300
|
MAURER ET AL.
pursue surgical treatment because they were unwilling to continue with the conservative management, because they observed one or more episodes of colic, or because the hernia seemed overly large or was fluctuating in size. The exact age at surgery was not available for Case 3 but was estimated to be somewhere between 5 and 8 weeks based on the drug dosages used, which were calculated based on bodyweight. In the remaining eight foals, age at presentation ranged from 0.5 to 13 weeks (median 9, IQR 7). Clinical examination findings relevant to the cases are summarised in Table 1 .
Surgical procedure
All inguinal hernias were indirect and nonruptured. In all cases in which the hernia had not reduced spontaneously with dorsal recum- bency prior to laparoscopic exploration, small intestine was found to be herniated. Retraction of small intestine into the abdomen was generally easy. No adhesions and no devitalised bowel were de- tected. The umbilical remnants were assessed as being unremark- able in all foals. In 7/9 cases, both vaginal rings were reduced during surgery. In Case 4, only the enlarged vaginal ring related to the her- nia was sutured. On the contralateral side, no hernia was present, and the vaginal ring did not appear enlarged. The surgeon was un- able to retract the left testis back into the abdomen. Because this foal was having respiratory difficulty under anaesthesia, the surgeon decided not to prolong anaesthetic time and so, herniorrhaphy and castration was carried out unilaterally only. In Case 9, herniorrhaphy was performed unilaterally because the vaginal ring contralateral to the side of herniation was assessed as not being enlarged. The lat- ter observation was supported by the intraoperative finding that the descended testis of that side could not be retracted into the abdo- men when placing gentle traction on the spermatic cord. This foal was not castrated. Bilateral castration was performed in 5/9 cases. In these cases, the testicles were readily retracted into the abdomen through the vaginal ring. Unilateral castration was performed in 2/9 cases. This included Case 4, where the surgery was discontinued be- cause the foal experienced respiratory difficulty under anaesthesia. In Case 2, the right testicle was found intra- abdominally and was therefore removed. Two foals (Cases 1 and 9) were not castrated. In Case 9, on the side of the hernia, an assistant grasped the descended testicle from outside the surgical field to maintain it in the scrotum during herniorrhaphy. Recovery from anaesthesia was uneventful in all cases. An overview of the surgical procedures is presented in Table 1 .
Intraoperative complications
In 6/9 cases, no intraoperative complications occurred. Case 4 showed respiratory problems during general anaesthesia but recov- ered uneventfully from anaesthesia. In Case 6, the foal slid cranially during the surgical procedure, because of inadequate fixation on the operating table. This foal needed to be repositioned to complete the
TABLE 1 Case details and surgical procedures performed.
Case no. Clinic Breed 1
2 3 4 5 6 7 8 9
ISME ISME FEH FEH
ISME ISME FEH FEH FEH
LUS FM TB TB
FM SW TB
ISH TB
Age at surgery (weeks)
4 1
5– 8 a 13
0.5 8
10 10 12
Hernia: Right (R), left (L), bilateral (B)
L L
B R R B R R L
Lusitano; NA, not available; SW, Swiss Warmblood; TB, Thoroughbred. a Estimated.
Reducible (yes/no)
Yes Yes Yes Yes Yes Yes Yes Yes Yes
Conservative management prior to surgery: Repeat manual reduction (M), Truss (T), None (N)
M
M/T M/T NA N N
NA
M/T M
Herniorrhaphy: Right (R), Left (L), Bilateral (B)
B B B R B B B B L
Castration: Right hemi- castration (R), Left hemi- castration (L), bilateral castration (B), not castrated (N)
N R B R B B B B
N
Follow- up (months)
93 8 3 4
22 21 5
17 7
Abbreviations: FEH, Fethard Equine Hospital; FM, Franches Montagnes (light breed of draught horses, indigenous to Switzerland); ISH, Irish Sport Horse; ISME, Swiss Institute of Equine Medicine; LUS,
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
