Occurrence of Incisional Complications After Closure of Equine Ventral Midline Celiotomies With 2 Polyglycolic Acid in Simple Interrupted Suture Pattern

The aim of this retrospective study was to describe the use of simple interrupted suture pattern for the closure of the abdomen after ventral midline celiotomy in horses and to evaluate the prevalence of resulting incisional complications. Seventy horses undergoing abdominal surgery (2006–2015) and surviving at least 30 days were included in the study. Closure technique of the abdominal wall was performed on three layers. Linea alba was closed with a simple interrupted pattern using number two coated braided absorbable polyglycolic acid suture. Follow-up information was recovered at the 90th day postoperatively. Incisional complications considered included drainage, infection, dehiscence, and herniation. The complications observed in the present study using simple interrupted suture pattern were 4.29% (3 of 70), lower than reported in literature with different suture pattern. Simple interrupted suture pattern could be a valid option for the closure of linea alba after ventral midline celiotomy in horses.     

Modified parainguinal approach for cystic calculus removal in five equids

This report describes a modification of the parainguinal approach for removal of cystic calculi: a ventral midline laparotomy‐guided parainguinal laparocystotomy. The ventral midline approach to the abdomen is rapid and routinely used by equine surgeons. With an arm introduced to the abdomen via the ventral midline, the surgeon is able to select the ideal parainguinal laparotomy incision location that allows bladder exteriorisation with the minimum amount of tension. Because the surgeon's hand is introduced via the ventral midline incision, the parainguinal incision can be sized to just allow exteriorisation of the urinary bladder and urolith, increasing extra‐abdominal bladder security during cystotomy while reducing incision size in the parainguinal region. Finally, an assistant's hand via the ventral midline incision can maintain bladder stability within the parainguinal incision during cystotomy closure.     

Difference in incisional complications following exploratory celiotomies using antibacterial‐coated suture material for subcutaneous closure: Prospective randomised study in 100 horses

Reasons for performing study: Incisional complications are a major post operative challenge following ventral midline exploratory celiotomy for abdominal pain in horses. They lead to discomfort, prolonged hospitalisation, longer recovery times and increased cost; therefore, investigation of preventative procedures are warranted. Objectives: To determine the clinical effect of antibacterial (triclosan) coated 2‐0 polyglactin 910 suture material on the likelihood of incisional infections when used for closure of subcutaneous tissue following ventral midline celiotomies in horses. Methods: One hundred horses undergoing exploratory celiotomy assigned at random to one of 2 groups. In the control group coated 2‐0 polyglactin 910 (Vicryl) was used for apposition of the subcutaneous tissue in a simple continuous pattern and, in the study group, antibacterial (triclosan) coated 2‐0 polyglactin 910 suture material (Vicryl Plus) was used. Post operatively an elastic adhesive abdominal bandage was applied, changed and the incision was inspected by a clinician blinded to the study protocol at 24–36 h and 6–9 days post operatively. Outcomes of interest were evidence of incisional pain, incisional oedema, sheath/udder oedema, incisional drainage, hernia formation and dehiscence. Results: Antibacterial‐coated suture material did not decrease the likelihood of incisional complications in 100 horses. Conclusions: A beneficial effect on ventral midline incisions in 100 horses was not evident by using antibacterial‐coated suture material. Potential relevance: Lack of effectiveness of antibacterial‐coated suture material in equine ventral midline closure after exploratory celiotomy and the observed potential adverse effects suggest that further clinical investigations are needed before using such material routinely on horses.     

lleocolostomy A Technique for Surgical Management of Equine Cecal Impaction

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.     

Ovariohysterectomy in Six Mares

Six mares had ovariohysterectomy performed for chronic pyometra associated with cervical abnormalities, uterine neoplasia, or removal of a macerated fetus. Ovariohysterectomy was performed through a ventral midline incision with access to the ovarian and uterine vessels aided by traction on the uterus and retraction of abdominal viscera. Abdominal pain, the most common complication after surgery, occurred in four mares but resolved within 36 hours. Peritonitis occurred in two mares; one mare was subsequently euthanatized. Other complications that resolved with treatment included infection of the uterine stump (two mares), abdominal hemorrhage (one mare), diarrhea (one mare), and incisional infection (one mare). Complications after surgery can be reduced by removing as much of the uterus as possible, minimizing peritoneal contamination with uterine contents, and providing a secure closure of the caudal reproductive tract.     

