Ultrasonographic assessment of standing laparotomy wound healing in dairy cows

[Surgery site healing disorder following laparotomy in cattle: a retrospective study]

OBJECTIVES

Wound healing processes in consequence to bovine abdominal surgery performed from 2007 to 2016 at the University of Veterinary Medicine in Vienna were retrospectively assessed. The aim of this study was to evaluate the occurrence of wound healing complications following abdominal surgery in cattle during this 10-year-period as well as to identify possible risk factors such as elevated temperatures.

MATERIAL AND METHODS

Surgical procedures finding inclusion comprised ileus, left and right abomasal displacement, caecal dilation or displacement (right flank laparotomies), foreign body syndrome (left flank laparotomy), and umbilical surgery. Additionally, weather data during the study period were collected in order to investigate the possible association between ambient temperatures and wound healing disorders.

RESULTS

During this period 1365 abdominal surgical procedures were performed. The majority (68.6 %) of the cattle were Simmental cows, followed by 19.6 % Holstein Friesians. Female animals were overrepresented (73.0 %), and 24.0 % of the patients were calves. In 156 cases (11.7 %), a postoperative wound healing disorder (WHD) occurred. The majority of the laparotomies were performed from the right side; of these 21.4 % were left abomasal displacements and 21.7 % ileus surgeries. Left abomasal displacements (24.4 %) and surgery in the umbilical region (21.2 %) were associated with a higher occurrence of WHDs than other abdominal surgical procedures. Animals with right abomasal displacement developing WHDs were significantly younger than those without a WHD. A significant association between WHD frequency and higher temperatures could not be demonstrated. A total of 34.6 % WHD occurred during the summer months (June-September). However, the probability of developing WHDs increased significantly starting at an environmental temperature of 12.5 °C. Most WHD were observed in May (17.1 %) followed by July (15.6 %) and June (15.3 %).

CONCLUSION AND CLINICAL RELEVANCE

The occurrence of WHDs is influenced by numerous different factors such as age of the animal, disease, and type of the surgical procedure. The environmental temperature may increase the risk to develop a WHD but is only one parameter of a multifactorial process.

Clinical characteristics, treatment, and outcome for cattle that developed retroperitoneal abscesses following paralumbar fossa laparotomy: 32 cases (1995-2017)

OBJECTIVE

To describe the clinical and clinicopathologic characteristics, treatment, and outcome for cattle that developed a retroperitoneal abscess (RA) following paralumbar fossa laparotomy (PFL).

ANIMALS

32 Holstein cows with RA.

PROCEDURES

The record database of a veterinary teaching hospital was searched to identify cattle that were treated for an RA between January 1995 and March 2017. Cattle with an RA > 30 cm in diameter located 3.5 cm subjacent to the skin that had undergone a PFL < 3 months before examination for the RA were evaluated. Information extracted from the record of each cow included signalment; physical examination, clinicopathologic, and transabdominal ultrasonographic findings; treatments administered; and outcome. Milk production data were analyzed for the lactations before, during, and after RA treatment.

RESULTS

Common physical examination findings were rumen hypomotility, anorexia, and fever, and common clinicopathologic findings were anemia and neutrophilia. Abdominal palpation per rectum and transabdominal ultrasonography facilitated RA diagnosis and identification of the optimal location for drainage. Thirty of 32 cows underwent surgical drainage of the RA and prolonged administration of systemic antimicrobials. Two cows were euthanized because of concurrent peritonitis, including 1 that underwent surgical RA drainage. Thirty cows were discharged from the hospital alive, and most returned to their previous level of milk production.

CONCLUSIONS AND CLINICAL RELEVANCE

Although uncommon, RA should be suspected in cows that develop anorexia and fever within 3 months after PFL. Cows with RA often returned to their previous level of milk production, but treatment was generally prolonged and costly.

Incisional infections associated with ventral midline celiotomy in horses

OBJECTIVE

To review the veterinary literature regarding healing and complications associated with equine celiotomy including anatomy and physiology, risk factors for incisional infection and hernia, and treatment.

ETIOLOGY

Celiotomy is the most common approach to treat horses with surgical colic. Incision through the linea alba provides exposure to most of the abdomen for exploration, exteriorization, and correction of surgical lesions. Incisional apposition relies on suture strength during anesthetic recovery and for the first 30 days postoperatively. Factors associated with the patient, surgical lesion and procedures, anesthesia, and recovery put the horse at risk for surgical site infection. Infection is the most important risk factor for incisional hernia formation.

DIAGNOSIS

A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage. Definitive diagnosis is based on positive bacteriologic culture of the incisional discharge. Incisional hernia is diagnosed by palpation of the incision, usually 30-60 days after surgery. Ultrasound of the incision may aide in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent.

THERAPY

No objective data exist to assess the efficacy of specific therapies for surgical site infections following celiotomy. Principles of treatment include the establishment of drainage, bandaging, antimicrobial therapy based on culture and sensitivity, and extended rest in an attempt to avoid incisional hernia or dehiscence. Treatment for incisional hernia includes prolonged circumferential bandaging, open or minimally invasive hernia repair, or no treatment.

PROGNOSIS

Incisional complications are associated with prolonged convalescence and diminished prognosis for return to athleticism. Limiting risk factors for surgical site infections, prompt treatment, and incisional support may optimize celiotomy healing and timely return to function. Horses compete in many disciplines with incisional hernias.

Prevention of post operative complications following surgical treatment of equine colic: Current evidence

Changes in management of the surgical colic patient over the last 30 years have resulted in considerable improvement in post operative survival rates. However, post operative complications remain common and these impact negatively on horse welfare, probability of survival, return to previous use and the costs of treatment. Multiple studies have investigated risk factors for post operative complications following surgical management of colic and interventions that might be effective in reducing the likelihood of these occurring. The findings from these studies are frequently contradictory and the evidence for many interventions is lacking or inconclusive. This review discusses the current available evidence and identifies areas where further studies are necessary and factors that should be taken into consideration in study design.