Incidence and risk factors of surgical site infection and septic arthritis after elective arthroscopy in horses.

OBJECTIVE: To determine the incidence of infection and associated risk factors, after elective arthroscopy. STUDY DESIGN: Retrospective case study. ANIMALS: Horses (n=1079) undergoing elective arthroscopy. METHODS: Medical records of all horses that underwent elective arthroscopy between 2006 and 2013 were reviewed. Age, gender, breed, surgeon, number of joints operated, total anesthetic time, perioperative antimicrobial administration, and the presence and size of osteochondral fragments/subchondral lesions were recorded. For each operated joint, the development of postoperative infection (surgical site infection [SSI] and/or septic arthritis) and long-term outcome (>6 months) were recorded. Multivariate logistic regression was used to test for association between the independent variables and the dependent outcomes. RESULTS: A total of 1741 joints in 1079 horses underwent arthroscopy. SSI without septic arthritis occurred in 1 fetlock joint (0.14%), 1 tibiotarsal joint (0.19%), and 6 femoropatellar joints (1.67%). Thirteen joints (0.75%) were diagnosed with septic arthritis, including 1 fetlock joint (0.14%), 4 tibiotarsal joints (0.74%), and 8 femoropatellar joints (2.23%). The probability of postoperative SSI was higher when large lesions (>40 mm long) were treated, compared to medium (20-40 mm, P = .005) and small (<20 mm, P < .001) lesions. SSI was a significant risk factor for the development of septic arthritis (P < .001). Although age did not affect the incidence of SSI, increasing age was associated with a lower rate of septic arthritis rate (P = .028). CONCLUSION: Septic arthritis after elective arthroscopy was more likely in the presence of SSI and younger age. Horses with large lesions were at risk for SSI, which translated into a higher incidence of postoperative septic arthritis after femoropatellar arthroscopy.

A retrospective report (2003-2013) of the complications associated with the use of a one-man (head and tail) rope recovery system in horses following general anaesthesia.

BACKGROUND: The mortality rate of horses undergoing general anaesthesia is high when compared to humans or small animal patients. One of the most critical periods during equine anaesthesia is recovery, as the horse attempts to regain a standing position. This study was performed in a private equine practice in Belgium that uses a purpose-designed one-man (head and tail) rope recovery system to assist the horse during the standing process.The main purpose of the retrospective study was to report and analyse complications and the mortality rate in horses during recovery from anaesthesia using the described recovery system. Information retrieved from the medical records included patient signalment, anaesthetic protocol, duration of anaesthesia, ASA grade, type of surgery, recovery time and complications during recovery. Sedation was administered to all horses prior to recovery with the rope system. Complications were divided into major complications in which the horse was euthanized and minor complications where the horse survived. Major complications were further subdivided into those where the rope system did not contribute to the recovery complication (Group 1) and those where it was not possible to determine if the rope system was of any benefit (Group 2). RESULTS: Five thousand eight hundred fifty two horses recovered from general anaesthesia with rope assistance. Complications were identified in 30 (0.51%). Major complications occurred in 12 horses (0.20%) of which three (0.05%) were assigned to Group 1 and nine (0.15%) to Group 2. Three horses in Group 2 suffered musculoskeletal injuries (0.05%). Eighteen horses (0.31%) suffered minor complications, of which five (0.08%) were categorised as failures of the recovery system. CONCLUSIONS: This study reports the major and minor complication and mortality rate during recovery from anaesthesia using a specific type of rope recovery system. Mortality associated with the rope recovery system was low. During recovery from anaesthesia this rope system may reduce the risk of lethal complications, particularly major orthopaedic injuries.

Standing laparoscopic peritoneal flap hernioplasty technique for preventing recurrence of acquired strangulating inguinal herniation in stallions.

OBJECTIVE: To describe a standing laparoscopic peritoneal flap hernioplasty (PFH) technique for closure of the vaginal ring, and to evaluate its effect on prevention of recurrent herniation in stallions, previously treated for acquired strangulating inguinal hernia (SIH). STUDY DESIGN: Case series. ANIMALS: Stallions (n = 30) aged 3-15 that had previous acquired SIH. METHODS: Bilateral standing laparoscopic PFH was performed on 30 stallions that had previous acquired SIH treated without castration. The vaginal rings were approached from 3 portals, 2 in the paralumbar fossa and a 3rd between the 17th and 18th ribs on the ipsilateral side. A large inverted U-shaped peritoneal flap was dissected from the abdominal wall proximal and cranial to the vaginal ring, reflected caudally over the vaginal ring, and secured to the abdominal wall with laparoscopic staples. In the first 11 stallions, only the cranial and mid third of the vaginal ring was covered. For the next 19 stallions, complete closure of the vaginal ring including the entire caudal aspect of the vaginal ring was achieved. RESULTS: SIH recurrence occurred in 4 of 11 stallions with incomplete ring closure whereas no SIH recurrence occurred when the entire vaginal ring was closed. No major complications occurred and cosmetic outcome was excellent. All breeding stallions were successfully used for breeding. CONCLUSION: Standing laparoscopic closure of the vaginal ring using a PFH is an effective way to prevent recurrence of SIH provided the entire vaginal ring, including the caudal aspect is covered by the flap. There seems to be no effect on subsequent fertility.

