LAPAROSCOPIC REPAIR OF CONGENITAL INGUINAL HERNIAS
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FIGURE 1 Illustration of different stages of the surgical procedure in an 8- week- old Swiss Warmblood foal: (a) Laparoscopic inspection shows an enlarged left vaginal ring (yellow arrowheads) with small intestinal loops (white asterisks) passing through the vaginal ring into the inguinal canal. (b) After the small intestinal loops have been retracted into the abdomen and the testicle has been removed, suturing of the vaginal ring starts at its caudal aspect. A first tissue bite is taken at the cranial border of the vaginal ring (yellow arrowheads) with the Endo Stitch™ laparoscopic suturing device loaded with the V- Loc™ barbed suture. The suture is passed through its looped end (green arrow) to anchor it. The next tissue bite is taken at the caudal border of the vaginal ring (blue arrowheads). (c) Completed suture closure of the left vaginal ring.
the second bite, the caudal portion of the vaginal ring was grasped (Figure 1b ). A simple continuous suture pattern was run from cau- dal to cranial, apposing the two borders of the vaginal ring. When arriving at the cranial end of the vaginal ring, the suture was held under moderate tension and cut with laparoscopic suture scissors, leaving a tag of approximately 1– 2 cm length (Figure 1c ). The same procedure was repeated on the contralateral side, if both vaginal rings were closed. In foals that were castrated, the testicles were removed from the
abdominal cavity following vaginal ring closure. To do so, a laparo- scopic forceps was inserted in the ipsilateral paramedian portal, the testicle was grasped, and the forceps withdrawn until the testicle was wedged against the opening of the cannula. The portal was then carefully enlarged with Metzenbaum scissors (if needed) until tes- ticle, cannula and forceps could be withdrawn from the abdomen. Finally, the abdomen was deflated, and all portals sutured in two layers (i.e. linea alba or external rectus sheath and skin) using ab- sorbable suture material and the surgical sites were covered with an adhesive dressing (Snögg Animal Polster, Animal Health [Farm and Stable GmbH and Co.]). Foals were recovered from general anaes- thesia hand- assisted and were allowed to nurse within the first hour after recovery.
Postoperative care
All subjects received systemic NSAIDs and antimicrobials in the postoperative period. The choice of agents used, and the duration of postoperative medication were at the discretion of the responsible surgeon. Additionally, gastroprotectants (sucralfate 20 mg kg −1 bwt PO) were administered. Foals underwent a daily clinical examina- tion for the duration of their hospitalisation and special attention was paid to control for any scrotal swelling and the laparoscopic portals. Adhesive dressings were left in place until they detached
by themselves and were not replaced. Owners were instructed to keep the mare and foal in a stable with access to a small paddock for a total duration of 4 weeks following surgery. After that, regular turnout could be resumed.
Statistical analysis
Numerical variables were presented as median and interquartile range (IQR) based on normality testing (Shapiro– Wilk test) using R version 4.1.1 (R Core Team, R Foundation for Statistical Computing).
RESULTS Clinical presentation
Nine foals underwent laparoscopic herniorrhaphy using the Endo Stitch™ in combination with a unidirectional barbed suture between May 2015 and July 2022. Two Franches Montagnes, one Irish Sport Horse, one Lusitano, one Swiss Warmblood and four Thoroughbreds were included. Inguinal herniation was noticed at or shortly after birth in all cases. Inguinal hernia was unilateral in seven and bilat- eral in two cases. Four of the unilateral hernias were right- sided and three were left- sided. All inguinal hernias were nonpainful on palpa- tion and reducible. Ultrasonography was inconsistently performed prior to surgery. One foal (Case 2) showed several episodes of colic immediately after inguinal hernia first occurred, but colic resolved after repeated manual reduction and application of a truss. Another foal (Case 6) was reported to sporadically show signs of mild colic at home. In this case, the size of the bilateral hernia was fluctuat- ing. Conservative management by repeated manual reduction and/ or application of a truss failed to resolve the condition where at- tempted. Owners of the foals presented in this case series elected to
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