Development of a laparoscopic technique for inguinal hernioplasty in standing horses

Abstract

Background: Most previously described techniques for laparoscopic inguinal hernioplasty (IH) in horses require advanced laparoscopic skills. Our objective was to describe a new laparoscopic IH technique using a surgical anchoring system. Methods: Standing laparoscopic IH was performed unilaterally in eight experimental stallions, using the contralateral inguinal canal (IC) as a control. A polyether ether ketone harpoon was anchored in the craniolateral aspect of the vaginal ring, and an extracorporeal knot was used to fix the device. Clinical evaluation, including testicular palpation and lameness examination, was conducted before and for 4 weeks after surgery. Repeat laparoscopy was performed 28 days later. Results: Standing laparoscopic IH was performed in all horses with a surgical time of 38 ± 12.85 minutes. In two animals, a small peritoneal tear occurred that did not require repair. No other complications were recorded. On repeat laparoscopy, all devices were in place, and the IC remained partially closed in all horses. Limitations: The procedure was performed on normal experimental horses and has not been employed on horses that have had an inguinal hernia. Conclusions: This new standing laparoscopic hernioplasty technique provides another potential method for simple partial closure of the IC in stallions at risk of or with history of inguinal herniation.

Laparoscopically Assisted Percutaneous Inguinal Ring Closure for Resolution of Inguinal/Scrotal Hernias in Rams: Cadaveric Study and Three Cases Report

“…In two of the three patients, the surgery was simple and fast to perform, without intraoperative complications except for a slight tearing of the peritoneum adjacent to the vaginal ring that occurred in Case 3. In our own experience with other species, these small peritoneal lacerations adjacent to the vaginal ring usually heal without causing problems or forming adhesions [16]. In Case 2, another complication took place: a subcutaneous and retroperitoneal emphysema formed and prevented visibility; thus, it was not possible to safely performing the LAPS of the IIR.…”

“…If the testicle must be spared, the surgical technique of choice is to partially close the IIR, which requires the use of laparoscopic surgery. The veterinary species in which the largest number of laparoscopic techniques have been described for this purpose is the horse, for which we can find several different approaches [4,16,17].…”

“…Another relevant point is the non-absorbable nature of the material used for suturing in this study. Several studies on laparoscopic hernioplasty in humans [5], dogs [8] and horses [4,16] recommend this type of non-absorbable material to maintain a mechanical closure over time, as this could provide additional security in the case of very large IIRs. Laparoscopic follow-up at 4 weeks in such studies showed no deleterious effects derived from the use of non-absorbable sutures such as infections, adhesions or other foreign body reactions [16].…”

“…Several studies on laparoscopic hernioplasty in humans [5], dogs [8] and horses [4,16] recommend this type of non-absorbable material to maintain a mechanical closure over time, as this could provide additional security in the case of very large IIRs. Laparoscopic follow-up at 4 weeks in such studies showed no deleterious effects derived from the use of non-absorbable sutures such as infections, adhesions or other foreign body reactions [16]. However, good results have also been obtained in porcine species with this technique, using absorbable sutures [9].…”

Use of Knotless Barbed Sutures in Laparoscopic Inguinal Hernioplasty in Horses: 40 Cases

“…Laparoscopic surgery, favored in recent years for its numerous advantages, such as quicker recovery, reduced pain, and fewer complications compared with traditional open surgery, has led to the development of various testicle-preserving laparoscopic hernioplasty techniques. These include intracorporeal suture closure of the VR [ 9 , 10 ], cylindrical polypropylene mesh prosthesis [ 11 ], peritoneal flap hernioplasty techniques [ 12 , 13 ], cyanoacrylate [ 14 ], a tacked intraperitoneal slitted mesh technique [ 15 ] or using a surgical anchoring system [ 16 ].…”