Laparoscopic closure of the vaginal rings in the standing horse using a tacked intraperitoneal slitted mesh (TISM) technique.

BACKGROUND: Indirect inguinal herniation (IIH) is a potentially life-threatening condition in stallions. The ideal preventive measure for breeding stallions ensures a minimally invasive closure of the vaginal ring that avoids recurrence of IIH while preserving both testicles. OBJECTIVES: To describe a minimally invasive laparoscopic tacked intra-peritoneal slitted mesh (TISM) technique in the standing horse to close the vaginal rings and to evaluate its efficacy in preventing recurrence of IIH in stallions. STUDY DESIGN: Retrospective case series. METHODS: Medical records of 17 stallions with a history of IIH were reviewed retrospectively. The surgical procedure was performed on the standing horse through a flank approach using four laparoscopic portals. The vaginal ring was covered with a commercial mesh. The mesh was partially cut to create a slitted mesh with two flaps: the dorsal flap was passed under the spermatic cord and ductus deferens and the ventral flap above. The mesh was secured in place with laparoscopic tacks. Long-term follow-up was obtained by a structured telephone interview of the owners. RESULTS: A total of 32 laparoscopic vaginal rings closures were successfully performed in 17 horses. No major intra- or postoperative complications occurred. None of the horse suffered from re-occurrence. Nine of the 13 active breeding stallions were breeding again with similar semen quality as before treatment, 4/13 will resume their breeding activity during the next breeding season. None of the horses were castrated and none of the owners reported abnormal size or shape of the testicles. In three stallions, post-operative pain and activity limitations were noted that gradually resolved after 6 months. MAIN LIMITATIONS: The lack of large numbers to compare the results of different mesh and tack combinations, the lack of follow-up veterinary examinations and the limited number of laparoscopic rechecks. CONCLUSION: The TISM technique is an effective minimally invasive technique to surgically reduce the size of the vaginal ring and thereby prevent recurrence of IIH.

Outcome after lacerations of the superficial and deep digital flexor tendons, suspensory ligament and/or distal sesamoidean ligaments in 106 horses.

OBJECTIVE: To report outcome after the surgical treatment of lacerations of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and/or distal sesamoidean ligaments (DSL) in horses. STUDY DESIGN: Case series. ANIMALS: Horses (n=106) with lacerations of the SDFT, DDFT, SL, and/or DSL. METHODS: Medical records (1988-2002) were reviewed for signalment, limb and tendon/ligament involvement (location and extent of injury, tendon sheath involvement), method of repair, and outcome. RESULTS: The median age of horses was 7 years and the follow-up time ranged from 1 to 10 years. Fifty-five percent of horses returned to their previous level of performance, 27% to a lower level, and 18% were euthanatized. Multivariate statistical analysis demonstrated that the number of structures transected had the most significant influence on outcome. No significant association was detected between outcome and tendon sheath involvement, tendon suturing, casting, or limb affected. Fetlock hyperextension was the most significant complication. CONCLUSIONS: A high survival rate can be expected after SDFT, DDFT, SL, and/or DSL lacerations in horses, but only 55% of affected horses returned to their previous activity level. The number of structures affected was the major factor determining whether horses returned to an equal level of performance.

Standing laparoscopic ovariectomy technique with intraabdominal dissection for removal of large pathologic ovaries in mares.

OBJECTIVE: To describe a standing laparoscopic ovariectomy technique with intraabdominal ovarian dissection inside a specimen retrieval bag for removal of large pathologic ovaries through small incisions. STUDY DESIGN: Case series. ANIMALS: Mares (n=43) aged 2-21 years and weighing 380-680 kg. METHODS: Unilateral laparoscopic ovariectomy was performed on 43 standing sedated mares. Ovaries were approached via 3 portal sites, 2 in the paralumbar fossa and a 3rd between the 17th and 18th ribs on the ipsilateral side. Ovaries were dissected free using either a LiNA Tripol-bipolar laparoscopic forceps or a Ligasure Vessel Sealing Device and removed by enlarging the proximal portal site ventrally using a grid technique. Use of a plastic specimen retrieval bag and cannula suction device facilitated intraabdominal dissection of very large ovaries into 2 or more pieces, before removal through small incisions. RESULTS: Regardless of size, all ovaries were removed successfully through small incisions (range, 5-10 cm), with no major complications and an excellent cosmetic result. All sport horses returned to previous levels of work or higher, with 93% of breeding mares successfully bred in the 1st season after surgery. CONCLUSIONS: Large pathologic ovaries can be easily and safely removed by standing laparoscopic ovariectomy on the mare. CLINICAL RELEVANCE: Standing laparoscopic ovariectomy combined with a small flank incision is a safe and highly effective technique for removal of large pathologic ovaries in the mare, negating the requirement for general anesthesia or large incisions.