Page 252 - Manual of Equine Field Surgery

248 LIMITED ABDOMINAL SURGERIES

EXPECTED OUTCOME

Edema of the incision site and prepuce may be

extensive but generally resolves with conservative

therapy. In uncomplicated and elective cases, re-

covery is usually straightforward and uneventful.

COMPLICATIONS

The prevalence of complications is low. Seroma

formation is probably the most common compli-

cation. 5 Failure to resect devitalized bowel is prob-

ably the most serious complication." This can be

avoided by careful evaluation of the intestine with

or without exploratory celiotomy to evaluate the

intestines. In neonates, exploratory celiotomy has

the added advantage of being able to remove the

umbilical remnants to reduce the incidence of

~~.lc....:e-~ septicemia. If there is preoperative concern about

Figure 44-4 Preplaced sutures in the superficial the systemic health of the foal, the viability of the

inguinal ring to close inguinal hernia. intestine, or the anticipated length or difficulty of

the procedure, the repair should be performed at

should be placed at varying distances from the an equine surgical facility, where potential com-

edges of the ring to avoid creating excessive plications can be readily addressed.

tension in one fascial plane. The subcutaneous Uncommon complications include incisional

tissues and skin may then be closed with infections, wound dehiscence with evisceration,

absorbable sutures. Passive drains may be consid- intestinal prolapse, paralytic ileus, bronchopneu-

ered in the presence of large dead spaces. Alterna- monia, abdominal adhesions, peritonitis, and

tively, the subcutaneous tissues and skin may be colic. In an unpublished review of inguinal hernia

left open to heal by second intention, particularly repair by the author, the incidence of complica-

in cases with extensive preoperative subcutaneous tions following repair was 13o/o (4 of 31 cases). In

dissection, a large amount of dead space, or com- the only published report identified, the survival

promised integrity of the overlying skin.
rate following inguinal herniorrhaphy was only

50°/o.6
POSTOPERATIVE CARE

. ALTERNATIVE PROCEDURES
Postoperative Care

Exercise Restridions: The foal should be Laparoscopic techniques have been developed to

rested in a stall or small paddock for at least 2 repair readily reducible inguinal hernias and pos-

weeks prior to returning to unrestricted pasture sibly salvage the affected testicle.i"

turnout or turnout with other foals.

Medications: Broad-spectrum antibiotics and non-

steroidal antiinflammatory agents are generally not

necessary. However, the presence of complicating COMMENTS

factors may alter this decision. Tetanus prophylaxis

should be current. In most cases, adequate antibod- Congenital inguinal hernias occur primarily in

ies to tetanus will be achieved by passive transfer via males. Most resolve spontaneously by 3 to 6

colostrum from an appropriately vaccinated mare. months of age. The cause of congenital inguinal

Other: lf placed, drains should be removed within hernias is unknown, but a hereditary predisposi-

2 days. Drainage from the drains or from the sub- tion may exist and it is generally agreed that cas-

cutaneous tissues of open incisions may cause tration should accompany the hernia repair.

scalding of the skin between the legs. The skin Development of the hernia is likely related to

surrounding the incision and between the legs

should be coated with petroleum jelly to minimize

this scalding.