Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions

Objective —To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.
Study Design —Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.
Animals or Sample Population—12 horses.
Methods —Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.
Results —All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less ( P <.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.
Conclusions —Peritoneal lavage reduced the frequency of intraabdominal adhesions.
Clinical Relevance —When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.     

Hand‐assisted laparoscopic adhesiolysis of extensive small intestinal adhesions in a mare after breeding injury

In this article we report the course of disease in a mare following severe vaginal injury during natural cover. Although the genital injury healed completely, the mare developed extensive intra‐abdominal intestinal adhesions causing complete small intestinal obstruction 2 years after the incident. The adhesion was not accessible during initial emergency laparotomy and a standing, hand‐assisted laparoscopic adhesiolysis and jejuno‐jejunal end‐to‐end anastomosis were subsequently performed. The mare was subjected to euthanasia 10 weeks after surgery due to recurrence of abdominal pain. The pertaining literature is discussed in regards to this case.     

A Modified Technique for Extensive Large Colon Resection and Anastomosis in Horses

Objective —To describe an alternative technique for large colon resection and anastomosis in horses.
Study Design —Retrospective study of clinical patients.
Animal Population —37 horses that had ventral midline celiotomies between July 1, 1990, and July 1, 1994.
Methods —Large colon resection and anastomosis was performed using a modification of previously described techniques. Modifications include mesocolon ligation with a stapling device and an end-to-end apposition of the right ventral and right dorsal colon.
Results —Twenty-one of the 37 horses were discharged from the hospital without complications. Two horses were euthanatized immediately after recovery from anesthesia because of hindlimb fracture. Fourteen horses were euthanatized in the initial postoperative period because of persistent endotoxemia and abdominal pain.
Conclusions —The described technique is a safe, reliable method for large colon resection and anastomosis in horses.
Clinical Relevance —The described technique is fairly simple to perform and requires less surgical time compared with other techniques.     

Evaluation of Percutaneous Gastrostomy as a Technique for Permanent Gastropexy

Objective- This study was designed to evaluate right-sided percutaneous endoscopic gastrostomy (PEG) as a method for creation of a permanent gastropexy.
Study Design- Percutaneous endoscopic gastrostomy adhesions were evaluated by gross examination and by mechanical testing and the results were compared with those obtained by conventional incisional gastropexy.
Animals or Sample Population- Fourteen mixed-breed dogs.
Methods- Incisional gastropexies were performed on the dogs of group one (N = 7) and PEG tubes were placed in the dogs of group 2 (N = 7). All skin sutures (group 1) and PEG tubes (group 2) were removed on day 14. The animals were maintained for an additional 44 days before euthanasia and immediate necropsy. Gastropexy adhesions were evaluated and collected for biomechanical evaluation using a materials testing machine.
Results- The duration of the procedure for group 2 was less (32.86 min ±7.65) than for group 1 (56.29 min ±8.28). The number of complications was not significantly different between group 1 and group 2 ( P =.103). Gastroperitoneal adhesions were present in 7 of 7 dogs in group 1 and 4 of 7 dogs in group 2. The adhesion lengths and widths were significantly larger in dogs in group 1 compared with those in group 2. The adhesions present in group 1 dogs sustained significantly greater tensile loads to failure (61.98 ±14.65 N), compared with the adhesions present in group 2 dogs (22.31 ±26.87 N).
Conclusions- Right-sided PEG inconsistently formed a weak gastropexy and the procedure was associated with a trend toward greater morbidity than incisional gastropexy.
Clinical Relevance- Right-sided PEG is not recommended as a means of prophylactic gastropexy.     

Occurrence of incisional complications and associated risk factors using a right ventral paramedian celiotomy incision in 159 horses

