Page 251 - Manual of Equine Field Surgery

Inguinal Herniorrhaphy 247

Vaginal tunic

and testicle

~~t;,,.);~

Figure 44-2 Direct inguinal hernia showing in-

~-C...k~ testines outside the abdomen next to the vaginal tunic

Figure 44-1 Indirect inguinal hernia viewed from containing the testicle.

the abdomen, and skin cut away from scrotum showing

intestine and testicle within the scrotum.

scrotum. Intestine is typically noted within the

vaginal tunic. Occasionally, the parietal vaginal

tunic or peritoneum in the region of the vaginal

ring tears and the intestine is directly under the

skin. Ruptures of the tunic or peritoneum can be

very large and are an indication that surgical

repair is indicated (Figure 44-2). The skin of very

young foals is thin. Stretching and thinning of the

skin can lead to blood supply disruption, ischemic

necrosis, and subsequent sloughing of the skin.

If the vaginal tunic is intact, a combination of

blunt and sharp dissection is used to free the tunic

and internal spermatic fascia from the external

spermatic fascia. The vaginal tunic and testicle are ~tc.J:~

twisted in order to «milk" the intestine back into Figure 44-3 For indirect inguinal hernias, the

the abdominal cavity (Figure 44-3). A transfixa- vaginal tunic can be twisted, starting at the testicle and

tion suture is then placed, while maintaining the twisting the vaginal tunic to force the intestines into the

twist, within the inguinal canal. The testicle and abdomen.

tunics are then emasculated distal to the ligature.

For ruptures of the vaginal tunic, the tear is The superficial inguinal ring is then closed

identified and the intestines are replaced into the with preplaced absorbable sutures (Figure 44-4).

•
abdomen. «Last-out, first-in" is the guideline for A simple interrupted or cruciate pattern using No.

feeding the loops of bowel back in the abdomen. 1 or No. 2 absorbable mono.filament suture mate-

This may require enlargement of the vaginal ring rial is recommended for closure of the superficial

depending on the condition of the intestine. Care inguinal ring. Use of a blunt-point hernia needle

should be taken to not inadvertently disrupt the (The Torrington Company, Torrington, Conn.)

delicate intestinal mesentery, The testicle and reduces the risk of inadvertently penetrating the

tunic are then emasculated in a routine manner. large vessels in the surgical field. The sutures