Endoscopic Anatomy of the Equine Guttural Pouch: An Anatomic Observational Study.

Guttural pouch endoscopy allows for both the visualization and treatment of many clinical problems in the equine retropharyngeal region. This area is extremely complex, and its description remains a real challenge for veterinary anatomists and practitioners. Six clinically normal equine cadavers were employed. Conventional dissections of guttural pouches without penetrating the guttural pouch membrane were first performed, and each adjacent structure was identified. Then, a guttural pouch endoscopic exam of the dissected heads was performed in order to correctly map each visible underlying anatomic structure identified in the previous dissection. This allowed us to: 1-identify each structure visible on endoscopic examination of the guttural pouch; 2-create a representative map of all the structures accurately identified via endoscopy; and 3-describe a systematic guttural pouch endoscopic examination with practical keys to help identification of the underlying vital structures. Our investigation provides new practical information on guttural pouch endoscopic anatomy and has allowed us to identify structures that were not previously described. We believe that this information may help with an accurate diagnosis in some cases and also potentially reduce iatrogenic trauma to important structures.

Clinical indications, complications, and long-term outcome of esophageal surgeries in 27 horses.

The main objective of this retrospective study was to describe clinical findings, management, and short- and long-term outcome in 27 horses that underwent various surgical techniques for esophageal disease. Surgical techniques (sometimes concurrently) performed were: esophagostomy (n = 14), esophagotomy with primary closure (n = 6), esophagomyotomy (n = 3), and esophagoplasty (n = 2). Esophageal perforation in 5 horses was treated by ventral drainage; 3 horses had the esophageal defect sutured (n = 3). Feeding tubes were placed in 15 horses. Postoperative complications occurred in 52% (14/27) with a median of 3 complications/horse (range: 1 to 7). Significantly more complications occurred in horses with a perforated esophagus. Eighteen horses (18/27; 67%) were discharged. Most horses (8/9; 89%) with a lesion located in the proximal esophagus were discharged. Horses with a higher number of postoperative complications, particularly postoperative infection, were more likely to be euthanized. One year after surgery, 41% of the horses were alive and free of complications.

Indications cliniques, complications et résultat à long terme de chirurgies œsophagiennes chez 27 chevaux. L'objectif principal de cette étude rétrospective a été de décrire les résultats cliniques, la gestion et les résultats à court et à long terme chez 27 chevaux qui ont subi diverses techniques de chirurgie pour le traitement de la maladie œsophagienne. Les techniques chirurgicales réalisées (parfois de manière concomitante) étaient : l'œsophagostomie (n = 14), l'œsophagotomie avec fermeture primaire (n = 6), l'œsophagomyotomie (n = 3) et l'œsophagoplastie (n = 2). La perforation œsophagienne chez 5 chevaux a été traitée par drainage ventral; 3 chevaux ont subi une suture du défaut œsophagien (n = 3). Des sondes d'alimentation ont été placées chez 15 chevaux. Les complications postopératoires se sont produites chez 52 % des chevaux (14/27) avec une médiane de 3 complications/cheval (fourchette : 1 à 7). Un nombre significativement supérieur de complications se sont produits chez les chevaux ayant une perforation de l'œsophage. Dix-huit chevaux (18/27; 67 %) ont reçu leur congé. La plupart des chevaux (8/9; 89 %) ayant une lésion situé dans l'œsophage proximal ont reçu leur congé. Il était plus probable que les chevaux avec un nombre supérieur de complications postopératoires, particulièrement une infection postopératoire, soient euthanasiés. Un an après la chirurgie, 41 % des chevaux étaient vivants et libres de complications.(Traduit par Isabelle Vallières).

Frequency of Undetected Glove Perforation and Associated Risk Factors in Equine Surgery.

OBJECTIVE: To estimate the frequency of undetected perforations in surgical gloves during equine surgery and to identify risk factors associated with occurrence. STUDY DESIGN: Observational cohort study. SAMPLE POPULATION: Surgical gloves-292 pairs. METHODS: Water leak tests were performed on gloves after equine surgery to detect perforations. Fifty pairs of unused gloves were also tested. Potential risk factors were recorded. Logistic regression was used to explore associations between putative risk factors and perforation. RESULTS: No perforations were detected in the unused gloves. Of 292 pairs of used gloves tested, 80 (27%) had at least one glove perforation per pair. The frequency of perforations was not different between surgery diplomates and residents (P=.69). The length and type of surgery were significantly associated with the likelihood of undetected glove perforation with surgeries longer than 60 minutes approximately 2.5 times more likely to result in glove perforation (P=.005). Surgery classified as soft tissue, orthopedic or exploratory celiotomy was 3 times more likely to result in glove perforation than minimally invasive surgery. The perforations occurred significantly more frequently in the nondominant hand (19%) than the dominant hand (11%) (P=.009). CONCLUSION: There is a high occurrence of undetected glove perforation in equine surgery. Precautions can be suggested based on this study although further investigation is required to assess whether glove perforations are associated with surgical site infections.

Ex Vivo Biomechanical Comparison of 4 Suture Materials for Laparoscopic Bladder Closure in the Horse.