Objective: To evaluate the occurrence of, and variables associated with, incisional complications after right ventral paramedian celiotomy in horses. Study Design: Case series. Animals: Horses (n=159). Methods: Occurrence of incisional complications after right ventral paramedian celiotomy was determined in 159 horses (161 celiotomies) that survived at least 30 days after surgery at a private equine hospital (2003–2007). Follow‐up information for 121 horses was obtained ≥90 days after surgery. Univariate analysis and multivariate logistic regression was performed to evaluate variables associated with incisional complications after celiotomy. Results: Of 161 celiotomies, ≥1 incisional complications occurred in 27 (16.8%) during hospitalization and/or after discharge, including: drainage (15.5%), skin dehiscence (3.7%), noticeable cutaneous scarring (1.9%), and herniation (0.6%). Variables significantly associated with incisional complications after multivariate analysis included: Quarter horse‐type breed (odds ratio [OR]: 3.9, 95% confidence interval [95% CI]: 1.3–11.7); use of an abdominal bandage (OR: 9.5, 95% CI: 2.9–30.8); and >4 postoperative febrile (>38.3°C) days (OR: 12.9, 95% CI: 2.8–58.2). Conclusions: Overall occurrence of incisional complications after right paramedian ventral celiotomy compared favorably to those reported for ventral median celiotomies. Several variables were associated with, but not necessarily predictive for, the occurrence of incision complications.     

Ventral Abdominal Approach for Laparoscopic Ovariectomy in Llamas

Objective —To evaluate a technique for laparoscopic ovariectomy by a ventral abdominal approach in the llama.
Study Design —Prospective evaluation.
Animal Population —Six healthy adult female llamas, aged 2 to 6 years.
Methods —Laparoscopic ovariectomy was performed with the llamas in a 30-degree Trendelenburg position. The mesovarium and proper ligament of the ovary were isolated, and two Hulka clips were placed in opposite directions across each mesovarium and proper ligament of the ovary. Ovaries were removed through either the instrument cannula or instrument portal.
Results —The ovaries, mesovarium, and proper ligaments of the ovaries were easily identified using laparoscopy by a ventral abdominal approach. The Hulka Clip Applicator was easy to use, and the Hulka Clips provided secure hemostasis of the vessels within the mesovarium. Mean duration of surgery was 35 minutes (range, 17 to 85 minutes). Two llamas were depressed after surgery but improved within 24 hours. No other complications occurred during an 18-month follow-up period.
Conclusions —Laparoscopic ovariectomy in the llama was facilitated by the use of Hulka Clips placed across the mesovarium and proper ligament of the ovary.
Clinical Relevance —Laparoscopic ovariectomy in the llama can be accomplished easily with few complications.     

Evaluation of laparoscopic adhesiolysis for the treatment of experimentally induced adhesions in pony foals

OBJECTIVE: To assess the efficacy of laparoscopic adhesiolysis in the treatment of experimentally induced adhesions in foals. ANIMALS: 8 healthy pony foals. PROCEDURE: Celiotomy was performed and adhesions created at the jejunoileal junction and at sites 0.5 and 1 m proximal to this junction, using a serosal abrasion method. Ten days after celiotomy, exploratory laparoscopy was performed. Laparoscopic adhesiolysis was performed in the treatment group only (4 foals, randomly selected). Thirty days after the exploratory laparoscopy, a final laparoscopic examination was performed, and the foals were euthanatized. The number and characteristics of abdominal adhesions were recorded during laparoscopy 10 and 30 days after celiotomy and during necropsy. RESULTS: At 30 days after celiotomy, the number of adhesions in the control group was significantly higher than the number in the treatment group. In the control group, all adhesions observed during the exploratory laparoscopy were still evident at the final laparoscopy and necropsy. In the treatment group, adhesions did not form again after separation. During final laparoscopy and necropsy, a focal adhesion between the omentum and site of the initial laparoscope portal was observed in 5 of 8 foals. CONCLUSIONS AND CLINICAL RELEVANCE: The serosal abrasion model is useful for studying abdominal adhesions in foals. Laparoscopic adhesiolysis was an effective technique to break down experimentally induced adhesions in the early maturation stage of formation in pony foals. Studies are required to investigate prevention of de novo adhesions at the laparoscope portal sites.     

Urinary Bladder Marsupialization for Treatment of Obstructive Urolithiasis in Male Goats

