Hand-assisted laparoscopic cystotomy for cystic calculus removal in male horses (3 cases).

A technique for hand-assisted laparoscopic removal of cystic calculi in male horses is described. Three cystic calculi ranging from 5 to 10 cm in diameter were removed successfully using bilateral para-inguinal laparoscopic portals assisted by a human hand within the abdomen, effectively sealing the midline incision. Long-term follow-up information obtained from referring veterinarians and owners indicated that the patients returned to their previous activity level and had no recurrence of clinical signs in the following 6 to 12 months. Key clinical message: Hand-assisted recumbent laparoscopy is a satisfactory surgical technique for removal of cystic calculi in horses which cannot be operated on standing or whose body condition would make the parainguinal approach difficult.

Cystotomie laparoscopique aidée de mains pour le retrait de calculs cystiques chez des chevaux mâles (3 cas). Une technique pour le retrait de calculs cystiques par laparoscopie aidée de mains chez des chevaux mâles est décrite. Trois calculs cystiques variant de 5 à 10 cm de diamètre furent retirés avec succès en utilisant des entrées laparoscopiques bilatérales para-inguinales aidées d'une main humaine à l'intérieur de l'abdomen, scellant avec succès l'incision sur la ligne médiane. Les informations sur le suivi à long terme obtenues des vétérinaires référant et des propriétaires indiquaient que les patients étaient retournés à leur niveau d'activité antérieur et qu'aucune récurrence des signes cliniques ne fut notée dans les 6 à 12 mois suivants.Message clinique clé:La laparoscopie couchée aidée de mains est une technique chirurgicale satisfaisante pour le retrait de calculs cystiques chez des chevaux qui ne peuvent être opérés debout ou dont la condition corporelle rendrait l'approche parainguinale difficile.(Traduit par Dr Serge Messier).

Cecal entrapment within the epiploic foramen in a mare.

An 11-year-old Thoroughbred mare with colic unresponsive to medical treatment underwent exploratory laparotomy. During surgery the cecum was found entrapped within the epiploic foramen from left to right. The entrapped cecum was reduced through the foramen by gentle traction. After reduction of the cecum, rupture of the portal vein was detected. Loss of a large amount of blood prompted euthanasia during surgery.

Encapsulation du cæcum dans le foramen omental chez une jument. Une jument Thoroughbred âgée de 11 ans atteinte de coliques ne répondant pas au traitement médical a subi une laparatomie exploratoire. Durant la chirurgie, le cæcum a été trouvé encapsulé dans le foramen omental de gauche à droite. Le cæcum encapsulé a été réduit par le foramen à l'aide d'une légère traction. Après la réduction du cæcum, la rupture de la veine porte a été détectée. La perte d'une grande quantité de sang a entraîné l'euthanasie durant la chirurgie.(Traduit par Isabelle Vallières).

Ex-Vivo Evaluation of a Modified Teno Fix(®) Device Repair Pattern Versus a 3-Loop Pulley for Repair of Equine Flexor Tendons.

OBJECTIVE: To compare the load to ultimate failure, load to a 2 mm gap, mode of failure, and gap at failure (mm) of the Teno Fix(®) (TF) to the 3-loop pulley (3LP) for repair of equine tendon lacerations. The use of 4TF devices versus 5TF devices on load to ultimate failure and load to a 2 mm gap was also compared. STUDY DESIGN: Ex vivo biomechanical study; unbalanced incomplete block (horse) design. SAMPLES: Cadaveric equine forelimb superficial digital flexor tendon (n = 20 paired tendons). METHODS: Ten tendon pairs were selected randomly and repaired with a 3LP and 4TF pattern, and 10 tendon pairs repaired with a 3LP and 5TF pattern. Load to ultimate failure, load to a 2 mm gap, mode of failure, and gap at failure were obtained using materials testing. RESULTS: The 3LP had a significantly greater ultimate load to failure (P < .001, respectively) and a significantly higher load to a 2 mm gap than both TF repairs (P < .001, respectively). The most frequent mode of failure was suture pull-out for the 3LP and anchor pull-out for the TF. Gap at failure was significantly larger in the 3LP than both TF repairs (P < .001). The ultimate load to failure was significantly higher for the 5TF than the 4TF (P = .004) but there was no significant difference in load to a 2 mm gap, or gap at failure between both TF repairs (P = .11, P = .15, respectively). CONCLUSIONS: Neither TF repair was stronger than the 3LP in load to ultimate failure and load to a 2 mm gap. Addition of a fifth TF device significantly increased the load to ultimate failure but did effect the load to a 2 mm gap over the 4TF.

