Laparoscopic‐assisted splenectomy in a horse with splenomegaly

This reports describes the surgical management of a horse evaluated for recurrent colic. These frequent colic episodes were attributed by exclusion to an abnormally enlarged spleen (idiopathic splenomegaly). Splenectomy was elected and performed with a laparoscopic assisted technique. The advantages observed by using this surgical approach were a clear view of the visceral aspect of the spleen and consequently an accurate dissection of the hilus of the spleen and associated vasculature. Ultimately the laparoscopic technique allowed the surgeons to reduce the size of the laparotomy incision required to remove the spleen and the overall invasiveness of the procedure. The horse recovered well from the procedure and ultimately returned to the previous level of competitiveness.     

Herniation of the small intestine through the femoral canal after castration in a 3‐year‐old Thoroughbred

Complications following castration are a potential problem in equine practice. Intestinal evisceration is a life‐threatening condition requiring immediate correction. The following case report describes a rare condition associated with post castration evisceration in a 3‐year‐old Thoroughbred. Shortly after the eviscerated small intestine was repositioned in the abdomen, the horse showed signs of colic and at the second surgery a 4.5 m jejunal loop was found incarcerated in the femoral canal. After resection and anastomosis, the femoral canal was obliterated using large moistened gauze sponges. The horse made a complete recovery and returned to race training. The occurrence of femoral hernia, a condition fairly common in man, has been described but no clinical cases have been reported in horses. This is a severe, although rare, complication after castration.     

Laparoscopically‐assisted ovariohysterectomy in three mares with pyometra

Open surgical ovariohysterectomy in the mare provides limited visualisation and a long surgical incision. Laparoscopically‐assisted ovariohysterectomy has been performed by the authors in 3 mares with pyometra. This approach does seem to offset some of these disadvantages.     

Standing hand‐assisted laparoscopic removal of large granulosa cell tumours in horses using a specimen retrieval bag and morcellator

This report describes a method for removal of large granulosa cell tumours through small paralumbar incisions using laparoscopic dissection of the mesovarium and subsequent removal of the ovary in a sterile retrieval bag via morcellation. Morcellation allows division of the granulosa cell tumour and subsequent reduction of incision size required for removal. The use of a specimen retrieval bag prevented contamination of the abdomen and incision with tumour cells during activation of the morcellator.     

Laparoscopic‐assisted tube cystotomy for urethral rupture in a foal

A 10‐day‐old Tennessee Walking Horse colt was hospitalised due to a pelvic urethral tear. After 2 unsuccessful attempts to repair the tear by primary closure, the colt underwent perineal urethroplasty and laparoscopic‐assisted tube cystotomy which permitted complete urine diversion and allowed the urethral tear to heal completely.     

Hand‐assisted laparoscopic nephrectomy in a standing horse for the management of renal cell carcinoma

An 18‐year‐old Quarter Horse gelding was examined for haematuria of 6 weeks' duration. Rectal examination identified an enlarged left kidney and ultrasonographic examination of the kidney identified grossly abnormal renal architecture. Hand‐assisted laparoscopic nephrectomy was performed following laparoscopic exploration of the abdomen for metastatic disease. A laparoscopic stapling device was successfully used to transect and ligate the renal vasculature and ureter. Histopathological examination of the kidney identified renal cell carcinoma. A 7 month survival was documented following surgery. Unilateral nephrectomy should be considered a therapeutic or palliative procedure for horses with renal cell carcinoma.     

Laparoscopic‐assisted diagnosis of anomalous unilateral abdominal cryptorchidism

This report describes an unusual case of unilateral abdominal cryptorchidism in a Shetland pony. On the cryptorchid side, no testicular structures were present in the inguinal area but testicular/epididymal remnants at the distal end of a pedunculated structure could be discerned in the abdomen at laparoscopic examination. Furthermore, the deferent duct was disconnected from the epididymal remnants and the deferent duct was visible at the caudal aspect of the bladder, traversing over the lateral ligament of the bladder into the vaginal ring where it ended blindly in the vaginal process. After laparoscopic removal of the testicular/epididymal remnants and castration of the contralateral normally descended testicle, the hCG stimulation test was negative and the pony no longer exhibited masculine behaviour.     