Evaluation of a Motorized Morcellator for Laparoscopic Removal of Granulosa‐Theca Cell Tumors in Standing Mares

Objective: To describe a motorized morcellator technique for laparoscopic removal of granulosa‐theca cell tumors (GCT) in standing mares and to evaluate long‐term outcome. Study Design: Case series. Animals: Mares (n=7) aged 4–15 years, with unilateral GCT. Methods: Tumor size was determined by transrectal palpation and ultrasonography. Standing sedated mares had 3 laparoscopic portal sites in the paralumbar fossa. After laparoscopic observation of the GCT, the mesovarium was desensitized, the ovarian pedicle transected with a LigaSure^® device, and the ovary grasped with forceps and cut in cylindrical tissue blocks using a motorized morcellator. Tissue blocks were removed through the laparoscopic sleeve. Outcome was determined by telephone interview of owners 6–40 months after surgery. Results: Estimated ultrasonographic median GCT diameter was 17 cm (range, 10–22 cm). Surgical time was 2–4.5 hours. There were no surgical complications. Two mares had mild subcutaneous emphysema at the portals after surgery. Convalescence was short, owners were satisfied with cosmetic outcome, and clinical signs associated with GCT did not recur. Conclusion: The motorized morcellator allows piecemeal removal of large GCT through a relatively small laparoscopic portal. Surgical complications were rare and the cosmetic outcome is favorable. Clinical Relevance: A motorized morcellator is a safe and minimally invasive technique for laparoscopic removal of GCT in mares.     

Single‐port laparoscopic incisional hernia repair in a horse

A 16‐year‐old Italian Saddle Horse gelding was referred for treatment of an incisional hernia that developed 7 months after a ventral midline laparotomy for treatment of acute abdominal pain. Physical examination revealed a hernia approximately 20 cm long and 15 cm wide on the ventral aspect of the abdomen. Ultrasonography revealed the dimensions of the hernia ring to be approximately 15 cm in length and 10 cm in width. A single‐port laparoscopic incisional hernia repair using an operating 0° laparoscope was performed with an appropriately sized (24 × 18 cm) piece of mesh fixed in place with simple interrupted transabdominal sutures. At 4 weeks post operatively, follow‐up physical examination and ultrasonography confirmed healing of the surgical site with no evidence of hernia recurrence. The same evaluation was done 6 months post operatively, and the horse returned to its previous level of activity 8 months post operatively. In horses, laparoscopic application of mesh should be considered among the treatment options for incisional hernia. In the present case, this technique was performed with a single port using an operative laparoscope, in contrast to the multiportal techniques reported previously. The case presented here demonstrates that single‐port laparoscopic herniorrhaphy is feasible, and allows proper placement of an expanded polytetrafluoroethylene intraperitoneal mesh in horses     

Transnasal endoscopic treatment of equine sinus disease in 14 clinical cases

Transnasal endoscopic sinus treatment was used in four horses diagnosed with primary sinusitis and 10 horses with dental sinusitis. Pre-existing (n = 5) or surgically created (n = 9) sinonasal fistulae were used as portals for transnasal endoscopic exploration, debridement and lavage of the inflamed sinus cavities. Endoscopic sinonasal fistulation was performed using either trans-endoscopic diode laser fibre (four cases) or an electrocautery instrument under endoscopic control (five cases). All procedures were performed on standing sedated horses with the use of local anaesthesia. In six cases, the ventral concha was fenestrated in order to gain a portal into the ventral conchal and rostral maxillary sinus. In two cases the dorsal concha was fenestrated to access the caudal group of the paranasal sinuses. One case required fenestration of the ventral conchal bulla due to its empyema. Post-operative bleeding was controlled with a nasal cavity tamponade for 24 h. Endoscopic lavage and debridement of the inflamed sinuses were performed every 2–3 days. Medical treatment consisted of antibiotic and anti-inflammatory drugs. In the cases of dental sinusitis, the underlying dental pathology was addressed. Median hospitalisation time was 10 days (range 5–25 days) and the median number of endoscopic procedures (including the initial procedure) was 4 (range 3–7). Cases were followed-up by telephone consultations with their owners. Intervals between discharge and last follow-up ranged from 4 to 22 months (median 9.5 months). Complete recovery was reported in 10 cases, clinical improvement (occasional nonpurulent discharge) in two cases. Two cases were readmitted due to recurrence of the purulent nasal discharge; both subsequently underwent trephination of the affected sinuses and made a full recovery after removal of the remaining pathological sinus content.     

