FA GI Diagnostics & GI Surgery Principles

Choosing a surgical approach

Since cows are excellent patients, we often have multiple options for surgery.  Localizing the lesion and narrowing the differential list helps the surgeon make the best guess. It is possible to close an approach and create a new incision in the same procedure.

Right paralumbar (right flank) approach

A right flank approach is the best approach for abdominal exploratory in any age ruminant (including calves) due to the left sided rumen. Exploratory surgery is a useful, relatively cheap and easily accessed diagnostic tool in cattle.

Due to the access to most structures, right flank surgery is used for abomasal displacements, intestinal surgery, (small and large)  kidney removal (rare), Csections (rare), and for sampling of other right sided structures.

Left  paralumbar (left flank) approach

The left flank is used for left displaced abomasum (if the surgeon has long arms), rumen and reticular disorders, esophageal access, dystocias and other disorders localized to the left on ultrasound or imaging.  Exploration from the left is limited due to the size of the rumen.  Surgeries include

  • left flank abomasopexy
  • rumenotomy for hardware, grain overload or foreign bodies (rumen, omasum or esophagus)
  • rumenostomy for chronic bloat or nutritional needs including feeding and rumen flora donors
  • Csection
  • flank ovariectomy

Right paramedian approach

Midline approaches are not useful due to the location of the rumen. Most ventral incisions are made to the right of midline and cranially (a few inches caudal to the xiphoid) to access the abomasum. This approach provides the only real access to most of the abomasum and is used to fix adhesions and to perform right paramedian abomasopexies. It is also useful for draining liver abscesses as well as abscesses from hardware disease or perforated abomasal ulcers.  Exploratory options are poor except in preruminants.

Cows are “cast” into recumbency using ropes and sedation. Feeding troughs can be used for smaller animals, maternity pens or other open spaces for adult animals. The cut out for the manure spreader can be used as a V trough.

Toggle pin procedures are also performed in dorsal recumbency but no incision is made.


One-step laparoscopy-guided abomasopexy versus omentopexy via right flank laparotomy to treat left displaced abomasum in dairy cows, in relation to return of milk yield. The Veterinary Journal 296-297 (2023) 105991

Comparing survival times in cattle with a left displaced abomasum treated with roll-and-toggle correction or right pyloro-omentopexy. 5/12 September 2020 | VET RECORD

Comparison of omentopexy versus pyloro-omentopexy for treatment of left abomasal displacement in dairy cows: 87 cases (2001–2005). JAVMA • Vol 251 • No. 10 • November 15, 2017

Surgical management of left displaced abomasum in dairy cattle. Veterinary Record | January 30, 2016 – Clinical decision making



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Large Animal Surgery - Supplemental Notes Copyright © by Erin Malone, DVM, PhD is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.