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.     

Complications associated with transurethral endoscopic‐assisted electrohydraulic lithotripsy for treatment of a bladder calculus in a gelding

A cystic calculus approximately 6 cm in diameter was diagnosed by ultrasonography and endoscopy in a 12‐year‐old Trakehner gelding with a history of haematuria and dysuria. Transurethral endoscopic lithotripsy with electrohydraulic shock waves was performed as a minimally invasive treatment option. Fragmentation of the calculus was achieved, the fragments of the calculus left in the bladder and excretion assisted by infusion of Ringer's solution. Twenty‐four hours after the third lithotripsy, the horse suffered a recurrence of dysuria and pollakiuria due to partial obstruction of the urethra by the calculus fragments. The treatment was repeated within the urethra until clearance of the fragments was achieved. The sharp fragments had produced a zone of urethral mucosal trauma, approximately 10 cm in length. At the follow‐up visit 4 weeks later, the patient had developed inflammation and swelling of the urethral mucosa, which was successfully treated with a 14 day course of anti‐inflammatory drugs. This resulted in normal urination. At the last follow‐up, the horse had been recurrence‐free for 12 months.     

Infertility in a mare with a chronic uterine tear,diagnosis and successful standing hand‐assisted laparoscopic repair

Uterine rupture is a well recognised and potentially fatal complication in the peripartum broodmare. This case report describes a 16 month history of infertility as the sole clinical sign in a Thoroughbred mare, subsequently diagnosed with a full thickness uterine tear. The clinical course, standing laparoscopically assisted repair and outcome are discussed.     

Laparoscopic assisted surgical removal of a congenital rectal hamartoma in a foal

In this report we describe a 3‐week‐old Paint horse filly that presented with rectal bleeding associated with a protruding mass. Rectal bleeding in neonates can be caused by infectious agents, trauma, congenital defects, rectal tears or tumours. Histopathology was performed on an avulsed piece of tissue. A second mass was identified endoscopically and was removed using a stapling instrument per rectum under endoscopic guidance and laparoscopic assistance. The mass was diagnosed as a rectal hamartoma. Recovery was uneventful.     

Peritoneal fluid accumulation in the femoral canal as a result of a post-traumatic femoral hydrocele in a mature Warmblood stallion

The following case report documents the clinical presentation, ultrasonographic appearance, surgical management and outcome of a horse with a traumatic tear extending from the superficial and deep inguinal rings, across the aponeurosis of the external abdominal oblique muscle and inguinal ligament, disrupting the femoral ring, vascular lacuna and peritoneum. This subsequently resulted in fluid accumulation within the femoral canal. This unusual injury and presentation gives rise to discussion of the aetiology and nomenclature that should be used to properly describe this injury.     

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.     

Arthroscopically‐assisted removal of an osteochondral fragment from the equine elbow using a caudo‐medial approach

An 8‐year‐old Polo pony mare was admitted for investigation of lameness related to swelling of the elbow. An intra‐articular fragment from the proximo‐medial radius was identified on radiographic examination. The fragment was removed arthroscopically under general anaesthesia via a caudo‐medial approach to the elbow joint.     

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     

Intra‐abdominal cystic lymphangiomatosis in a Thoroughbred foal

Cystic lymphangiomas are rare malformations of the lymphatics that result in the formation of a cystic mass. Where multiple cysts are seen, the condition is termed cystic lymphangiomatosis. This case describes the diagnosis and unique management of cystic lymphangiomatosis in a 10‐day‐old Thoroughbred foal. Ultrasonography, histopathology and laparoscopy were essential for diagnosis and appreciation of the extent of disease. Ultimately, the cystic lymphangiomatosis was so extensive in this foal that complete surgical excision was considered impossible and the presence of adhesions within the abdomen indicated a very poor long‐term prognosis; the owners elected for euthanasia at age 14 weeks. Although rare, lymphangioma and lymphangiomatosis should be considered as a differential diagnosis for an intra‐abdominal mass in a young horse.