Laparoscopic hernioplasty in recumbent horses using transposition of a peritoneal flap

Objective— To evaluate the efficacy of a laparoscopic peritoneal flap hernioplasty (PFH) to close anatomically the vaginal ring and to evaluate its protective effect in horses with a history of strangulated inguinal hernia (SIH) against future herniation.
Study Design— Prospective study.
Animals— A first group of 5 ponies, 3 horses and 1 donkey with no history of SIH and a second group of 4 horses 'clinical cases' with a history of SIH.
Methods— A laparoscopic PFH was effected on all horses under general anaesthesia. Peritoneum ventro-lateral to the vaginal ring was elevated and cut on 3 sides, separated from the underlying muscle, then inverted and attached dorso-medially and laterally to the parietal wall using intra-corporeal stitches (6 cases) or laparoscopic staples (7 cases). Animals of the first group (n=9) underwent a standing laparoscopy 7 days post-operatively to visualize the vaginal rings. Horses of the second group were followed to confirm the absence of re-herniation.
Results— The laparoscopic check-up showed that the vaginal ring had been effectively and completely covered in all cases except the first one. No adhesions was observed. In the four clinical cases, none of the horses have had a reccurence of SIH at the time of writing (6 months to 4 years).
Conclusion— Laparoscopic hernioplasty on a recumbent horse is feasible by closing the vaginal ring with a peritoneal flap. This technique was efficient in our cases to prevent recurrence of SIH but more cases are needed. This technique may reduce inflammation and irritation of the spermatic cord, which could otherwise jeopardise the animal's breeding career.
Clinical Relevance— Laparoscopic PFH coud be used in horses with a history of SIH.     

Laparoscopic Mesh Incisional Hernioplasty in Five Horses

Objective— To report a technique for incisional hernioplasty in horses using laparoscopic placement of a prosthetic mesh.
Study Design— Case series.
Animals— Horses (n=5) with ventral median abdominal incisional hernia.
Methods— A telescope and 2 instrument portals were established bilaterally, lateral to and distant from the hernia margins. After exposure of the internal rectus sheath by removal of retroperitoneal fat with endoscopic scissors and monopolar cautery, a prosthetic mesh was introduced into the abdomen and secured intraperitoneally using transfascial sutures with or without supplemental endoscopic hernia fixation devices.
Results— Successful placement of the prostheses was achieved without major intra- or postoperative complications. Repairs were intact in all horses (follow-up range: 6–23 months) without evidence of adhesion formation. Cosmetic results compared favorably with those typically achieved using conventional, open hernioplasty techniques.
Conclusion— Incisional hernia repair in horses can be successfully achieved with a laparoscopic intraperitoneal mesh onlay technique.
Clinical Relevance— Laparoscopic mesh hernioplasty has promise as a safe and effective method for repair of incisional hernias in horses.     

Laparoscopic cryptorchidectomy in horses.

Laparoscopic cryptorchidectomy was successfully performed in 15 standing or recumbent horses. In 3 horses, owners believed that castrations had been performed, but the horses had retained stallion-like behavior. Successful removal of undescended testes in these horses stopped this behavior. Laparoscopy offered excellent visualization of the structures of the vaginal ring and facilitated removal of the abdominally located testis. The internal and external inguinal rings were not invaded, thus the chance of serious complications that may result during open cryptorchidectomy procedures was minimized.     

Laparoscopic inguinal herniorrhaphy with barbed suture in a ram

A 7-month-old Hampshire ram, with no history of trauma or breeding, was referred for treatment of acute, unilateral scrotal swelling. Physical examination revealed a moderately sized, soft, left-sided, non-reducible swelling of the proximal scrotum and mild swelling of the scrotal neck. Ultrasound evaluation of the scrotum revealed morphologically normal testicles and a mild accumulation of free fluid in the left vaginal tunic. Unilateral, laparoscopic inguinal herniorrhaphy under general anesthesia was performed. The herniated omentum was reduced and barbed suture was used to imbricate the internal inguinal ring and the vaginal ring. No recurrence of herniation was reported 5 months after surgery.Key clinical message:Laparoscopic inguinal herniorrhaphy with barbed suture can be a safe and effective means of scrotal hernia resolution in a ram. When performed by a competent surgeon experienced in laparoscopy, this treatment for inguinal and scrotal herniation may minimize post-operative pain, provide a rapid return to function, and preserve normal testicular and scrotal anatomy.     

