3. The operational site is identified about 4-7 inches (10-15cm) behind the end of the xiphoid (breastbone) and prepared according to the preference of the surgeon. (Cleaned, clipped, scrubbed, sanitized, etc.) At the surgeon's discretion, the abomasum may be ausculted in this area with a stethoscope. When auscultating, the cow should be positioned with the loudest 'ping' in the center of the operational site previously described.

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It should be remembered that the abomasum will assume its normal anatomical position under most circumstances, except when concurrent adhesions or peritonitis might prevent normal movement to its correct anatomical location. Such cases are few, but occasionally cause failure to toggle the abomasum. This condition might merit a laparotomy for further evaluation.

4. Have an assistant place the pressure of a knee, hand, or foot, on the lower left abdominal quadrant ahead of the udder, or in lieu of an assistant, the surgeon may elect to place a knee or foot on the abdomen from the cow's right side. This will help to ensure that the abomasum is in proper position and as close to the ventral abdominal wall possible.

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