Page 256 - Manual of Equine Field Surgery
P. 256
252 LIMITED ABDOMINAL SURGERIES
exposed. At this point, the hernial sac is resected peritonitis. The open technique is i11dicated for
to the level of the fibrous ring of the hernia. repair of large hernias, irreducible hernias, or
Careful palpation of the hernial ring will identify hernias complicated by enterocutaneous fistula.
a thinned triangular area on the cranial and The subcutaneous tissue and skin are closed
caudal borders of the ring with the fibrous por- similarly for both open and closed techniques.
tions of the linea alba in a fusiform shape (Figure The suture material and patterns are left to the
45-5). The tissue within this triangular area may surgeon's preference. We use No. 2-0 polydiox-
be removed. anone, polyglactin 910, or poliglecaprone. A sub-
.
Closure of the abdominal wall consists of cuticular layer in the skin rather than traditional
appositional absorbable sutures (No. 1 or No. 2 skin closure or the use of absorbable sutures in the
depending on the size of the foal). The suture pat- skin eliminates the need for suture removal. {
terns are similar to those recommended for the
closed technique. The vest-over-pants or Mayo
I
mattress suture pattern is not recommended POSTOPERATVE CARE
because the pattern tends to excessively focus or
increase the tension of the suture line rather than rostoperative Care
simply closing the space between the fibrous por-
tions of the hernial ring. 3 Exercise Restridions: The foal should be
The only significant advantage of the open rested in a stall or small paddock for at least 4
technique is the ability to assess the contents of weeks prior to returning to unrestricted pasture
the hernial sac. The disadvantages of the open turnout or turnout with other foals. The incision
line should be palpated and examined for ade-
technique are the slightly increased risk of post- quate healing before unrestricted exercise is
operative evisceration, abdominal adhesions, and
allowed.
Medications: If the procedure is uncomplicated,
only preoperative antibiotics and anti-inflammatory
agents are indicated. Tetanus prophylaxis should
be current.
Suture Removal: Nonabsorbable sutures should
be removed in 10 to 14 days.
·' " ,, .
'
Palpable border \
of defect in linea alba r\
EXPECTED OUTCOME
..
•
If the margins of the body wall defect are carefully
identified during surgery and adequate tissue
bites are obtained using strong nonreactive suture
material, closed and open hernia repairs have a
high success rate. Mild periincisional edema is
common during the first postoperative week.
COMPLCATIONS
I
. '
-;! . ..
Reported complication rates for either surgical
hernia repair or the clamp technique have been
A
reported to be between 7°/o and 19°/o.4'5 Seroma
Figure 45-5 A, Careful palpation of the hernial ring formation is probably the most common compli-
will identify a thinned triangular area on the cranial and
caudal borders of the ring with the fibrous portions of cation associated with both surgical techniques
the linea alba in a fusiform shape. B, The tissue within and generally occurs as a result of inadequate
this triangular area (black arrow) may be removed along closure of subcutaneous dead space. Hematomas
with the fibrous tissue forming the base of the triangle may also occur if inadequate hemostasis occurred
(white arrow), in an open herniorrhaphy. Dotted line during surgery. Generally, hematomas and
indicates the line of incision. seromas regress on their own and require no