Objectives —To describe a surgical procedure for urinary bladder marsupialization and to report the results obtained from its use in the treatment of obstructive urolithiasis in male goats.
Study Design —Retrospective evaluation.
Animals or Sample Population—Male goats with obstructive urolithiasis.
Methods —Medical records of male goats that had urinary bladder marsupialization for the treatment of obstructive urolithiasis were reviewed. Data retrieved from the medical records included signalment, postoperative treatment, duration of hospitalization, and short-term and long-term complications. Median values for measured variables were calculated.
Results —A total of 18 of 19 goats survived. Urinary flow was re-established in all 19 goats at the conclusion of surgery. Short-term postoperative complications (bladder mucosal prolapse and death) were observed in 2 goats. Long-term postoperative complications (cystitis and fibrotic stomal closure) occurred in 2 animals. Median duration of hospitalization was 4 days. At the time of follow-up, mild urine scald was reported for all goats. Clinical signs of upper urinary tract disease or obstruction were not reported. A total of 15 of 17 owners were satisfied with the procedure.
Conclusions —Urinary bladder marsupialization provided long-term resolution of urinary outflow obstruction in all goats with acceptable morbidity.
Clinical Relevance —Urinary bladder marsupialization is a procedure that provides a good prognosis for long-term resolution of obstructive urolithiasis in male goats.     

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.     

Cosmetic Dehorning in Goats

Objective — This article describes a technique using primary closure when dehorning goats, and report the results of 22 cases.
Study Design — Medical records of goats that had cosmetic dehorning were reviewed.
Animals or Sample Population — Twenty-two goats.
Methods — The medical records of 22 goats, not previously dehorned by other methods, that were cosmetically dehorned between January 1988 and September 1995 were reviewed. Data retrieved from the medical record included age, breed, sex, surgical technique used for dehorning, and any complications that occurred after surgery. All clients were contacted by telephone to determine the course of postoperative healing for each goat. A surgical technique to remove the horns and close the defect primarily was described.
Results — The mean age of the goats, all male Nubian or Nubian-Spanish cross, was 6.9 months (range, 2 to 24 months). Horn base diameter ranged from approximately 2 to 4 cm. Mean time from surgery until follow-up was 12.9 months (range, 3 to 57 months). All incisions healed by first intention in 10 to 14 days. Clinical signs of sinusitis were not noted, and owners were pleased with the healing time and cosmetic result obtained.
Conclusions — Primary closure of skin defects after dehorning of goats can be achieved with minimal postoperative care and excellent cosmetic appearance.
Clinical Relevance — Primary closure after dehorning in mature goats reduces aftercare.     

Laparoscopic Cryptorchidectomy in Standing Horses

Objective — The purpose of this study was to determine the feasibility of using laparoscopy to remove cryptorchid testes from standing horses.
Study Design — Prospective clinical study.
Animals or Sample Population — Eleven client-owned horses ranging in age from 4 months to 2 years.
Methods — Abdominal insufflation was initiated and maintained using a 20 F insufflation tube, attached via a stopcock, to the low pressure regulator on a standard carbon dioxide pressure tank. After trocar and laparoscope placement in the ipsilateral flank the testes were identified. Local anesthesia of the structures to be manipulated was administered through the instrument channel on the operative laparoscope, using a catheter with a needle attached. Testes were grasped with large laparoscopic forceps and exteriorized through the abdominal wall. Ligation and transection of the mesorchium was extracorporeal. The descended testes were removed using a standard standing technique.
Results — Complications were minor, including mild colic in one horse. The mean surgical time for standing laparoscopic cryptorchidectomy and castration of these colts was 58.9 ±24.3 minutes.
Conclusions and Clinical Relevance — Standing laparoscopic cryptorchidectomy, using the instrumentation described, is a safe and practical technique in young horses.     

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.     

Paralumbar Fossa Laparoscopic Ovariectomy in Horses With Use of Endoloop Ligatures

Objective —The purposes of this study were to develop a technique of paralumbar fossa laparoscopic ovariectomy using Endoloop ligatures and to avoid a laparotomy incision for ovary removal by using a 33–mm diameter muscle spreader trocar-cannula unit.
Animals or Sample Population —Seven mares.
Methods —Bilateral laparoscopic ovariectomy was performed under general anesthesia in two horses and under neuroleptanalgesia and local anesthesia in five standing mares. Ovaries were approached from the ipsilateral paralumbar fossa through two portal sites located in the paralumbar fossa and a third between the 17th and 18th ribs. Insufflation of the abdominal cavity was achieved using an automatic carbon dioxide insufflator. Two Endoloop ligatures were placed on the mesovarium. The cannula, located in the center of the paralumbar fossa, was removed, and a 33-mm diameter trocar-cannula unit, with a cone-shaped muscle spreader extremity, was inserted through the same portal. The mesovarium was transected between the ovary and the ligatures. The ovaries were removed from the abdomen through the 33-mm diameter cannula. The abdominal wall was closed in a routine manner.
Results —No major complications occurred during or after surgery.
Conclusion —Paralumbar fossa laparoscopic ovariectomy in mares using Endoloop ligatures and the 33-mm diameter trocar-cannula unit was an effective technique for ovariectomy of normal ovaries in this study.
Clinical Relevance —Endoloop ligatures provide a viable alternative for laparoscopic ligation of ovarian pedicles in mares.     

