What are the indications and techniques for right vs left flank omentopexy for displaced abomasum?

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Right flank laparotomy omentopexy is the standard open surgical approach for left displaced abomasum (LDA), performed with the cow standing via a right paralumbar fossa incision using an inverted-L block with 100 mL of 2% procaine. The abomasum is repositioned from the left to the right ventral abdomen, and omentopexy is performed approximately 4–6 cm caudal to the pylorus before routine closure.3 Left flank laparotomy omentopexy uses the same standing approach but through the left paralumbar fossa. Both right and left flank laparotomy techniques produce a comparable peritoneal inflammatory response, with peritoneal fluid leukocyte counts rising to a median of 13.1 G/L (right flank) and 13.6 G/L (left flank) on day 1 after surgery — significantly lower than the 33.7 G/L seen after laparoscopic abomasopexy.2 Both laparotomy approaches also cause an increase in blood and peritoneal fluid creatine kinase on day 1 postoperatively, whereas laparoscopy elevates peritoneal fluid creatine kinase only.2 The primary indication for right flank laparotomy omentopexy is LDA requiring open surgical correction, particularly when visualization of the abdominal cavity is needed, when concurrent disease requires manual exploration, or when percutaneous techniques are contraindicated.7 Percutaneous methods such as the blind-stitch and toggle-pin carry a high risk of complications including localized peritonitis, adhesions, and incorrect fixation, which may necessitate salvage right flank laparotomy omentopexy.7 The total cost of a failed blind-stitch followed by laparotomic rescue has been documented at 897 € for the second intervention alone, with associated lost milk revenue of 4,168 €.7 Rolling followed by immediate right flank omentopexy is an accepted approach when the LDA is difficult to correct from the right side alone. Rolling induces right-sided abomasal displacement in 44% of cases, with the abomasum returning to a normal position in 54.1% of cases after rolling.6 Adverse e