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.     

Parainguinal laparotomy as an alternative surgical approach for removal of an enterolith in the small colon of a horse

This report describes the use of a parainguinal approach to the abdomen to remove an obstruction in the small colon that could not be removed using an initial ventral midline approach. The use of a parainguinal approach should be considered for removal of an obstruction in the distal portion of the small colon.     

Parainguinal laparocystotomy for urolith removal in geldings

OBJECTIVE: To describe parainguinal laparocystotomy for urolith removal and to report outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Ten geldings with uroliths. METHODS: Signalment, number, size, type of uroliths, surgical technique, and complications were recorded. Long-term follow-up was obtained by telephone interviews with the client and/or examination by the referring veterinarian. RESULTS: Cystic calculi, 3-9 cm in diameter, were removed by parainguinal laparocystotomy. Mean surgical time was 59 minutes (range, 40-100 minutes). With this approach, ligation of the pudendal or superficial epigastric vessels was not needed. Serous incisional drainage resolved without treatment in 3 horses and 2 horses developed moderate-to-severe incisional swelling. On long-term follow-up (mean, 52 months; range, 11-82 months) for 9 horses, owners reported no recurrence of clinical signs associated with cystic calculi. CONCLUSIONS: Parainguinal laparotomy represents a satisfactory alternative approach to the apex of the bladder for urolith removal. CLINICAL RELEVANCE: Parainguinal laparocystotomy avoids the pudendal and superficial epigastric blood vessels that are encountered when performing median or paramedian laparocystotomy in geldings. This approach minimizes dead space by avoiding the reflection of the prepuce in paramedian or median approaches.