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Roll and toggle versus right pyloro-omentopexy in cattle with an LDA

Clinical Scenario

One of your clients, Mr Bradford, rings up and states that he thinks he might have a cow with a left displaced abomasum (LDA). You visit the farm, perform an examination and congratulate Mr Bradford on his deduction. Mr Bradford is keen for a correction to be performed as the cow is one of his best milkers and he would like to give her the best chance possible. You discuss the risks and benefits associated with either a roll and toggle or a right pyloro-omentopexy procedure (you have had experience with both of these). Mr Bradford's main concern is how many more lactations she will have following the procedure. You wonder if there is any evidence to support increased post-operative longevity with either approach.


3-Part Question (PICO)

In [cattle with a left displaced abomasum] does [roll and toggle correction compared to right pyloro-omentopexy] 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 exp Cattle/ OR bovine.mp. OR bovines.mp. OR bos.mp.)

AND

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

AND

(toggle.mp. OR toggling.mp. OR conservative treatment.mp. OR conservative therapy.mp. OR conservative technique.mp. OR closed suture technique.mp. OR closed technique.mp. OR R&T.mp. OR Sterner-Grymer.mp. OR Grymer-Sterner.mp. OR TPS.mp. OR bar suture.mp. OR pin suture.mp. OR laparotomy.mp. OR exp Laparotomy/ OR omentopexy.mp. OR pyloro omentopexy.mp. OR OM.mp. OR PLOM.mp. OR Hannover.mp.)

CAB Abstracts 1910 to Present using the OVID interface

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

AND

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

AND

(toggle.mp. OR toggling.mp. OR conservative treatment.mp. OR conservative therapy.mp. OR conservative technique.mp. OR closed suture technique.mp. OR closed technique.mp. OR R&T.mp. OR Sterner-Grymer.mp. OR Grymer-Sterner.mp. OR TPS.mp. OR bar suture.mp. OR pin suture.mp. OR laparotomy.mp. OR exp laparotomy/ OR omentopexy.mp. OR pyloro omentopexy.mp. OR OM.mp. OR PLOM.mp. OR Hannover.mp.)

Search Outcome

MEDLINE

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

CAB Abstracts

  • 462 papers found in CAB search
  • 456 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 4 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

Bartlett et al. (1995) Michigan, USA

Title:

Economic comparison of the pyloro-omentopexy vs the roll-and-toggle procedure for treatment of left displacement of the abomasum in dairy cattle.

Patient group:

72 dairy cows with LDA on one farm

Study Type:

Randomised controlled trial

 

Outcomes:
  • Number of cows culled post-surgery
  • Number of cows that died
  • Daily milk production (milk weights) for 120 days after correction
  • Value of lost milk production (compared with herd mates –‘controls’)
  • Estimated cost of cows removed from the herd
  • Estimated total economic impact of LDA   

 

Key Results:
  • No significant differences between treatment group populations prior to intervention
  • No significant differences between groups in relation to culling according to the BET authors' analysis - 12 cull and 23 alive (35 total) vs. 6 cull and 31 alive (37 total).
  • Surgically treated cows had a slower return to milk production than roll and toggle cows, but they reached higher levels of milk production. Overall there was no significant difference in total milk production losses between these two groups. 
  • Cows in surgical group had significantly more economic loss than cows in roll and toggle group (P=0.048).
  • No significant differences between metritis/no metritis (BET authors' analysis) and severe metritis/moderate metritis and no metritis (P=0.12).
  • Study authors state that metritis is associated with total economic impact, however P value = 0.13.
Study Weaknesses:
  • Cows from only one farm involved in the study
  • Somewhat unclear how cows were assigned to the 3 different surgeons
  • Not all the causes of cow death or reasons for culling are described
  • Did not use referenced methods for measurements of all outcomes
  • Not all statistics used were described in the methods; difficult to determine what type of analysis was carried out for all results given
  • Significance level not stated in methods
  • Sample size calculation not carried out
  • Not stated if ethical approval was obtained
  • Lack of basic data reported in results
  • Null findings not really interpreted in the discussion
  • Funding source not stated
Attachment:
No attachments.

Comments

It is unlikely that survival will be the only factor taken into consideration by farmers and vets when decision-making on similar cases; other factors may be important to consider. There was no distinction made between culling and natural death in the study, which could have affected the results.
The main focus of the paper was to look at the economic evaluation of the two treatments. It is unclear how the costs of the procedures were calculated, although this was not the primary aim of this BET. A seperate BET focusing specifically on the costs of either the procedure itself or the outcomes in relation to milk yield could be carried out in the future.

Bottom line

The evidence suggests there is no difference between the two types of approach (roll and toggle versus pyloro-omentopexy) in relation to survival. However, this single study relates to animals on one farm, therefore further studies are required to strengthen the evidence base in this area.  Choice of technique should be based on the surgeon’s/farmers' preferred approach or individual practice guidelines.

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

Bartlett PC, Kopcha M, Coe PH, Ames NK, Ruegg PL, Erskine RJ (1995). Economic comparison of the pyloro-omentopexy vs the roll-and-toggle procedure for treatment of left displacement of the abomasum in dairy cattle. Journal of the American Veterinary Medical Association 206 (8): 1156-62.

About this BET

First author:
Marnie Brennan
Second author:
Hannah Doit
Institution:

CEVM, University of Nottingham

Search last performed:
2017-04-04 10:45:14
Original publication date:
2015-03-27 10:45:14
Last updated:
2017-04-04 10:45:14
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