Standing flank laparotomy for the treatment of small colon impactions in 15 ponies and one horse

Impactions are the most common problem affecting the small colon in horses and are much more prevalent in ponies and miniature horses. Ventral midline laparotomy under general anaesthesia is the standard of care for this condition when medical management fails to resolve the impaction or when the impaction causes complete intraluminal obstruction and tympany. This case series reports the use of standing flank laparotomy (SFL) in 15 ponies with focal small colon impactions and one large breed horse with an elongated small colon impaction. All cases presented with signs of colic of 1–4 days' duration. The horses were initially vigorously treated with both enteral and parental fluids but failed to pass faeces, with no resolution of abdominal distention or pain. In all cases, a definitive diagnosis was made during SFL and the small colon appeared to be viable. The impaction was resolved by extraluminal massage. In the horse and in one pony, in addition to extraluminal massage, high enema was administered during surgery. Routine perioperative treatment with fluids, analgesics, antimicrobials and wound care was provided. All animals survived to discharge. The time from surgical resolution of the impaction to passing faeces was less than 2 h in all but one case. Median duration of hospitalisation was 2 days and all animals returned to their original use by 2 months. The encouraging results of this case series suggest that SFL is a viable alternative to ventral laparotomy for ponies and horses with either focal SCI or extensive SCI.     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Clinical and ultrasonographic evaluation of three suture techniques for closure of the equine linea alba

Surgical technique plays an important role in preventing ventral midline incisional complications. The aim of this study was to compare the clinical and ultrasonographic outcome of three suture techniques for closure of the linea alba. In this prospective case series (n = 43), horses operated for acute abdominal intestinal disease through a midline incision were randomised in three groups: closure with a conventional continuous technique (Group 1), a small stitches continuous technique (Group 2) and the UX-technique (shoe-lace configuration, Group 3). Age, sex, body weight, type and duration of surgery were recorded and the suture to wound length ratio was calculated. Clinical evaluation of the wound (wound discharge) was performed daily during hospitalisation. At 7 weeks post-operatively the linea alba was evaluated clinically and ultrasonographically. The linea alba width was measured halfway along the length of the incision. One horse in Group 1 had acute incisional dehiscence, but there were no further significant differences between the groups in the short term. Seven weeks post-operatively two horses had complete herniation in Group 1 and one horse had partial herniation in Group 2. In the UX group no herniation occurred. The incidence of herniation was not significantly different between the groups. On ultrasound at 7 weeks the linea alba width was significantly smaller in Group 2 (P = 0.00029) and Group 3 (P = 0.0018) compared with Group 1, even with exclusion of the acute incisional dehiscence and two herniated horses. Limitations were the small group size and relatively low incidence of incisional complications for statistical analysis. It was concluded that the use of small stitches and the UX-technique resulted in a smaller linea alba width compared with the conventional continuous suture technique and might therefore be preferred for closure of the linea alba in equine colic surgery.     

Cesarean section in cows.

The goals of the cesarean section are preservation of the dam and calf and the future reproductive efficiency of the dam. The outcome of the cesarean section is a self-fulfilling prophecy. Numerous variables may affect the successful outcome of this procedure. Case selection is the most important and often overlooked variable. In addition, skin preparation,surgical technique, calf viability at the time of surgery, and exteriorizing the uterus can affect outcome. Minimizing excessive adhesion formation is equally important because it may affect reproductive efficiency adversely.Good surgical technique, including gentle tissue handling, appropriate suture materials and patterns, and adequate infolding of the uterine incision to prevent leakage, combined with antibiotics and anti-inflammatories when indicated can help minimize detrimental adhesions that may affect adversely the future reproductive efficiency of the cow. When dealing with anemphysematous fetus, intensive medical management perioperatively isa crucial determining factor of cow survival. Anti-inflammatories, high doses of intravenous antibiotics, and a ventral midline approach that permits adequate uterine exteriorization and reduces abdominal contamination also are likely key elements that contribute to the high survival rates of cows with emphysematous fetuses.     

