298
|
Ireland and the Equine Clinic Bern at the Swiss Institute of Equine Medicine, Switzerland, between May 2015 and July 2022 were re- viewed. Cases were included if vaginal ring closure was performed laparoscopically using an automated laparoscopic suturing de- vice (Endo Stitch™, Medtronic (Schweiz) AG) in combination with a custom- made unidirectional barbed suture (V- Loc™ 180 Absorb- able Reload for Endo Stitch™ suturing device, Medtronic (Schweiz) AG). Data specifically retrieved from the medical records comprised age, breed, side of herniation, reducibility of the hernia, presence of colic, precedent conservative management, intraoperative findings, as well as any note of intra- and postoperative complications, includ- ing possible re- herniation. Long- term follow- up was obtained from owners by telephone in-
terviews or email using a standardised questionnaire. In a structured interview, owners were asked about the general condition of the foal during convalescence, healing of the laparoscopic portal sites, if signs of colic occurred and if re- herniation was observed. Further- more, in all colts that were not castrated as part of the laparoscopic herniorrhaphy, it was inquired whether the colt had been castrated in the meantime and (if so), if complications were encountered with the castration procedure.
Preparation for surgery
Foals were allowed to nurse before surgery. All subjects received nonsteroidal anti- inflammatory drugs (NSAIDs)
(flunixin meglu-
mine 1.1 mg kg −1 bwt IV or phenylbutazone 4.4 mg kg −1 bwt IV), prophylactic antimicrobials (benzylpenicillin 30,000 IU kg −1 bwt IV in combination with gentamicin sulfate 6.5 mg kg −1 bwt IV or amikacin 20 mg kg −1 bwt IV; or oxytetracycline 6.6 mg kg −1 bwt IV) and 3000 IU tetanus serum (Equilis® Tetanus Serum, MSD Animal Health GmbH) prior to anaesthesia. Before induction of general anaesthesia, foals were sedated with xylazine 0.3– 1 mg kg −1 bwt IV, according to age and individual response. Analgesia was pro- vided with butorphanol 0.02 mg kg −1 bwt IV or levo- methadone 0.05 mg kg −1 bwt IV at the discretion of the anaesthetist. General anaesthesia was induced with a mixture of 3 mg kg −1 bwt ketamine hydrochloride IV and 0.05 mg kg −1 bwt diazepam IV. Maintenance of general anaesthesia was achieved with isoflurane (end- tidal concentration 1.2%– 1.5%) vaporised in 100% oxygen and de- livered via a circle system. The trachea was intubated and lungs
were ventilated to maintain normo- capnoea (end- tidal CO 2 35– 45 mmHg). The foals were positioned in dorsal recumbency on the operating table. One surgeon suspended the hindlimbs on a hori- zontal bar to allow for elevation of the caudal part of the foal later during surgery. Vital parameters (heart rate, respiratory rate, arte- rial blood pressure, blood oxygen saturation), as well as inspired/
expired gas (fraction of inspired oxygen, end- tidal CO 2 , end- tidal isoflurane), were continuously monitored. A urinary catheter was placed, and the caudal ventral abdomen was clipped, aseptically prepared and draped.
Surgical procedure
A 1.5 cm skin incision was made approximately 3 cm cranial to the umbilicus. Using a number 11 blade, a small stab incision was made through the linea alba, and a blunt teat cannula was advanced into
the peritoneal cavity and used to insufflate CO 2 or ambient air to produce abdominal distension. Once the pressure of 10– 15 mmHg was reached, the teat cannula was withdrawn and the incision in the linea alba was elongated to fit a trocar- cannula unit, which was then inserted in the distended abdomen. The trocar was removed and a 10 mm, 57 cm, rigid 30° angle laparoscope (Karl Storz SE & Co. KG) or 10 mm, 47 cm, rigid 0° laparoscope (Richard Wolf GmbH), depending on the surgeon ' s preference, was introduced through the cannula. The operating table was tilted 30°, or the caudal part of the foal was elevated by lifting the bar suspending the hindlimbs, to have the foal in Trendelenburg position, thus displacing the viscera cranially. Sub- sequently, the vaginal rings were inspected (Figure 1a ) and paramed- ian instrument portals were created similarly as described previously (Mariën et al., 2001 ). Briefly, the instrument portals, one on each side, were created slightly caudal to the umbilicus, equidistant in the paramedian plane between the superficial inguinal ring and um- bilicus. A spinal needle was used to confirm appropriate location of these portals. A small incision was made at these sites and a trocar- cannula unit was inserted in these portals under direct laparoscopic observation. If not already spontaneously reduced in Trendelenburg position, herniated intestines were retracted into the abdomen using atraumatic laparoscopic forceps. Depending on the owner ' s preference, the testicles were spared,
or foals were castrated. For laparoscopic castration, the atraumatic forceps were placed in the contralateral instrument portal, passed underneath the median ligament of the bladder, and traction was applied on the mesorchium to pull the testis through the vaginal ring into the abdominal cavity. The testis was then grasped with the lap- aroscopic forceps and held in position so that the ligament of the tail of the epididymis could be transected using an electrothermal bipolar vessel- sealing device (Liga Sure™, Medtronic [Schweiz] AG) inserted through the remaining ipsilateral instrument portal. There- after, the mesorchium with the testicular vasculature and the ductus deferens with its mesoductus were sealed and transected with the Liga Sure™. The testicle was then temporarily deposited in the cau- dal aspect of the peritoneal cavity. For closure of the vaginal ring, the Endo Stitch™ suturing de-
vice was loaded with a 20 cm USP 2- 0 or 0 (surgeon ' s preference) polyglyconate absorbable unidirectional barbed suture (V- Loc™) and introduced in the abdomen through the contralateral instrument portal. Suturing was started at the caudal border of the vaginal ring if the gonadal structures had been removed, or just cranial to the vascular structures contained within the mesorchium, if the foal was not to be castrated. First, a generous bite of the caudal edge of the internal abdominal oblique muscle, forming the cranial border of the internal inguinal ring, was taken. The suture was then anchored by passing the needle through the looped end and pulling it tight. With
MAURER ET AL.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