Thoracic trauma in horses.

Traumatic injuries involving the thorax can be superficial, necessitating only routine wound care, or they may extend to deeper tissue planes and disrupt structures immediately vital to respiratory and cardiac function. Diagnostic imaging, especially ultrasound, should be considered part of a comprehensive examination, both at admission and during follow-up. Horses generally respond well to diligent monitoring, intervention for complications, and appropriate medical or surgical care after sustaining traumatic wounds of the thorax. This article reviews the various types of thoracic injury and their management.

Ultrasound assisted arthroscopic approach for removal of basilar sesamoid fragments of the proximal sesamoid bones in horses.

OBJECTIVE: To describe an ultrasound assisted arthroscopic approach for removal of non-articular basilar sesamoid fragments in Thoroughbred yearlings. ANIMALS: Thoroughbred yearlings (n = 7). METHODS: Basilar sesamoid fragments identified during pre-sale radiographic examination were removed using a palmar/plantar arthroscopic approach to the fetlock joint and ultrasonographic guidance. Complete fragment removal was confirmed by ultrasonography and radiography. RESULTS: Basilar sesamoid fracture fragments were localized and removed successfully using rongeurs and a radiofrequency probe for soft tissue dissection of the fragment. Complete fragment removal was confirmed by ultrasonography and radiography. No intra- or postoperative complications occurred. At 6-8 months follow-up, no fragments or bony proliferation at the base of the sesamoid was observed. CONCLUSIONS: Ultrasonographic guidance can be used to facilitate localization, dissection, and confirmation of removal of basilar fragments of the proximal sesamoid bone.

Biomechanical testing of a novel tendon implant device for the repair of equine flexor tendon lacerations.

OBJECTIVE: To compare in vitro strength and failure characteristics of a tendon implant against a 3 loop pulley suture pattern for equine superficial digital flexor tendon (SDFT) laceration repair. STUDY DESIGN: Experimental. STUDY POPULATION: Cadaveric equine forelimb SDFT (n = 16). METHODS: One tendon of each of 8 pair of SDFT was randomly selected for repair with either the 3-loop pulley (3LP) suture pattern using 2 polydioxanone or with 4 stainless steel suture and anchor implants (SA). Ultimate load to failure, mode of failure, gap at failure, and load to 2 mm gap were obtained using a materials testing system synchronized with a high-speed camera. Statistical evaluation was made using Student's t-test; significance was set at P ≤ .05. RESULTS: The 3LP failed at a significantly (P = .0001) greater load (363.5 ± 83.7 N) than SA (132.4 ± 26.8 N), but the load to a 2 mm gap (3LP = 164.9 ± 67.7 N, SA = 114.5 ± 21.5 N) was not significantly different (P = .09). Failure mode was by suture pull out and anchor pull out respectively. The gap at failure was significantly larger in the 3LP than in SA repair (P = .000005). CONCLUSIONS: Both the SA repair and the 3LP resisted similar tension to 2 mm gap. However, the ultimate load to failure of the SA repair was only 36% that of the 3LP repair.

Surgical technique and short-term outcome for experimental laparoscopic closure of the epiploic foramen in 6 horses.

