Page 254 - Manual of Equine Field Surgery

CHAPTER 45

Umbilical Herniorrhaphy

David A. Wilson

with a peritoneal lining (hernial sac). The hernial
INDICATIONS
sac generally contains small intestine.

Uncomplicated congenital umbilical hernias that

have persisted until 5 to 6 months of age, gradu- PROCEDURE

ally enlarged over time, or failed to respond

1
to conservative therapy. Complications may Closed Herniorrhaphy

develop in congenital umbilical hernias, which An approximately 10-cm fusiform incision is cen-

can significantly increase the complexity and tered over the umbilicus. Generally, intestine will

expense of repair. One report has shown a com- be palpable within the hernial sac and the hernia

plication rate of 8.80/o.2 Hernia repair before these can be readily reduced. The incision is continued

complications develop is desirable.
through the subcutaneous tissue with care taken

to not penetrate the hernial sac. The skin and sub-

EQUIPMENT cutaneous tissues are dissected from the hernial

sac (Figure 45-1). At the attachment of the

No special equipment is required for surgical umbilicus, the hernial sac can be very thin and is

repair of umbilical hernias. easily penetrated. If the sac is penetrated, the

defect in the sac is closed with No. 2-0 absorbable

suture material.

PREPARATION AND POSITIONING The hernial sac is then inverted into the

abdomen (Figure 45-2). Absorbable sutures (No.

The surgery is performed with the horse under 1 or No. 2 depending on the size of the foal) are

general anesthesia in dorsal recumbency. The placed in the fibrous hernial ring, with care taken

ventral abdomen is clipped, prepared, and draped to not incorporate intestine into the suture line

for aseptic surgery. In males, the bladder may be (Figures 45-3 and 45-4). The specific suture

catheterized in males and the prepuce closed with pattern for closure of the hernial ring is left to the

towel clamps or suture to minimize urine conta- discretion of the surgeon. Simple interrupted,

mination of the surgery site. cruciate, and far-near-near-far patterns are com-

monly used.

The advantages of the closed method of repair

ANATOMY are the relative ease of the procedure and the

reduced risk of postoperative peritonitis or evis-

An umbilical hernia consists of a midline defect ceration. Disadvantages include not being able to

in the body wall and an outpouching of the skin thoroughly assess the contents of the hernial sac,

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