Post-partum uterine rupture: Standing repair in three mares using a laparoscopic technique

Three mares underwent diagnostic laparoscopy because of suspicion of post-partum uterine ruptures. All three horses showed clinical signs of a uterine rupture between 1 and 3 days after parturition and underwent diagnostic laparoscopy. In all cases a full thickness uterine rupture could be detected and was sutured laparoscopically. Availability of suture material and surgeon experience were responsible for the surgical methods chosen for repair. In the first case, a hand-assisted laparoscopic approach was chosen for suturing the ruptured uterus, whereas in the other cases the approach was entirely laparoscopic. In the second case, extracorporeal knots were used for the repair and in the last case described a barbed loop suture was available for closure of the uterus. Two of three mares were alive for at least 12 months after surgery without any abdominal problems. One of these mares delivered a healthy foal 2 years after surgery. The remaining mare died 3 months after surgery but no necropsy was done. Laparoscopy should be considered for post-partum mares with signs of peritonitis to access the uterus and repair a rupture if it is accessible. A laparoscopic approach using intracorporeal knots or barbed sutures for the repair of the uterine rupture as well as a hand-assisted laparoscopic approach are feasible. The use of the barbed suture for intracorporeal closure makes the minimal invasive laparoscopic technique easier to perform.     

Continuous absorbable suture pattern in the closure of ventral midline abdominal incisions in horses

A retrospective study was performed to evaluate the healing of ventral midline abdominal incisions, closed with a simple continuous suture pattern using absorbable suture material, in 139 horses and foals. Dehiscence and incisional hernia developed separately in two horses. The low incidence of dehiscence and incisional hernia, compared with their reported incidence following the use of interrupted suture repair, leads the authors to recommend this alternative method of abdominal incision closure in horses. The security of closure is not sacrificed and the advantages of a rapid closure are desirable.     

Rectal tears in the horse: an analysis of 35 cases

The records of 35 horses with Grade 3 or 4 rectal tears, presented to the Veterinary Medical Center at Texas A & M University over a five year period, were reviewed. Grade 3 tears were sub-classified according to whether the remaining tissue was serosa (Grade 3a) or mesorectum (Grade 3b). Five horses were destroyed on presentation and 30 were treated by primary suture closure (8 horses), faecal diversion alone (9 horses) or in combination with suture closure (11 horses) and packing of the tear with medicated gauze sponges (two horses). Faecal diversion was achieved with a temporary indwelling rectal liner (TIRL) in 19 horses and colostomy in one. Survival was related to classification of the tear, efficacy of first aid measures administered at time of injury and method of treatment. Seventy-four per cent of horses with Grade 3a tears and 44 per cent of those with Grade 3b tears survived. Grade 4 tears had a grave prognosis. Horses given adequate first aid before admission had a better survival rate. With proper patient selection, primary closure of the tear with sutures yielded excellent results. In horses which were not candidates for suture closure alone, a combination of faecal diversion and suturing gave better results than faecal diversion only. In addition, selected horses were treated successfully by packing the rectal tear with gauze sponges. The results demonstrate the value of a TIRL to divert faeces and appropriate first aid measures in treating rectal tears.     

Loop colostomy for management of rectal tears and small-colon injuries in horses: 10 cases (1976-1989).

Loop colostomy was performed in 10 horses as treatment for grade-III rectal tears (n = 6 horses), small-colon infarction (n = 2 horses), perirectal abscess and stenosis (n = 1 horse), and small-colon stricture (n = 1 horse). In 7 horses, the colostomy was constructed through a single incision low in the left flank, with closure of the incision around the stoma (single-incision technique). In 3 horses, 2 of which had colostomy performed as a standing procedure, the selected segment of small colon was placed from a flank incision into a separate, small incision low in the left flank (double-incision technique). Five horses underwent colostomy reversal (at 18 to 63 days) and 2 of these horses, both with grade-III rectal tears, recovered completely. Of 8 horses that did not survive, 6 died from the primary disease or associated complications. Technical problems associated with colostomy accounted for death of 2 horses. One horse had gastric rupture attributable to suture occlusion of the small intestine after colostomy reversal, and another horse had complications of incisional infection after repair of a peristomal hernia. Small-colon prolapse through the stoma necessitated premature reversal of the colostomy in a horse that was euthanatized because of worsening laminitis. Minor complications of the colostomy procedure were partial stomal dehiscence (n = 4 horses), partial dehiscence of the flank wound after colostomy reversal (n = 2 horses), and small ventral midline hernia after colostomy reversal (n = 1 horse). Loop colostomy may be of benefit to horses with rectal tears, provided it is done soon after the tear occurs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical technique to repair grade IV rectal tears in post-parturient mares

