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This Concept Map, created with IHMC CmapTools, has information related to: Right Flank Omentopexy procedure, STEP 8- Once the abomasum is returned to its normal position, the duodenum resumes its normal horizontal position and is commonly observed to fill with gas. STEP 9- Once the abomasum has been returned to its correct position, the technique of omentopexy (or pyloro-omentopexy) is the same whether it is an LDA, RDA, or RTA. STEP 10- The omentum is grasped and pulled out through the incision. It is gently retracted dorsad and caudad until the pylorus can be visualized. The fold of omentum may be held by an assistant or attached to the upper part of the skin incision with towel forceps while the anchoring sutures are placed., STEP 6- Once to the left of the rumen, the hand, with the fingers closed, is used to sweep the abomasum back to the right side of the abdomen. If sweeping from the left does not completely reposition the abomasum one may reach along the right body wall ventrally to find the muscular pylorus and pull the abomasum into the normal position. Gentle dorsocaudal pulling on the omentum, is also helpful in this manipulation. STEP 7- If the rumen is full, it may be necessary to elevate the caudal ventral blind sac of the rumen with the inside of the elbow, to allow the abomasum to be pulled along under the rumen. Repositioning the abomasum to displace the rumen to the right slightly off the left body wall by using the left forearm may be helpful. STEP 8- Once the abomasum is returned to its normal position, the duodenum resumes its normal horizontal position and is commonly observed to fill with gas., STEP 10- The omentum is grasped and pulled out through the incision. It is gently retracted dorsad and caudad until the pylorus can be visualized. The fold of omentum may be held by an assistant or attached to the upper part of the skin incision with towel forceps while the anchoring sutures are placed. STEP 11- Two mattress sutures of no. 1 or no. 2 synthetic absorbable suture material (one cranial to the incision and one caudal to it) are placed through the peritoneum and transverse abdominal muscle and through both layers of the fold of omentum. STEP 12- The sutures are placed about 3 cm caudal to the pylorus. The peritoneum and transverse abdominal muscle are then sutured in a simple continuous pattern with no. 1 or no. 2 synthetic absorbable suture, and the omentum is incorporated into the suture line in the ventral two-thirds of the incision., STEP 4- Pressure is applied firmly with the forearm and the hand to release the gas, or the tubing may be attached to a suction device. The end of the tubing placed in a cup of water if suction is not available to appreciate the gas being removed assuring there is not obstruction of the needle or tubing. STEP 5- The needle is withdrawn and is carried back carefully, with the tubing folded to avoid contamination. The abomasum is returned to its normal position by following the peritoneal surfaces ventrally with the hand between the rumen and the body wall. STEP 6- Once to the left of the rumen, the hand, with the fingers closed, is used to sweep the abomasum back to the right side of the abdomen. If sweeping from the left does not completely reposition the abomasum one may reach along the right body wall ventrally to find the muscular pylorus and pull the abomasum into the normal position. Gentle dorsocaudal pulling on the omentum, is also helpful in this manipulation., RIGHT PARALUMBAR FOSSA (FLANK) OMENTOPEXY PROCEDURE STEP 1- The abdomen is entered through a 20-cm vertical incision in the right paralumbar fossa starting 4–5 cm ventral to the transverse processes of the lumbar vertebrae. The duodenum will be vertical instead of in its normal horizontal position. STEP 2- Palpate the left side of the abdomen by deflecting the greater omentum craniad. Then pass left arm caudal to the omentum and rumen to palpate the abomasum distended with gas on the left side of the rumen. This confirms the diagnosis of LDA., STEP 2- Palpate the left side of the abdomen by deflecting the greater omentum craniad. Then pass left arm caudal to the omentum and rumen to palpate the abomasum distended with gas on the left side of the rumen. This confirms the diagnosis of LDA. STEP 3 - The abomasum may be deflated using a 14–16-gauge needle with a length of sterile tubing attached. The needle is carried caudal to the rumen to the most dorsal part of the displaced abomasum and is inserted obliquely through the abomasal wall. STEP 4- Pressure is applied firmly with the forearm and the hand to release the gas, or the tubing may be attached to a suction device. The end of the tubing placed in a cup of water if suction is not available to appreciate the gas being removed assuring there is not obstruction of the needle or tubing., STEP 12- The sutures are placed about 3 cm caudal to the pylorus. The peritoneum and transverse abdominal muscle are then sutured in a simple continuous pattern with no. 1 or no. 2 synthetic absorbable suture, and the omentum is incorporated into the suture line in the ventral two-thirds of the incision. STEP 13- The internal and external abdominal oblique muscle layers and the skin are closed as in a routine flank laparotomy. Right paralumbar fossa Pyloropexy Procedure