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Umbilical Herniorrhaphy 253
specific therapy. However, seroma and hernatoma mandate emergency surgery. 2'8'9 Hernias that
formation may progress to subcutaneous infec- suddenly increase in size, become edematous
tion, which can be determined by the presence of or painful, or are associated with depression or
focal tenderness, persistent inflammation, and colic warrant urgent clinical evaluation and
moisture or discharge at the suture sites. Sub- exploratory surgery. Hernias that exhibit these
cutaneous infections are treated with warm com- signs are not amenable to field surgery, and the
presses and systemic antibiotic therapy. If not horse should be referred to an appropriate surgi-
resolved by 10 to 14 days postsurgery, ultrasonog- cal facility. Careful evaluation of the umbilical
raphy may be used to identify subcutaneous masses by palpation and ultrasonography will
abscesses and needle aspiration or lancing of the help to differentiate complicated umbilical
abscesses considered. Uncommon complications hernias from the uncomplicated, reducible
associated with the open technique include evis- hernias.
ceration, abdominal adhesions, and peritonitis. The goals of surgical repair of an umbilical
hernia are obliteration of the hernial sac and
repair of the defect in the abdominal wall. Alter-
ALTERNATIVE PROCEDURES natives to surgical repair of hernias include the
application of hernial clamps or elastrator rings
The advantages of hernial clamping or the appli- and the injection of irritating substances around
cation of elastrator rings have been reported to be the base of the hernial sac. These alternatives are
ease of application and cost. 1'5'6 The primary dis- usually successful in obliterating the hernial sac
advantage of hernial clamping is the risk of incor- but do not directly repair the defect in the abdom-
porating gut into the clamp and inadequate inal wall.
fibrosis of the abdominal wall defect. The proce-
dure should be done under general anesthesia
with the foal in dorsal recumbency. Clamping is REFERENCES
recommended only for hernias that are uncom-
plicated, easily reducible, and less than 8 cm in 1. Adams SB, Fessler JF: Umbilical herniorrhaphy. In
length. Additionally, the hernial sac should be Adams SB, Fessler JF, editors: Atlas of equine surgery,
easily palpable to ensure there are no contents Philadelphia, 2000, WB Saunders.
within the sac when applying the clamp. Some 2. Freeman DE, Orsini JA, Harrison IW, et al: Compli-
surgeons believe that clamping is easier in females cations of umbilical hernias in horses: 13 cases
than in males as the prepuce can get in the way (1972-1986), J Am Vet Med Assoc 192:804, 1988.
in males. 111 males, the smallest possible clamp 3. Orsini JA: Management of umbilical hernias i11 the
should be selected and carefully padded to prevent horse: treatment options and potential complica-
tions, Equine Vet Educ 9:7, 1997.
injury to the foal's sheath.5
4. Wilson DA, Baker GJ, Boero MJ: Complications of
celiotomy incisions in horses, Vet Surg 24:506, 1995.
5. Riley CB, Cruz AM, Bailey JY, et al: Comparison of
COMMENTS hetniorrhaphy versus clamping of umbilical hernias
in horses: a retrospective study of 93 cases (1982-
Umbilical hernias are a conunon congenital defect 1994), Can Vet J 37:295, 1996.
in young horses. Females are twice as likely as 6. Greenwood RES, Dugdale DJ: Treatment of umbili-
7
males to have the defect. Many hernias are small cal hernias in foals with elastrator rings, Equine Vet
and will resolve with time or with more conser- Educ 5:113, 1993.
vative measures such as manual daily reduction, 7. Freeman DE, Spencer PA: Evaluation of age, breed,
and gender as risk factors for umbilical hernia in
the application of a truss, or umbilical clamps.1 horses of a hospital population, Am J Vet Res 52:637,
Umbilical hernias generally require surgery if they 1991.
persist until 5 to 6 months of age, if they gradu- 8. Steckel RR, Nugent MA: Parietal hernia in a horse,
ally enlarge over time, or if they fail to respond to
• J Am Vet Med Assoc 182:818, 1983 .
conservative therapy; Most hernias are uncompli- 9. Markel MD, Pascoe JR, Sams AE: Strangulated
cated and reducible. Some (80/o to 10°/o) sustain umbilical hernias in horses: 13 cases (1974-1985),
complications that are life threatening and J Am Vet Med Assoc 190:692, 1987 .
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