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Roll and toggle versus right abomasopexy in cattle with an LDA

Clinical Scenario

You diagnose a left displaced abomasum (LDA) in a 2nd lactation dairy cow, eight days after calving, in one of your higher yielding pedigree herds. Your client, Mr Clowes, is keen to correct the displacement as soon as possible. He has heard that the roll and toggle correction method is easier and quicker to perform, and therefore will cost him less, compared to the standard surgical approach you usually use, a right paramedian abomasopexy. However, this cow is a young valuable animal and your client states he will only opt for roll and toggle correction if the rates of survival are at least as good as surgery. You wonder if there is a difference in survival between the two techniques...

3-Part Question (PICO)

In [cattle with a left displaced abomasum] does [roll and toggle correction compared to right abomasopexy] affect [survival in the herd]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(cow.mp. OR cows.mp. OR cattle.mp. OR bovine.mp. OR bovines.mp. OR bos.mp. OR exp Cattle/)

AND

(abomasal displacement.mp. OR LDA.mp. OR LDAs.mp. OR DA.mp. OR DAs.mp. OR abomasum.mp. OR abomasums.mp. OR exp Abomasum/)

AND

(toggle.mp. OR grymer.mp. OR sterner.mp. OR TPS.mp. OR conservative treatment.mp. OR conservative therapy.mp. OR R&T.mp. OR toggling.mp.)

AND

(abomasopexy.mp. OR laparotomy.mp. OR surgical treatment.mp. OR surgical therapy.mp. OR surgery.mp. OR exp Laparotomy/)

CAB Abstracts 1910 to Present using the OVID interface

(cow.mp. OR cows.mp. OR cattle.mp. OR bovine.mp. OR bovines.mp. OR bos.mp. OR exp cattle/ OR exp cows/)

AND

(abomasal displacement.mp. OR LDA.mp. OR LDAs.mp. OR DA.mp. OR DAs.mp. OR abomasum.mp. OR abomasums.mp. OR exp abomasum/)

AND

(toggle.mp. OR grymer.mp. OR sterner.mp. OR TPS.mp OR conservative treatment.mp. OR conservative therapy.mp. OR R&T.mp. OR toggling.mp.)

AND

(abomasopexy.mp. OR laparotomy.mp. OR surgical treatment.mp. OR surgical therapy.mp. OR surgery.mp. OR exp laparotomy/)

Search Outcome

MEDLINE

  • 9 papers found in MEDLINE search
  • 7 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 1 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 41 papers found in CAB search
  • 38 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 1 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Kelton et al. (1988) USA

Title: Bar suture (toggle pin) vs open surgical abomasopexy for treatment of left displaced abomasum in dairy cattle.
Patient group: 59 dairy cows that developed an LDA within the first 60 days of lactation
Study Type: Randomised controlled trial
Outcomes:
  • Survival - mortality and culling rates up to 60 days into the subsequent lactation
  • Return to normal milk production
  • Return to normal feed consumption
  • Recurrence of LDA
  • Physical examination - rectal temperature, heart rate, respiratory rate, rumen motility
  • Tissue reaction at the site of the incision
  • Measurements were made at 4 follow up appointments: 3-5 days, 10-14 days, 50-60 days post surgery and approximately 60 days into the subsequent lactation.
Key Results:
  • 14/28 cows in the abomasopexy group and 18/31 in the roll and toggle group were still in their herds at the fourth follow up visit (according to Table 3)
  • There was no statistically significant difference between the two treatment groups in the number of cows culled or which died through the first 60 days of the next lactation (14/28 cows died or were culled in the abomasopexy group, 13/31 in the roll and toggle group). The reasons for culling/death could only be directly attributed to the intervention in one case in the roll and toggle group
  • There were no significant differences between the two treatment groups for any of the outcome measurements at the first two follow up visits (p>0.05)
  • There were no significant differences between the two treatment groups for milk production, feed intake or recurrence of LDA at the 3rd and 4th follow up visits (p value not stated for this table of results)
Study Weaknesses:
  • Some outcome measurements were measured subjectively by owners - milk production and feed consumption 
  • No standardisation of the tissue reaction site scale used. Scale is not described in enough detail to be repeated
  • No level of statistical significance stated in the methods
  • No sample size justification and the groups were relatively small (28 and 31)
  • Missing cow in the results (cow is from the surgical abomasopexy group)
  • Statistical tests performed and their results not always clear for all outcome measures
  • No discussion of blinding or how outcomes were assessed.  The interventions were surgical, so traditional blinding may not have been appropriate.  A discussion on any potential sources of bias would have been beneficial
  • Multiple farms used; it is possible levels of aftercare varied between farms
  • Not stated whether the surgeon was the same each time
  • No mention of ethical approval
  • No funding source stated
Attachment:
No attachments.

Comments

This is a relatively small, randomised controlled trial with some methodological limitations. Further larger studies would be beneficial to generate more evidence to answer this question.

Bottom line

Based on the limited available evidence, there is no difference in survival in the herd between cows treated for LDA by a roll and toggle procedure or a right abomasopexy procedure.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Kelton DF, Garcia J, Guard CL, Dinsmore RP, Powers PM, Smith MC, Stehman S, Ralston N, White ME, (1988). Bar suture (toggle pin) vs open surgical abomasopexy for treatment of left displaced abomasum in dairy cattle. Journal of the American Veterinary Medical Association 193(5):557-559.








About this BET

First author:
Kathryn Wareham
Second author:
Hannah Doit
Institution:
CEVM, University of Nottingham
Search last performed:
2015-05-11 16:04:30
Original publication date:
2015-05-29 16:04:30
Last updated:
2015-05-29 16:04:30
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