Single‐port laparoscopic incisional hernia repair in a horse

Abstract

Summary A 16‐year‐old Italian Saddle Horse gelding was referred for treatment of an incisional hernia that developed 7 months after a ventral midline laparotomy for treatment of acute abdominal pain. Physical examination revealed a hernia approximately 20 cm long and 15 cm wide on the ventral aspect of the abdomen. Ultrasonography revealed the dimensions of the hernia ring to be approximately 15 cm in length and 10 cm in width. A single‐port laparoscopic incisional hernia repair using an operating 0° laparoscope was performed with an appropriately sized (24 × 18 cm) piece of mesh fixed in place with simple interrupted transabdominal sutures. At 4 weeks post operatively, follow‐up physical examination and ultrasonography confirmed healing of the surgical site with no evidence of hernia recurrence. The same evaluation was done 6 months post operatively, and the horse returned to its previous level of activity 8 months post operatively. In horses, laparoscopic application of mesh should be considered among the treatment options for incisional hernia. In the present case, this technique was performed with a single port using an operative laparoscope, in contrast to the multiportal techniques reported previously. The case presented here demonstrates that single‐port laparoscopic herniorrhaphy is feasible, and allows proper placement of an expanded polytetrafluoroethylene intraperitoneal mesh in horses

Hernioplasty with Laparoscopy Mesh Application in Equine with Incisional Hernia

“…As hérnias de tamanho pequeno a médio podem ser tratadas de maneira conservativa com uso de bandagens compressivas [5,8]. O reparo de hérnias grandes é realizado cirurgicamente e muitos métodos são relatados para correção dos defeitos na parede abdominal [2,4,6,9,17], porém, os mais comuns são o fechamento primário da hérnia por suturas e o implante de telas. Autores compararam a eficácia desses métodos e concluíram que, em muitos casos, há complicações pós-cirúrgicas graves [4,17].…”

“…Autores compararam a eficácia desses métodos e concluíram que, em muitos casos, há complicações pós-cirúrgicas graves [4,17]. Devido às falhas destas técnicas, alguns trabalhos procuraram alternativas para redução de hérnias na espécie equina, sendo uma delas a correção da afecção por meio de laparoscopia [2,6,15]. Procedimentos laparoscópicos são desejáveis porque permitem melhor visualização do abdômen e são técnicas menos invasivas, além disso, diminuem os problemas pós-operatórios causados pelas técnicas abertas [11].…”

Single incision mesh incisional hernioplasty in the horse: Significant clinical benefits?

“…The case report by Gandini et al . () in this issue chronicles a technical tour de force: laparoscopic incisional mesh hernioplasty in a gelding via a single laparoscopic portal. Similar to the surgical technique reported by Bucher et al .…”

“…The case report by Gandini et al (2017) in this issue chronicles a technical tour de force: laparoscopic incisional mesh hernioplasty in a gelding via a single laparoscopic portal. Similar to the surgical technique reported by Bucher et al (2011), Gandini and his colleagues employed an operating laparoscope, one incorporating an instrument channel paralleling the optical axis of the laparoscope itself.…”

“…Clinical experience is sufficiently limited that similar claims by equine surgeons are perilous, yet the results to date are encouraging. The praiseworthy efforts of early adopters such as Gandini et al (2017) will contribute substantially to our understanding of the advantages and limitations of existing and future surgical techniques for treatment of incisional hernias. Indeed, lessons learned and shared will enhance our rate of progress in minimally invasive surgery in general.…”