Objective— To describe a surgical technique for repair of grade IV rectal tears after parturition in mares and to report outcome.
Study Design— Clinical report.
Animals— Horses (n=6) with grade IV rectal tears.
Methods— Mares were sedated and restrained in standing stocks. After caudal anesthesia and evacuation of feces from the rectum, the perineal region was aseptically prepared. Four stay sutures were placed through the external anal sphincter before vertical transection (12 o'clock). Caudal retraction of the tear was performed using Allis tissue forceps (5 mares) or stay sutures before accurate apposition of the tear margins with steel staples below the tissue forceps. The mucosal edges were then sharply dissected leaving ∼5 mm edges which were apposed in a single layer (2-0 poliglecaprone 25) before stapler release. In 1 mare, the rectal tear was identified and apposed using a 2-layer hand-sutured closure. Systemic antibiotics and anti-inflammatory agents were administered postoperatively (5 mares) and standing abdominal lavage performed (3 mares).
Results— Four mares survived long term and subsequently became pregnant. Immediately after surgical repair, 1 mare was anesthetized for exploratory celiotomy and abdominal lavage but fractured her pelvis during recovery from anesthesia and was euthanatized. A 2nd mare was euthanatized after 72 h because of severe diffuse peritonitis; however, the repair was still intact.
Conclusion— In standing mares, rectal tears can be exteriorized by prolapse through the anal sphincter after sphincterotomy and repaired in 2 layers with staples oversewn with a continuous suture pattern.
Clinical Relevance— Rectal tears occurring as a result of parturition can potentially be repaired efficiently using an oversewn stapled primary closure technique.     

Diaphragmatic Hernia Repair in Three Young Horses

Objective- This clinical report describes surgical correction of diaphragmatic hernia in three young horses.
Study Design- Retrospective investigation of medical records and subsequent racing performance.
Animals- Three young horses with diaphragmatic hernia.
Results- Three young horses with signs of abdominal pain had diaphragmatic hernia causing small intestinal strangulation. The strangulated small intestine was resected and an end-to-end jejuno-jejunal (two horses) or a side-to-side jejuno-cecal anastomosis (one horse) was performed. Diaphragmatic hernias were closed with a continuous suture pattern. All horses recovered and raced. No difference in race records was found between the subject horses and their siblings. One subject horse died of colic at 5 years of age, but the cause of the colic was undetermined. The remaining two horses are in use as broodmares and have produced multiple foals without recurrence of signs of diaphragmatic hernia
Conclusions- Diaphragmatic hernias can be repaired in horses. These horses can achieve race records similar to their siblings and can produce foals without recurrence of signs of diaphragmatic hernia.     

A Review of Laparoscopic Cryptorchidectomy

Laparoscopic cryptorchidectomy has provided the surgeon with an easy, efficient means of locating and castrating abdominally retained testes without the complications associated with routine open approaches. It is especially useful when the horse's castration history is unknown, or if previous attempts at cryptorchid castration have been made. With the direct visualization that laparoscopy provides, surgeons are able to visualize both vaginal rings for presence of intra abdominal and inguinal testis in addition to testicular remnants and adhesion formation from previous surgical manipulations. Furthermore, because it is minimally invasive, laparoscopy shortens patient confinement time and reduces postoperative complications such as eventration. With experience, it is a technically easy procedure and can safely be performed on anesthetized or standing sedated horses.     

Incisional Hernias in the Horse Incidence and Predisposing Factors

Medical records of 210 horses that survived ventral midline celiotomy for at least 4 months were examined and owners were queried to determine factors contributing to incisional hernia formation. The incidence rate of incisional hernias within 4 months was 16%. Factors significantly associated with occurrence of incisional hernias were incisional drainage, closure of the linea alba with chromic gut suture material, previous midline celiotomy, excessive incisional edema, castrated male sex, postoperative leukopenia, and postoperative pain (colic). Factors not significantly associated with occurrence of incisional hernias were suture pattern used for linea alba closure, concurrent enterotomy or intestinal resection, postoperative bandage or stent, postoperative fever, hypoproteinemia, diarrhea, respiratory disease (coughing), and peritonitis. Hernias developed in horses within 12 weeks of surgery, with the earliest hernia recognized at week 2. Of 30 horses for which information was available, only one hernia developed in 24 (80%) and two or more hernias developed in 6 (20%) along the incision. Multiple hernias tended to be smaller than single hernias.     