OBJECTIVE: To describe a laparoscopic technique for, and short-term outcome after, closure of the epiploic foramen (EF) in horses. STUDY DESIGN: Descriptive, experimental study. ANIMALS: Healthy, adult horses (n = 6). METHODS: Laparoscopic portals to approach the EF were identified in standing horses. Under laparoscopic observation, the gastropancreatic fold and right lobe of the pancreas were grasped with Babcock forceps and secured to the caudate hepatic lobe using helical titanium coils to obliterate the EF. Surgical procedure time and intra- and postoperative complications were recorded. Serial analysis of select serum enzymes was used as an indication of involvement of the pancreas and liver. Closure was reevaluated at 4 weeks using repeat laparoscopy, and necropsy was performed immediately after. RESULTS: At initial surgery, EF closure was successful in all 6 horses; median surgical time was 40.5 minutes (range, 22-110 minutes). Serum gamma-glutamyl transferase (GGT) and sorbitol dehydrogenase (SDH) were not significantly altered by the surgical procedure; however, aspartate aminotransferase (AST) and amylase (AMY) were transiently increased. At repeat laparoscopic reevaluation, closure was complete in 5 horses, with partial closure of the EF observed in 1 horse. No complications related to the procedure were noted during or after surgery in any horse. CONCLUSIONS: EF closure in the standing horse can be accomplished without complications to the surrounding organs and vessels.

Effects of gastric distension on intraabdominal pressures in horses.

OBJECTIVE: To determine the effect of gastric distension on intraabdominal pressures (IAP) measured directly from the intraperitoneal space. DESIGN: Prospective, experimental study. SETTING: A university-based equine research facility. ANIMALS: Ten healthy adult horses, 5 males and 5 females. INTERVENTIONS: Intraabdominal pressures were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder at 6 time points: at rest, after placement of a nasogastric tube, and after instillation of each 5 L increment up to a total of 20 L of water. Simultaneously, mean arterial pressures (MAP) were obtained using a tail cuff, and abdominal perfusion pressures (APP) were calculated using the measured IAP minus the measured MAP. MEASUREMENTS AND MAIN RESULTS: Baseline direct IAP measurements were subatmospheric (-4.5 ± 3.0 cm H2 O). IAPs were not significantly affected by placement of a nasogastric tube (-2.69, 95% CI [-3.24, -2.14], P = 0.4195), but were significantly increased after placement of 5 L (-1.73, 95% CI [-2.28, -1.18], P = 0.0015), 10 L (-0.54, 95% CI [-1.09,0.01], P = 0.0001), 15 L (0.89, 95% CI [0.34, 1.44], P = 0.0001), or 20 L (3.08, 95% CI [2.53, 3.63], P = 0.0001) of water into the stomach. APPs were not significantly different for any volume of fluid infused into the stomach (P = 0.05 for all comparisons). CONCLUSION: IAPs were significantly increased when > 5 L of water was infused into the stomach. These results indicate the need for further research in clinical cases to determine the relationship between gastric pressures and the development of intraabdominal hypertension in horses.

Effects of compressive abdominal bandaging and transrectal palpation on intra-abdominal pressures in horses.

OBJECTIVE: To determine the effect of an abdominal support wrap and transrectal abdominal palpation on intra-abdominal pressures (IAPs) measured directly from the peritoneal space. DESIGN: Prospective, experimental study. SETTING: A university-based equine research facility. ANIMALS: Ten healthy adult horses, 5 males and 5 females. INTERVENTIONS: IAPs were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder. Triplicate measurements were obtained at rest, during transrectal palpation, after placement of an abdominal support wrap, and during transrectal palpation with the support wrap still in place. Simultaneous mean arterial pressures were obtained using a tail cuff and abdominal perfusion pressures were calculated using the measured IAP minus the measured mean arterial pressures. MEASUREMENTS AND MAIN RESULTS: Baseline direct pressure measurements were subatmospheric (-4.5 ± 3.0 cm H(2) O). IAPs were not significantly affected by transrectal palpation, but were significantly increased after placement of an abdominal support wrap (-1.19 ± 3.01 cm H(2) O; P = 0.01). Abdominal perfusion pressures were not significantly affected by either transrectal palpation or application of the support wrap. CONCLUSION: IAPs were significantly increased after application of an abdominal support wrap commonly used after exploratory laparotomy. Further investigations are warranted to determine the clinical implications of abdominal bandaging on IAP and its implications on postoperative complications including intra-abdominal hypertension. However, transrectal abdominal palpation likely does not contribute to abdominal hypertension in normal horses.