OBJECTIVE: To compare a knotless, barbed suture to standard suture using laparoscopic suturing methods in an ex vivo model of equine bladder repair. STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Equine cadaver bladders (n=42). METHODS: A 5-cm incision was created and repaired in a laparoscopic training box with 4 different suture materials. Groups 1 and 2 used 2-0 poliglecaprone and 2-0 glycomer knotless, barbed suture, respectively, placed using laparoscopic instruments. Groups 3 and 4 used 0 and 2-0 polyglyconate knotless, barbed suture, respectively, placed using an automated laparoscopic suturing device. All groups used a double-layer inverting pattern. Time for suture placement was recorded. Bladders were inflated with water and bursting strength pressures recorded, including a control group of intact bladders. Statistical analysis using a linear model and taking into account the unequal variances was followed by a post-hoc Tukey's test. Significance was set at P<.05. RESULTS: Bursting strength did not vary significantly between treatment groups, but was significantly decreased compared to the control group (P<.001). Time to place the sutures with the 2 automated suture device groups (groups 3 and 4) was significantly faster than those in which the suture was placed using laparoscopic needle holders and forceps (groups 1 and 2; P=.001). CONCLUSION: Knotless, barbed suture may be a viable alternative to standard suture material for laparoscopic closure of the urinary bladder in horses. Further cyclic and in vivo testing should be performed before use in clinical cases.

Comparison of an alcohol-based hand rub and water-based chlorhexidine gluconate scrub technique for hand antisepsis prior to elective surgery in horses.

This prospective clinical study evaluates the effectiveness of an alcohol-based hand rub (Avagard™) for pre-surgical hand antisepsis in an equine hospital and compares it with traditional scrubbing technique using 4% chlorhexidine gluconate sponges and water. Prior to elective surgery, 3 board-certified surgeons were randomly assigned to hand antisepsis with either technique. Culture samples of each hand were taken at 4 times: before and after neutral soap hand wash, after scrub or rubbing technique, and after surgery. There was no significant difference in mean bacterial colony forming units between scrub and rub techniques over the 3 time periods (P = 0.6), controlling for initial counts. One horse from the scrub group had a skin incision infection following stifle arthroscopy; this was resolved with medical treatment. The alcohol-based hand rub is equivalent in efficacy for pre-surgical hand antisepsis to traditional water-based scrubs in an equine hospital setting.

Comparaison de l'alcool à friction et d'une technique de brossage au gluconate de chlorhexidine à base d'eau pour l'antisepsie des mains avant les chirurgies non urgentes chez les chevaux. Cette étude clinique prospective évalue l'efficacité d'un alcool à friction (AvagardMD) pour l'antisepsie des mains préalable à une chirurgie dans un hôpital équin et elle la compare à la technique de brossage traditionnelle au moyen d'éponges de gluconate de chlorhexidine 4 % et d'eau. Avant une chirurgie non urgente, trois chirurgiens agréés ont été assignés au hasard à l'antisepsie des mains avec l'une ou l'autre technique. Des échantillons de chaque main ont été prélevés quatre fois pour culture : avant et après le lavage des mains avec un savon neutre, après la technique de brossage et de friction et après la chirurgie. Il n'y avait aucune différence significative dans les moyennes des dénombrements bactériens d'unités formatrices de colonies entre les techniques de brossage et de friction pendant les trois périodes de temps (P = 0,6), en tenant compte des témoins pour les dénombrements initiaux. Un cheval du groupe de brossage a développé une infection au site de l'incision après une arthroscopie du grasset qui a été résolue par traitement médical. La friction des mains à l'alcool est équivalente, en matière d'efficacité pour l'antisepsie des mains avant la chirurgie, au brossage traditionnel à l'eau dans un milieu hospitalier équin.(Traduit par Isabelle Vallières).

In vivo effects of a single intra-articular injection of 2% lidocaine or 0.5% bupivacaine on articular cartilage of normal horses.

OBJECTIVE: To assess the effects of an intra-articular (IA) lidocaine or bupivacaine injection on synovial fluid (SF) biomarkers of cartilage metabolism. STUDY DESIGN: Experimental. ANIMALS: Horses (n = 6). METHODS: The study had 2 components, each with an identical design: the first arm assessed the effects of bupivacaine (0.5%) IA in the intercarpal joints and, after a 2-week washout period, the second was conducted to evaluate the effects of IA lidocaine (2%) in the tarsocrural joints. The mares were randomly assigned to receive the test local anesthetic in the target joint or the placebo (0.9% NaCl) in the contralateral joint. After a 2-week washout period, treatments were reversed, yielding 6 joints for each treatment. SF samples were collected for measurement of biomarkers of cartilage metabolism. RESULTS: IA bupivacaine or lidocaine induced a significant increase in both markers of cartilage matrix synthesis (CS846-aggrecan and CPII-type II collagen) suggesting an anabolic effect. Bupivacaine also resulted in an unanticipated decrease in both collagen degradation markers (C2C and C1,2C). CONCLUSIONS: These results reveal an anabolic effect of single IA injections of local anesthetics on cartilage metabolism. Although collagen degradation biomarker results were not increased, it is possible that the anabolic response is because of an undetected cartilage insult, and requires further investigation.