Closed One-Stage Functional End-to-End Jejunojejunostomy in Horses With Use of Linear Stapling Equipment

Objective—To use gastrointestinal linear stapling instrumentation to perform a closed one-stage functional end-to-end jejunojejunostomy in adult horses as an alternative to a stapled side-to-side jejunojejunostomy.
Study Design—Clinical outcome, anatomic and histological architecture, and anastomotic dimensions were determined at 2, 4, 8, 16, and 24 weeks postoperatively. Animals or Sample Population—18 adult horses.
Methods—The anastomosis and peritoneal cavity were inspected for adhesions. The diameter and circumference of the anastomosis and jejunum oral and aboral to the anastomosis were determined from digitized contrast radiographs and linear measurements. Healing of anastomotic sites was evaluated histologically.
Results—Three horses were euthantized in the immediate postoperative period. In the 15 surviving horses, there were no peritoneal adhesions or distortion of the anastomoses and stomas remodeled in an end-to-end fashion. The mean anastomotic staple line (7.48 cm) and mucosa (6.89 cm) diameters were significantly ( P < .05) larger than the mean jejunal diameter oral (6.03 cm) and aboral (6.01 cm) to the anastomosis. The mean anastomotic luminal circumference (13.61 cm) was significantly ( P < .01) larger than the mean oral (11.43 cm) and aboral (11.12 cm) jejunal circumference. Histologically, there was adequate mucosal and muscularis mucosae reapposition with a moderate degree of fibrosis and inflammation.
Conclusions —Closed one-stage functional end-to-end jejunojejunostomy resulted in an acceptable functional anastomosis.
Clinical Relevance —This technique appears to be an acceptable alternative to linearly stapled, side-to-side jejunojejunostomies performed in horses.     

Prognosis Factors for Survival in Cats After Removal of a Primary Lung Tumor: 21 Cases (1979–1994)

Objective —To identify possible prognostic factors for survival time in cats with a primary lung tumor after surgical excision.
Study Design —Retrospective clinical study.
Animal Population —21 cats with histologically confirmed primary lung tumors removed surgically.
Methods —Medical records for cats treated between 1979 and 1994 at 14 participating veterinary referral hospitals were reviewed.
Results —After surgical resection and recovery, 18 cats died from metastatic disease with a median survival time of 115 days (range, 13 to 1,526 days). Three cats were lost to follow-up at 119 days, 251 days, and 410 days after the surgical procedure. Contingency table analysis to determine if an association existed between clinical findings (breed, age, gender, body weight, clinical signs, duration of clinical signs, and radiographic findings) or histological features and survival time was performed. Only histological morphology of the primary lung tumor showed a significant association with survival time. Twelve cats with moderately differentiated tumors had a significantly longer survival time (median, 698 days; range, 19 to 1,526 days) than the nine cats with poorly differentiated tumors (median, 75 days; range, 13 to 634 days).
Conclusions —Surgical resection of a solitary primary lung tumor in cats is indicated.
Clinical Relevance —A poor prognosis for long-term survival is warranted for those cats having a poorly differentiated primary lung tumor.     

Ventral Abdominal Approach for Laparoscopic Cryptorchidectomy in Horses

Objective —To report a ventral abdominal approach and a ligating loop technique for laparoscopic cryptorchidectomy in horses.
Study Design —Prospective.
Sample Population—Six horses, aged 1 to 5 years, with retained testes.
Methods —One laparoscopic portal and three to four instrument portals were used for ventral abdominal laparoscopic cryptorchidectomy. Laparoscopic instruments were used to maneuver and secure the testis through a ligating loop (modified Roeder knot) that was secured from outside the abdominal cavity. Only minimal enlargement of one instrument portal was used to remove the testicle.
Results —Three horses were bilateral cryptorchids, and three were unilateral (left side, two; right side, one) cryptorchids. Operative time, defined as the time from laparoscope insertion to removal, ranged from 20 to 25 minutes for unilateral cryptorchids and from 40 to 50 minutes for bilateral cryptorchids.
Conclusions —The reported technique allowed decreased tension on the tissues during ligation and removal of the testis from the peritoneal cavity. Improved observation of the abdominal cavity, ligation security, shortened patient confinement time, and minimally invasive technique are all considered to be benefits of laparoscopic cryptorchidectomy.
Clinical Relevance —Direct observation of retained testes and intraabdominal castration are distinct advantages of the use of laparoscopy in horses that have had previous unsuccessful surgical attempts, horses with unknown histories that have retained testicular tissue, or bilateral abdominal cryptorchids.     

