Mesh hernioplasty for repair of incisional hernias of the ventral body wall in large horses

Early herniorrhaphy of large traumatic abdominal wounds in horses and mules

REASONS FOR PERFORMING STUDY

Surgical treatment of traumatic abdominal hernias is usually delayed for 2-3 months following injury. The residual defects are then repaired by herniorrhaphy or mesh herniorrhaphy.

OBJECTIVE

To describe the outcome following herniorrhaphy (without a mesh) within 21 days of initial injury to repair external traumatic lateral abdominal hernias in horses and mules.

STUDY DESIGN

Descriptive case series.

METHODS

Twenty-two cases were included. Surgical treatment involved exposure of the hernia sac and closing of the abdominal wall defect with interrupted Mayo mattress or cruciate sutures after reduction of the herniated organ into the peritoneal cavity. Data collected included cause and site of the hernia, surgical findings, immediate and long-term post operative complications, return to use, duration of convalescence and hernia recurrence.

RESULTS

Falling while crossing impassable pathways was the most common initial cause of the hernia (9/11 horses and 10/11 mules). Adhesion formation to underlying viscera was found intraoperatively in 2 cases. Uncomplicated healing occurred in all animals except 3 with suture abscesses and one with a subcutaneous seroma. At the time of follow-up (6-24 months after surgery), complete recovery without recurrence of herniation was achieved and animals had returned to their previous use.

CONCLUSION

Herniorrhaphy within 21 days using interrupted Mayo mattress or cruciate pattern sutures can be effective for treating external traumatic abdominal hernias in horses and mules. The Summary is available in Chinese - see Supporting Information.

Use of a novel silk mesh for ventral midline hernioplasty in a mare

Background

Ventral midline hernia formation following abdominal surgery in horses is an uncommon complication; however, it can have serious consequences leading to increased morbidity and mortality. Currently, mesh hernioplasty is the treatment of choice for large ventral midline hernias in horses to allow potential return to normal function. Complications following mesh hernioplasty using polypropylene or polyester mesh in horses can be serious and similar to complications seen in human patients, including persistent incisional drainage, mesh infection, hernia recurrence, intra-abdominal adhesions, mesh or body wall failure, recurrent abdominal pain (colic), and peritonitis. This report describes the use of a novel bioresorbable silk mesh for repair of a large ventral midline incisional hernia in a mature, 600-kg horse. To our knowledge, this is the first report of its kind in the literature.

Case presentation

A 9-year-old, 600-kg Warmblood mare presented with a ventral midline hernia following emergency exploratory celiotomy 20 months prior. The mare was anesthetized and a hernioplasty was performed using a novel bioresorbable silk mesh (SERI^® Surgical Scaffold; Allergan Medical, Boston, MA). No complications were encountered either intra- or postoperatively. The mare was discharged from the hospital at 3 days postoperatively in an abdominal support bandage. At 8 and 20 weeks postoperatively, ultrasonographic assessment showed evidence of tissue ingrowth within and around the mesh. The mare was able to be bred 2 years in a row, carrying both foals to full gestation with no complications. Following both foalings, the abdomen has maintained a normal contour with no evidence of hernia recurrence.

Conclusions

Ventral abdominal hernias can be repaired in horses using a bioresorbable silk mesh, which provides adequate biomechanical strength while allowing for fibrous tissue ingrowth. The use of a bioresorbable silk mesh for the repair of ventral hernias can be considered as a realistic option as it potentially provides significant benefits over traditional non-resorbable mesh.

Comparison of primary closure of incisional hernias in horses with and without the use of prosthetic mesh support

REASONS FOR PERFORMING STUDY

Repair of incisional hernias in horses has been described previously; however, this report describes the outcome of primary closure of incisional hernias in a large number of horses and compares these results with those of mesh implantation.

OBJECTIVE

To report the perioperative care, complications and long-term outcome of primary closure of incisional hernias in horses and to compare these results with a second population of horses in which prosthetic mesh was used.

METHODS

Medical records of horses undergoing an incisional herniorrhaphy between 1998 and 2009 were reviewed. Information obtained included case details, factors from the initial surgery that contributed to the hernia formation, method of hernia repair and outcome. Comparisons between horses with and without mesh were made using logistic regression.

RESULTS

Thirty-eight horses with primary closure and 9 horses with mesh implantation met inclusion criteria. Long-term follow-up for cases in which a mesh was not used was available for 25 cases; of these, 21 horses (84%) had a normal cosmetic appearance and 4 (16%) had a visible defect. There was no significant difference between the 2 repair methods in terms of age, sex, breed, weight, size of the hernia, number of defects, timing of the repair or cosmetic outcome. Horses in which a mesh was used had significantly longer duration of surgery and hospitalisation, and were significantly more likely to develop post operative complications while having a longer duration of convalescence prior to return to use.

CONCLUSIONS

Primary apposition of incisional hernias in horses without the use of mesh support appears to result in a good cosmetic outcome while avoiding the complications associated with mesh implantation in this population of horses.

POTENTIAL RELEVANCE

Surgical time, duration of hospitalisation, and post operative complications may be reduced by using this technique of primary repair and avoiding mesh implantation.

Update on recent advances in equine abdominal surgery

In recent years important advancements in colic surgery have led to improved prediction of survival rates, better survival rates, and decreased complication rates. This article describes several modalities to combat and prevent incisional hernia and intestinal adhesion formation in horses undergoing colic surgery. These modalities have had a positive impact on reducing complications in horses after surgery.