Objective: The laparoscopic abomasopexy by Janowitz (1998) requires a fibrinous connective tissue adhesion between the abdominal and the abomasal wall to prevent the recurrence of abomasal displacement. After resolution of the inflammatory process, however, these adhesions are organized and receded, much as in the case of traumatic reticuloperitonitis given by BISCHOFF (1998), BROWN et al. (1998), and TUCKER et al. (1996). This order and regression makes the patients suffer from abomasal displacement which, treated with laparoscopic abomasopexy, is responsible for relapses (see JANOWITZ (1998), SEEGER (2005), and KÖTTER (2005)).Specific studies on the development of such inflammatory adhesions after laparoscopic abomasopexy have not yet been performed. It was therefore the objective of this study to determine the local findings in the field by using ultrasound to examine the abomasum fixation area in patients suffering from left-side abomasal displacement, which operated according to the Janowitz procedure to the 450th day post-operation. Materials and methods: Thirty-five German Holstein cows, of a mean age of 4.8 years (2 to 7.4 years) were admitted to the clinic suffering from left-sided abomasal displacement. The operative treatment was carried out according to the endoscopic process described by JANOWITZ (1998).The sonographic examinations were carried out starting immediately after surgery (day 0), mainly using 5 MHz linear transducer (DP-3300 Vet MINDRAY® ). Further investigations followed after four weeks, three months and six months, then at three-month intervals until the disappearance of the adhesions. In each case the abomasum fixation area in transverse and longitudinal directions was investigated.Results: At day 0 the adhesions were not yet detectable. However, these adhesions were at four weeks and three months after surgery found in all studied patients. Thereafter, the number of animals with detectable adhesions decreased, so that the adhesions between the abdominal and the abomasum wall at six months post-operation were at 89% (25 out of 28 animals); after nine months were at 85% (22 out of 26 animals); and after twelve months were only 40% (10 out of 25 animals) of the patients. Fifteen months after the laparoscopic abomasal fixation only 1 of the 25 remaining study animals (4%) showed adhesions. The toggle-pin visibility was detectable directly and four weeks post-operation. In two animals the toggle-pin presented itself after the 90th day; the toggle-pin was detectable ultrasonographically even on the 180th and 270th days post-operation. In the majority of cases (68%) the shape of the adhesion area was oval; round-shaped adhesion formed in about 26% of cases and the remaining 6% of patients adhesion shapes was irregular. A calcification in the center of the adhesion was ultrasonographically detected in 59% of the study subjects. During the study period only one cow showed a relapse of abomasum displacement three months post-operation. Conclusions: Ultrasound examination can recognize and identify the adhesions of an abomasum fixation area. These adhesions reach their maximum four weeks after surgery, then the adhesions continue to fall, although at considerable individual variations. Since the time of next calving is usually about 12 months after surgery, only 40% of the study subjects with ultrasonographically detected fixation (adhesions) were traced to the subsequent lactation term. This was observed in 19 subjects in this study, which suggests that the occurrence of abomasal displacement still must be added to other predisposing factors, which are not given in any lactation.
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