Anaerobic peritonitis caused by Clostridium septicum as a complication of routine castration in a 2‐year‐old Warmblood horse

This case report describes an unusual case of anaerobic peritonitis in a 2‐year‐old horse following castration. The horse was evaluated 2 weeks following castration for signs of acute, severe abdominal pain and swelling surrounding a previous castration site. Physical examination revealed marked scrotal and ventral abdominal oedema that was cool and crepitant upon palpation. Ultrasonographic evaluation was unrewarding because gas shadowing distributed throughout the subcutis prevented imaging of the abdominal cavity. Ventral midline celiotomy revealed a copious amount of malodorous, serosangious, cloudy peritoneal fluid that was submitted for culture. Abdominal exploration revealed the gastrointestinal tract to be in its anatomically correct position. There was diffuse petechiation of the small intestine and large intestine, oedema and crepitant swelling surrounding the left inguinal ring and body wall. The abdomen was lavaged with 10 l of sterile saline prior to closure of the celiotomy and the left castration incision was opened digitally, releasing a large volume of serosanguinous fluid and gas that flowed freely from the incision site and deeper inguinal tissues. The horse was placed in the recovery box where it suffered cardiac arrest. Culture of the peritoneal fluid revealed heavy growth of Clostridium septicum. This case of anaerobic peritonitis represents an unusual complication following castration not previously reported in the horse.     

Bacterial Culturing of Ventral Median Celiotomies for Prediction of Postoperative Incisional Complications in Horses

Objective - The purpose of this study was to determine whether detection of bacterial contamination of ventral midline incisions was predictive of postoperative incisional complications in horses undergoing exploratory celiotomy for colic. Study Design - Prospective study. Animal or Sample Population - Horses that had ventral median celiotomies for colic at Colorado State University between May 1, 1991 and April 30, 1993 were studied prospectively. Complete information was obtained on 66 horses. Methods - Bacterial cultures were obtained from ventral midline incisions at surgery. Information regarding the type of surgery performed (celiotomy vs celiotomy plus enterotomy or enterectomy), preoperative total nucleated cells and presence of a left shift, postoperative fever (>38.5°C), incisional drainage, incisional herniation, and outcome were obtained from medical records. Additional information concerning incisional drainage, herniation, and survival was obtained at a minimum of 18 months after surgery. Results - Examination of odds ratio (ORs) and confidence intervals (CIs) revealed that a celiotomy plus enterotomy or enterectomy was positively, but not significantly, associated (OR > 1) with positive culture results, presence of incisional drainage and incisional herniation. A significant association between incisional drainage and hernia formation was found; odds of incisional herniation were 62.5 times greater in horses that had incisional drainage. Incisional drainage and herniation were negatively associated with patient survival. The later association was significant (OR = 0.18, P=.04). Conclusions - This study indicated that detection of bacterial contamination at incisional closure by the swab culture technique was not beneficial in the prediction of postoperative incisional problems in horses undergoing colic surgery. Incisional drainage or infection appeared to be associated with hernia formation. Clinical Relevance - Immediate treatment of incisional drainage or methods to prevent incisional infections may decrease hernia formation.     

Open Peritoneal Drainage in Horses With Experimentally Induced Peritonitis

Peritonitis was induced in 12 horses by median celiotomy and 1 hour of small intestinal ischemia. Six horses had primary closure of the incision, whereas six horses had a plastic mesh sutured to the ventral abdominal wall leaving the abdomen open for ventral drainage. The mesh was removed after 5 days and the abdominal wall was closed by apposition of the linea alba and subcutaneous tissues and approximation of the skin edges. Peritoneal fluid was collected and analyzed for nucleated cell count and total protein concentration on days 0 and 5. Serum biochemical profiles, serum electrolyte concentrations, and complete blood counts were performed on days 0, 1, 2, 5, 6, 10, and 14. Body weight, rectal temperature, and physical examination findings were recorded daily for 30 days, then horses were euthanatized and the abdominal cavity was examined for the presence of adhesions. Histological examination was performed to assess the inflammatory response of the healing body wall; inflammation scores were significantly lower in horses that had primary closure of the incision. The mesh was well tolerated by all horses and allowed egress of peritoneal fluid for 5 days. Adhesions were present in four control horses and in two horses that had open peritoneal drainage. All horses that had open drainage developed incisional infections after mesh removal. Abdominal wall herniation did not occur in any of the horses. The mild peritonitis induced in this study was insufficient to establish the efficacy of open peritoneal drainage for an established peritonitis in horses; however, the results of this study indicate that open peritoneal drainage is feasible in horses.     