Application of Ventral Pins and Polymethylmethacrylate for the Management of Atlantoaxial Instability: Results in Nine Dogs

Objective — The purpose of this report was to determine the efficacy of the application of ventral pins and polymethylmethacrylate for the management of congenital and traumatic atlantoaxial instability (AAI) in dogs.
Study Design — Medical records and radiographs of nine dogs with AAI were reviewed for neurological deficits, clinical diagnosis, surgical technique, and long-term outcome.
Sample Population — Six toy breed dogs with congenital AAI and three medium or large breed dogs with traumatic AAI were identified for inclusion in the study.
Methods — The atlantoaxial joints of nine dogs with AAI were surgically stabilized using ventral application of pins and polymethylmethacrylate. Follow-up evaluation for resolution of clinical signs and possible complications of surgery was performed in all dogs. The median follow-up time for surviving dogs (8) was 11.5 months with a mean of 13 months.
Results — An excellent outcome was identified in five patients. Three dogs had a good outcome and one dog died of respiratory complications. Cervical pain was eliminated or significantly reduced in all dogs that survived and none of the dogs had major residual neurological deficits.
Conclusions — Arthrodesis could not be confirmed on follow-up radiographs due to the presence of the polymethylmethacrylate; however, adequate stabilization of C1-C2 appears to have been achieved based on the resolution of clinical signs.
Clinical Relevance — Application of ventral pins and polymethylmethacrylate is an effective means of surgical treatment for congenital and traumatic AAI.     

Splenocaval Shunting for Alleviation of Portal Hypertension in a Dog: A Case Report

Objective —To describe the construction and use of a splenocaval shunt to prevent portal hypertension in a dog with iatrogenic rupture and subsequent complete occlusion of an intrahepatic portosystemic shunt (IPSS).
Study Design —Case report describing a single, client-owned animal.
Results —During dissection, the back wall of an IPSS was torn. Complete shunt occlusion was required to control the hemorrhage. This resulted in the development of life-threatening portal hypertension. Emergency splenocaval shunt construction reduced the portal pressure from 47 to 20 cm H₂0. The dog experienced minimal postoperative complications. A second surgical procedure was performed a month later to completely ligate the splenocaval shunt.
Conclusions —A splenocaval shunt can be used to divert blood from the portal to the systemic circulation to control portal hypertension. In this dog, it resulted in a successful outcome with few complications.
Clinical Relevance —The splenocaval shunt could be constructed before the dissection of a difficult IPSS if problems arise as occurred in the dog described in this report. Complete IPSS occlusion can be performed without development of portal hypertension.     

Limb Salvage Surgery for Osteosarcoma of the Proximal Humerus: Outcome in 17 Dogs

Objective —To describe function and identify factors that affect outcome in dogs undergoing limb salvage surgery for osteosarcoma (OS) of the proximal humerus.
Study Design —A retrospective study of dogs in which OS of the proximal humerus was treated with limb salvage surgery.
Animals —17 client-owned dogs.
Methods: Records were analyzed for functional outcome, recurrence, metastasis, and survival.
Results —Outcome was good to excellent in 12% of dogs. Recurrence, metastasis, and survival were significantly affected by completeness of surgical margins. Double plating of the distal allograft-host junction significantly reduced frequency of biomechanical failure.
Conclusions —Limb salvage surgery for OS of the proximal humerus did not result in acceptable function and was fraught with postoperative complications. Outcome was significantly affected by completeness of surgical margins.
Clinical Relevance —Limb salvage surgery for OS of the proximal humerus in dogs cannot be recommended until improvement in functional outcome and reduction in postoperative complications can be achieved. The dependence of outcome on completeness of surgical margins supports aggressive en bloc resection and marking and evaluating surgical margins.