Minimally Invasive Inguinal Approach for Tube Cystostomy

Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.
Study Design— Case series.
Animals— Dogs (n=9) and cats (6).
Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.
Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.
Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.
Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.     

Acquired incarcerated inguinal hernia: a review of 13 horses

The case records of 13 horses with acquired incarcerated inguinal hernia in January-August 1983, were reviewed. Nine cases were in stallions. The remaining four involved eventration 5-48 hours following castration. Ages ranged from 1-17 years. Horses showed a variable degree of colic. Bowel was felt to pass through the internal inguinal ring on rectal examination in most cases. The physical features of the scrotum varied considerably. Resection of ischemic jejunum and/or ileum was necessary in three horses. Two horses were euthanized at surgery (one with bilateral ischemic jejunum, one with bowel perforation), and a further horse on day 16 postsurgery following development of multiple adhesions. All stallions were castrated. Follow-up for 6-24 months (mean 12.7) disclosed that all ten discharged horses were alive and healthy (recovery rate 77%).     

Indications, surgical technique, and long-term experience with laparoscopic closure of the nephrosplenic space in standing horses

OBJECTIVE: To describe surgical technique and outcome after laparoscopic closure of the nephrosplenic space for treatment of recurrent left dorsal displacement of the left colon (LDDLC) in standing horses. STUDY DESIGN: Retrospective study. ANIMALS: Forty-four horses with LDDLC. METHODS: Laparoscopic portals were located in the left flank region. After administration of etilefrin intravenously to contract the spleen, the dorsal splenic margin was sutured to the nephrosplenic ligament to obliterate the nephrosplenic space. Horses were re-examined (< or = 3 years) for history of recurrence. In addition, medical records of 4,852 horses treated for colic over 16 years were evaluated to establish incidence of LDDLC and recurrence after treatment. RESULTS: Splenic contraction facilitated suture placement and closure of the nephrosplenic space was achieved without complications. LDDLC recurrence did not occur although 5 horses had subsequent episodes of colic; 4 horses had displacement of the ascending colon between the spleen and body wall. Review of medical records revealed an incidence of LDDLC of 6% and recurrence of 21% in a population of horses with signs of colic. CONCLUSION: Laparoscopic closure of the nephrosplenic space, facilitated by etilefrin-induced splenic contraction can be efficiently performed in standing horses. CLINICAL RELEVANCE: Laparoscopic ablation of the nephrosplenic space should be considered in horses that are predisposed to recurrent LDDLC.     

Castration of Horses with Primary Closure and Scrotal Ablation

Fourteen horses and one pony, 1 to 16 years of age, were castrated with a technique designed to promote primary healing and ablation of the scrotum following removal of descended testicles. Twenty-six testicles (10 nondescended, 15 normal descended testicles, and 1 neoplastic descended testicle) were removed. Nondescended testicles were removed through a skin incision over the external inguinal ring. Descended testicles were removed, and the scrotum was ablated by excision of the ventral scrotum. All testicles were removed by emasculation. The common vaginal tunic was not opened prior to emasculation of the descended testicles, and transfixation liqation sutures were used in only two horses. All incisions were closed with multiple layers of synthetic absorbable sutures in the subcutaneous and subcuticular tissues. All incisions healed by primary intention, and 14 recovered without complications. As a result of incomplete scrotal ablation, one horse had temporary lameness and swelling of the scrotal area that resembled the presurgical appearance.     

Use of an inguinal approach adapted from equine surgery for cryptorchidectomy in dogs and cats: 26 cases (1999-2010)

