs. The concentrations of IL-6 at week 1 post-rumenotomy in group A were significantly higher (65.05 ± 31.11 ng/L) than in groups B (15.86 ± 0.29), D (18.75 ± 5.81) and C (14.86 ± 0.79 ng/L). The lack of significant changes in the mean values of rectal temperature, respiratory rate, and heart rate implies that the standing rumenotomy utilizing the MSRSC did not vary in surgical stress severity from the conventional approaches; RSCF and SSR, done in lateral recumbency. The IL-6 in group D was lower when compared to the values in group A females at 72 hours and at week 1 for the male KBGs, suggesting profound surgical stress among females and males in groups A and B over group D. Standing restraints cause less surgical stress than lateral recumbency restraints, making it a better procedural approach for rumenotomy in goats.
... The increased vascularity and muscle tissues associated with the paramedian approach are thought to enhance healing and reduce incisional herniation (Noorsdy, 1979). The advantage of the midline approach is that the linea alba provides a stronger holding layer compared with the paramedian or the low oblique approach (Schultz et al., 2008). The thin facial layers with interposed muscle layers may be why the lateral approaches are more likely to herniate. ...
... Details of the surgical techniques for performing a cesarean section are well described in the literature (Turner and Mc Ilwraith, 1989;Campbell and Fubini, 1990;Frazer and Perkins, 1995;, Kolkman et al., 2007Schultz et al., 2008Purohit et al., 2013. After shaving and scrubbing with soap and water the site is scrubbed with savlon. ...
Cesarean section is one of the oldest surgical procedure performed in veterinary medicine and involves the removal of calf near parturition by lapro-hysterotomy. While a number of sites have been described for surgery the choice of operative site depends upon the condition of the cow, presence of a live/dead and /or emphysematous fetus which also determine the outcome of surgery. Most cesarean sections in cows can be satisfactory performed under local infiltration anesthesia with mild sedation. Perioperative care (before, during and after surgery) seems to be of utmost significance in deciding the outcome of surgery. The history, operative sites, anesthesia, operative procedure post operative care and future fertility of cesarean section in cows are described in this review.
... There are different surgical approaches for cesarean section in cows with variable degrees of advantages and disadvantages. These include standing left and right paralumbar celiotomy, recumbent left and right paralumbar celiotomy, recumbent ventral midline celiotomy, ventral paramedian celiotomy, ventrolateral celiotomy, and standing left oblique celiotomy (Schultz et al., 2008). The selection of an appropriate approach depends on the type of dystocia, health status of the cow, environmental conditions, availability of assistants, and the surgeon's preference (Schultz et al., 2008). ...
... These include standing left and right paralumbar celiotomy, recumbent left and right paralumbar celiotomy, recumbent ventral midline celiotomy, ventral paramedian celiotomy, ventrolateral celiotomy, and standing left oblique celiotomy (Schultz et al., 2008). The selection of an appropriate approach depends on the type of dystocia, health status of the cow, environmental conditions, availability of assistants, and the surgeon's preference (Schultz et al., 2008). ...
... However, the left oblique approach is preferable under most circumstances because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Most of the time, many junior surgeons also perform left paralumbar celiotomy which may be due to their comfort with one specific approach or lack of familiarity with other available options (Schultz et al., 2008). Furthermore, the selection of preferable alternative surgical approaches and techniques also greatly influences the outcome of a cesarean section. ...
Dystocia is an abnormal and difficult birth in which the first or the second stage of labour is markedly prolonged and subsequently found impossible for the dam to deliver without artificial aid. In cattle, it can be relieved by different obstetric methods, including the cesarean operation and fetotomy. Caesarean section is the extraction of the fetus or foeti from the dam, through a surgical opening in the abdominal wall and the uterus. This surgical method can be performed by about eight alternative surgical approaches in bovines with its advantages and disadvantages. However, the selection is dependent on many factors like the type of dystocia, the cows and environmental conditions, the availability of assistants, and the surgeon's preference. For cows, most surgeons use a standing left paralumbar celiotomy. However, the left oblique approach is also preferable under most circumstances because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Besides, alternative approaches are also available that will further limit the potential for contamination but many junior surgeons perform the left paralumbar celiotomy using the same approach each time due to their comfort with one specific approach or lack of familiarity with other available options. Therefore, the objective of this review is to provide basic insights and highlight the cesarean section incision approaches with their relative advantages and disadvantages in cows.
... Surgery in sheep under general anaesthesia for Sectio Caesarea (SC) is a relatively common procedure in veterinary practice, and contrary to cattle [1], the surgery is usually performed under general anaesthesia. The abdominal cavity can be accessed in the left flank or via the ventral mid-line [2]. ...
Background:
Performing Sectio Caesarea in sheep under general anaesthesia is a common procedure in veterinary practice. The abdominal cavity can be accessed via linea alba, for which the ewe is positioned in the supine position, whereby rumen and uterus can compromise lung function. Although the rumen represents an important reservoir for fluid and electrolytes, and kidney function during anaesthesia is essential, these parameters have not been focused on in research. Therefore, the objective of this study is to contribute data on blood parameters, ruminal fluid, and kidney function tests during laparotomy.