Correction of bilateral ureteral defects in a foal

Bilateral ureteral defects were diagnosed as the cause of depression and azotemia in an 8-day-old Thoroughbred filly. The azotemia resulted from accumulation of urine in the retroperitoneal area. A ventral midline laparotomy was performed, and defects found in both the left and right ureter were repaired. Uroperitoneum and abdominal distention, presumably from urine leakage at the left ureteral surgery site, were detected on the fourth postoperative day and necessitated abdominal drainage. Thirty-six hours later, the leakage stopped spontaneously, and the foal recovered normally. This report should help to differentiate ureteral defects in foals from the more common syndrome of ruptured bladder.     

Yellow fat disease (steatitis) in 20 equids: Description of clinical and ultrasonographic findings

Diagnosis of steatitis can be challenging due to nonspecific clinical signs and ultrasonography might be a useful aid for making a diagnosis. The objective of this retrospective clinical case study was to describe history, clinical signs, ultrasonographic findings, treatment and outcome in equids with steatitis. The medical records of all equids presented to the Department of Large Animal Internal Medicine, Ghent University between January 2008 and December 2015 were reviewed retrospectively to identify horses suffering from steatitis. A total of 20 cases with steatitis were reviewed. History included dullness, recumbency, decreased appetite and weight loss. Fever, ventral oedema, stiff/painful gait and a painful neck were found. Low haematocrit, low vitamin E and selenium and increased levels of creatinine kinase and particularly lactate dehydrogenase were almost consistent findings. On ultrasound, ventral oedema was found. Ventral extraperitoneal, perirenal, mesenteric, coronary and caudal mediastinal fat showed homogenously increased echogenicity. The ventral extraperitoneal fat in particular was surrounded by oedema or free fluid. Increased amounts of abdominal, thoracic and pericardial fluid were often found. Fat biopsies were taken in the neck, or from the ventral extraperitoneal fat in the ventral flank. Steatitis was confirmed in all horses where a fat biopsy was taken (n = 13). Treatment consisted of selenium and vitamin E (intramuscular injection followed by oral treatment) supplementation and anti-inflammatory treatment (dexamethasone or prednisolone parenteral or oral) for at least 1–4 weeks. A total of 15 animals (75%) survived. Full recovery took about 2–6 months. In conclusion, steatitis is an uncommon disease in young horses usually seen during winter. It may be underdiagnosed because of nonspecific clinical signs. Ultrasonography is a useful aid for the diagnosis of yellow fat disease based upon the increased echogenicity of ventral extraperitoneal, perirenal, mesenteric, coronary and caudal mediastinal fat and increased amount of surrounding fluid.     

Luteoma in two mares treated by ovariectomy

A 15-year-old Paint mare (Case 1) and a 15-year-old Arabian mare (Case 2) were presented for aggressive and undesired behaviour. Reproductive evaluation revealed, initially, an enlarged ovary with a smaller/normal sized contralateral ovary in each case. Granulosa cell tumour (GCT) panel testing revealed elevated inhibin B in both cases and elevated anti-Mullerian hormone (AMH) levels only in Case 1 determined from currently established reference ranges. Based on a presumptive diagnosis of GCT, bilateral standing ovariectomy was elected for both mares. In each case neoplastic tissue consistent with luteoma was detected only on histological examination in the smaller/normal sized left ovary; the right ovary appearing normal. Long-term follow-up was performed 1 year and 5 years post-operatively by telephone. The owners were satisfied with the outcome and each patient demonstrated resolution of aggressive stallion-like behaviour. Each case returned to the owners' intended use. In conclusion, luteoma should be considered as a differential diagnosis for ovarian neoplasms in horses related to behavioural abnormalities, even in normal-sized ovaries.