OBJECTIVE-To determine whether a surgical technique used in cryptorchid horses can be used successfully to remove testicles retained in the inguinal region or abdominal cavity in dogs and cats. DESIGN-Retrospective case series. ANIMALS-22 dogs and 4 cats with cryptorchidism. PROCEDURES-In 1999 through 2010, 26 cryptorchid patients underwent surgery during which an incision was made over the inguinal ring and the undescended testicle was located for removal via identification of the vaginal process and the embryonic gubernaculum. Castration was performed once a testicle was located in the inguinal region or via removal of an intra-abdominally located testicle through the inguinal canal. RESULTS-4 dogs and 1 cat were bilaterally cryptorchid. Testicles were retained in the abdominal cavity in 18 dogs and in the inguinal region in 4 dogs; in all 4 cats, undescended testicles were located in the inguinal region. Twenty-one dogs and 4 cats were castrated without breaching the abdominal cavity; in one of those dogs, the inguinal ring was enlarged to permit extraction of a tumorous testicle. In 1 dog, the inguinal ring was enlarged into a paramedian laparotomy and viscera were manipulated to exteriorize an intra-abdominally located testicle because the gubernaculum had ruptured. Major intraoperative or long-term complications did not occur. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that as in horses, the surgical approach over the inguinal ring, wherein the vaginal process and the remnant of the gubernaculum are identified and used to locate an undescended testicle for removal, can be used successfully in dogs and cats.     

Laparoscopic Splenectomy in Goats

Objective— To report laparoscopic splenectomy in goats.
Study Design— Experimental study.
Animals— Healthy female goats (n=9); aged, 10–18 months; weighing, 22–30 kg.
Methods— Food was withheld for 24 hours and water for 10 hours. Anesthetized right laterally recumbent goats had a laparoscopic portal and 3 instrumental portals created in the left flank. Splenic attachments were dissected with monopolar electrocautery and blunt dissection through 2 instrument portals. Exposure and isolation of splenic vessels was performed with laparoscopic "right-angle" preparation forceps. Vessels were ligated with a medium-titanium clip and 2 silk sutures and then transected between the silk sutures. The detached spleen was manipulated into a specimen retrieval bag, morcellated, and the bag retrieved through an enlarged portal. Repeat laparoscopic examination was performed at 1 month.
Results— Laparoscopic splenectomy required 70 minutes (range, 52–88 minutes) and was successful without major intraoperative and postoperative complications. Postoperatively, all goats had signs of mild abdominal discomfort. On repeat laparoscopy, with the exception of 1 goat that had a focal omental adhesion to the enlarged portal site, no other abnormalities were identified.
Conclusions— Laparoscopic splenectomy can be accomplished in goats using 4 portals in the left flank and a combination of monopolar cautery dissection of splenic attachments, ligation of vessels using metal clips and intracorporeal ligatures, and intra-abdominal morcellation of the detached spleen in a specimen retrieval bag.
Clinical Relevance— Laparoscopic splenectomy is an effective and safe technique in goats.     

Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing

Objective— To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome.
Study Design— Retrospective study.
Animals— Horses (n=10) with type Ia P1 fractures.
Methods— Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses.
Results— Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively.
Conclusions— Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture.
Clinical Relevance— Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.     

Laparoscopic surgical technique for repair of rectal and colonic tears in horses: an experimental study

OBJECTIVE: To determine the efficacy of laparoscopic surgical techniques for repair of rectal lacerations in horses. STUDY DESIGN: Experimental study. ANIMAL OR SAMPLE POPULATION: Thirty-two segments of equine bowel placed in an equine pelvitrainer, 8 equine cadavers, and 3 normal horses. METHODS: In experiment 1, 3 laparoscopic intestinal-repair techniques were evaluated in an equine pelvitrainer: suturing with needle holders, with an automatic suture device, and stapling with a hernia stapler. In experiment 2, descending colon lacerations were sutured laparoscopically using needle holders in a pelvitrainer and in equine cadavers. In experiment 3, iatrogenic rectal lacerations were sutured laparoscopically with needle holders in horses under general anesthesia. These horses were evaluated for 7 days' postoperatively by clinical examination and blood and peritoneal fluid analysis. The horses were euthanatized 7 days' postoperatively and necropsied. The repaired colonic segments were collected for determination of bursting pressures, degree of luminal narrowing, and microscopic examination of the suture line. RESULTS: For the 3 techniques, there was no significant difference in repair time or degree of luminal narrowing, but bursting pressure was higher in segments repaired by use of needle holders or with the suture device. Colonic and rectal lacerations were sutured successfully with laparoscopic needle holders. No major complications were recorded. At necropsy, adequate healing was confirmed by a high bursting strength (>140 mm Hg) and by histologic examination. CLINICAL RELEVANCE: A novel laparoscopic method can be used to repair iatrogenic rectal lacerations in horses. Whether this method may be used for clinical cases of rectal tears must be investigated.