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the body wall is not thick enough to support the weight of the abdominal viscera. Seroma formation, as long as it does not become secondarily infected, should be managed with pressure bandaging and time if possible. As soon as the seroma is either drained or decompressed with a needle the risk for infection increases exponentially. Once infected, the establishment of drainage is indicated as well as systemic antimicrobial therapy. The best way to deal with seroma formation is to prevent it in the first place predominantly by careful closure of dead space during surgical closure of the incision. Reherniation occurs because of either excessive tension


on the body wall closure or post operative incisional infection. Fortunately, reherniation is relatively uncommon because most congenital body wall defects are fairly small (<5–10 cm) and can generally be closed tension free. Foals with a previous history of attempted surgical repair for a body wall defect are at greatest risk for reherniation. Animals with a failed herniorrhaphy are challenging because normal body wall is no longer present. A variable amount of fibrosis makes reconstruction difficult. It is of paramount importance following reherniation to resect the edges of the hernia to fresh bleeding edges. For the majority of cases, the body wall can be reconstructed with suture material only. In instances with thin, body wall with tension a mesh overlay should be considered, although horses treated with mesh implantation, following failed herniorrhaphy are at increased risk for incisional infection.


Aftercare


Foals are administered prophylactic antimicrobials for the surgical procedure. Typically procaine or potassium penicillin G is administered prior to surgery and discontinued within 24 h post operatively for routine sutured herniorrhaphy. Following mesh herniorrhaphy, antimicrobials are administered for a minimum of 3–5 days. For these cases i.v. administration of penicillin and gentamicin is most commonly selected. If incisional seroma formation develops or an incisional infection occurs following discontinuation of i.v. antimicrobials, oral antimicrobials are administered for an additional 7–10 days. Trimethoprim sulfamethoxazole is the most common antimicrobial used. Following surgical repair, foals should be


confined to box stall for a minimum of 3–4 weeks. After a period of box stall rest they can be turned out into a small paddock for an additional 3 weeks. The prognosis for congenital body wall defects is


favourable as long as the aforementioned surgical principles are followed. Post operative complications are relatively rare but, when they develop, reherniation becomes the primary concern.


Author’s declaration of interests No conflicts of interest have been declared.


References


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Riley, C.B., Cruz, A.M., Bailey, J.V., Barber, S.M. and Fretz, P.B. (1996) Comparison of herniorrhaphy versus clamping of umbilical hernias in horses: a retrospective study of 93 cases (1982-1994). Can. Vet. J. 37, 295-298.


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