Clinical and ultrasonographic evaluation of three suture techniques for closure of the equine linea alba

Abstract

Summary Surgical technique plays an important role in preventing ventral midline incisional complications. The aim of this study was to compare the clinical and ultrasonographic outcome of three suture techniques for closure of the linea alba. In this prospective case series (n = 43), horses operated for acute abdominal intestinal disease through a midline incision were randomised in three groups: closure with a conventional continuous technique (Group 1), a small stitches continuous technique (Group 2) and the UX‐technique (shoe‐lace configuration, Group 3). Age, sex, body weight, type and duration of surgery were recorded and the suture to wound length ratio was calculated. Clinical evaluation of the wound (wound discharge) was performed daily during hospitalisation. At 7 weeks post‐operatively the linea alba was evaluated clinically and ultrasonographically. The linea alba width was measured halfway along the length of the incision. One horse in Group 1 had acute incisional dehiscence, but there were no further significant differences between the groups in the short term. Seven weeks post‐operatively two horses had complete herniation in Group 1 and one horse had partial herniation in Group 2. In the UX group no herniation occurred. The incidence of herniation was not significantly different between the groups. On ultrasound at 7 weeks the linea alba width was significantly smaller in Group 2 (P = 0.00029) and Group 3 (P = 0.0018) compared with Group 1, even with exclusion of the acute incisional dehiscence and two herniated horses. Limitations were the small group size and relatively low incidence of incisional complications for statistical analysis. It was concluded that the use of small stitches and the UX‐technique resulted in a smaller linea alba width compared with the conventional continuous suture technique and might therefore be preferred for closure of the linea alba in equine colic surgery.

Ultrasonographic evaluation of the width, thickness, and length of the normal linea alba in standing and dorsal recumbent horses

“…The use of ultrasonography to evaluate the LA is well established in human medicine 12,21,23 and is mainly used to determine the width of the LA in cases of rectus diastasis, an increased distance between the medial borders of the rectus abdominis muscles caused by (repeated) stretching of the LA during, for example, pregnancy 22 . Although ultrasonography has been used under clinical circumstances for evaluation of the equine LA postoperatively, 15,24,31 this report of present study is the first to describe the anatomical variation of the normal equine LA by using this technique.…”

Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study

“…AAD in people has been attributed to abdominal wall sutures being too tight or not widely enough placed 9 . Optimal methods for closure of the equine linea alba is an area that has been studied extensively both in‐vitro and in‐vivo utilising different suture material types, sizes, suture patterns and suture bites 8,10–14 . A continuous suture pattern had been used to close the linea alba in most of the AAD cases.…”

What do we currently know about incisional complications of colic surgery?

“…The effect of abdominal closure technique on incisional complications has been extensively studied (Anderson et al, 2015; Biedrzycki & Brounts, 2016; Bischofberger et al, 2010; Colbath et al, 2014; Coomer et al, 2007; Darnaud et al, 2016; Isgren et al, 2017; Kilcoyne et al, 2019; Magee & Galuppo, 1999; Mair & Smith, 2005; Rinnovati et al, 2016; Salem et al, 2016; Scharner et al, 2017, 2018; Smith et al, 2007; Torfs et al, 2010; Verkade et al, 2020). The standard abdominal wall closing technique includes 3 layers, linea alba (LA), subcutaneous (SC) and skin.…”

“…Routine ultrasonographic evaluation of post-operative colic cases can aid early diagnosis and initiation of appropriate therapy, and potentially speed the recovery and improve the outcome if infection is indeed present (Protopapas et al, 2000;Rubio Martínez et al, 2012;Shearer et al, 2020;Verkade et al, 2020).…”