Methods:
Laparotomy was performed in 14 ewes, whereof five animals were pregnant ewes (PE) and nine non-pregnant ewes (NPE). A total of seven animals received isoflurane in addition to oxygen (inhalational anaesthesia (InhA)) and seven ewes were anaesthetised with xylazine and ketamine (total intravenous anaesthesia (TIVA)); all ewes received lumbosacral anaesthesia. Blood, urine, and ruminal fluid were sampled every hour over a three-hour period.
Results:
On comparing InhA to TIVA, higher values were detected for TIVA in haemoglobin, paced cell volume, sodium, phosphate, glucose concentration in the blood, and phosphate in ruminal fluid. Lower values were detected for TIVA in partial pressure of oxygen, oxygen saturation, and creatinine clearance. On comparing PE to NPE, higher values were detected in PE in magnesium and ruminal calcium. Lower values in PE were detected in chloride, base excess in the blood, and ruminal phosphate. Over time, an increase in partial pressure of carbon dioxide, glucose in the blood, glucose in urine, and a decrease in protein and albumin could be observed.
Conclusion:
Surgery in sheep in the supine position should be performed with additional oxygen to maintain physiological pO2 and sO2 values. Kidney function could be maintained with a minimal electrolyte infusion regime. Additional glucose is not necessary, even in pregnant ewes. Further research should be conducted on parameters in ruminal fluid.
... 8,10,11 While some earlier studies raise theoretical concerns associated with one-layer technique including leakage, peritonitis, and adhesions, 3,5 these complications have not been observed in greater frequency in the few, more recent studies comparing one-layer with two-layer handsewn end-to-end techniques in vivo where both techniques have similar postoperative complications and survival rates. 4,7,12 The Utrecht pattern, also known as the modified Cushing pattern, is performed with oblique bites toward the incision line in staggered fashion. Its use has been mostly limited to closure of hysterotomies in cows in 1-or 2-layers 12 with no difference in adhesion prevalence compared to a Lembert pattern. ...
Objective:
To compare end-to-end jejunal anastomoses with a one-layer (Utrecht) and two-layer (simple continuous/Cushing) patterns.
Study design:
Experimental study.
Animals:
Eight healthy adult horses.
Methods:
Jejunal end-to-end anastomoses were performed in randomly assigned one-layer or two-layer patterns. Horses were recovered from surgery and monitored for complications. At 14 days, the opposite pattern was performed (cross-over design) prior to euthanasia. Duration of closures was compared between patterns. Serosal width was measured before harvesting anastomotic sites from the first procedure. Luminal diameter was measured, and sections were collected for histological evaluation of heating after routine and immunohistochemical staining.
Results:
One-layer closure was faster (716 ± 86 s) than two-layer closures (1136 ± 111 s). Postoperative complications were minimal. No difference was detected in lumen size between groups. The lumen was reduced by 18% after one-layer and 15% after two-layer closures (p = .34). Serosal adhesions to the mesentery without clinical evidence of obstruction were observed in two horses with two-layer closure. Histopathological scores for inflammation, infection, and healing did not differ between groups.
Conclusion:
Jejunal anastomosis with one-layer Utrecht technique was about 7 min faster and led to similar luminal reduction and histological healing scores as two-layer jejunojejunostomies.
Clinical significance:
The outcomes of one-layer Utrecht jejunojejunostomies in healthy horses justify clinical evaluation of this technique.
... Per-vaginal delivery of the foetus was attempted by gentle traction but was not sucessful. Caesarean section was performed by ventral mid line approach following the standard procedure (Schultz et al., 2008) and a dead hydrocephalic male foetus was delivered (Fig. 1). Dissection of foetal head revealed the presence of strawcoloured fluid in sub-arachnoid space, affirming that the foetus was malformed and congenital external hydrocephalus was also confirmed. ...
A rare case of dystocia due to external congenital hydrocephalic foetus with ankylosis of
forelimbs managed by ventral midline surgical approach in a crossbred cow is reported.
... The author prefers the standing approach for ease of accessing and exteriorizing the uterus. 10 The left flank oblique approach is the author's preferred approach, with exceptions being if the calf is known to be in the right horn or if the left side of the animal is inaccessible due to the available facilities. 10 The skin incision runs from approximately 4 inches (10 cm) below the lumbar transverse processes and 2 to 4 inches (5 to 10 cm) cranial to the tuber coxae in a cranioventral direction. The incision is generally 12 to 18 inches (30 to 45 cm) in length. ...
... 10 The left flank oblique approach is the author's preferred approach, with exceptions being if the calf is known to be in the right horn or if the left side of the animal is inaccessible due to the available facilities. 10 The skin incision runs from approximately 4 inches (10 cm) below the lumbar transverse processes and 2 to 4 inches (5 to 10 cm) cranial to the tuber coxae in a cranioventral direction. The incision is generally 12 to 18 inches (30 to 45 cm) in length. ...
... The author recommends packing off the abdomen prior to opening the uterus to prevent/reduce contamination. 10 Flank/ Low flank: This approach is useful for accessing the uterus in cattle that are recumbent or that are put into lateral or semi-sternal recumbency for surgery. 10 ...
A C-section is a surgery that can be performed in the field to resolve difficult dystocias. When used early in the calving process, it is possible to obtain positive results, including a live calf and a reproductively sound cow. Tips for maximizing success during these sometimes challenging procedures will be covered.
