Laparoscopically Assisted Percutaneous Inguinal Ring Closure for Resolution of Inguinal/Scrotal Hernias in Rams: Cadaveric Study and Three Cases Report

The aim of this study is to evaluate a laparoscopically assisted percutaneous suture (LAPS) procedure to treat inguinal hernia (IH) while preserving testicles in rams. An ex vivo experiment with six ram cadavers and a report of three clinical cases are discussed. In cadavers, both internal inguinal rings (IIR) were partially closed by LAPS. Two LAPS methods were tested: (1) using a laparoscopic portal closure device and (2) using a suture loop inserted through needles in each IIR. After each procedure, the closure was laparoscopically evaluated and the number of U- sutures was recorded. The procedure was also performed on three client-owned rams with unilateral non-strangulated IH and the occurrence of re-herniation was followed up. In cadavers, LAPS of the IIRs could be easily and satisfactorily performed with either of the two systems, requiring one to three U-sutures per IIR. No differences were observed between the two surgical procedures. In two clinical cases, the procedure was successfully performed without reoccurrence of herniation or alterations in reproductive behavior in the following 3 and 6 months. In the third case, the hernia was reduced but a retroperitoneal emphysema during laparoscopy prevented hernioplasty and the animal herniated again. In conclusion, LAPS of IIR can be used as a simple and feasible treatment to preserve testicles in rams with IH.

Risk factors for, frequency, and type of complications after temporary tube cystostomy in goats, sheep, and pigs

OBJECTIVE

To describe risk factors for as well as type and frequency of complications, time to occurrence of complications, and mortality after temporary tube cystostomy alone or in combination with other surgical procedures, in goats, sheep, and pigs.

STUDY DESIGN

Retrospective case series.

ANIMALS

One hundred thirteen goats, eight sheep, and six pigs.

METHODS

Medical records of goats, sheep, and pigs that underwent temporary tube cystostomy alone or in combination with urethrotomy at the Veterinary Medicine Teaching Hospital, University of California-Davis from January 1, 2007 to December 31, 2018 were reviewed. Signalment, presurgical and surgical procedures, urolith type and location, and postoperative complications and mortality were analyzed. In goats, logistic regression analysis was performed to determine association between the presence of complications or mortality as well as candidate predictor variables.

RESULTS

Postoperative complications were reported in 54.9% (62/113) of goats, 37.5% (3/8) of sheep, and 50% (3/6) of pigs. The most frequent type of complication was reobstruction. Median (range) time to first complication was 171 days (1-2247) for goats. In sheep and pigs, the range for time to re-presentation for complications was 11 to 37 and 17 to 1182 days, respectively. Proportions of nonsurvivors after tube cystostomy were 48.4% (30/62) goats, 1/8 sheep and 2/6 pigs. No association between examined predictor variables and the occurrence of complications or mortality was detected.

CONCLUSION

The risk of complications and mortality after temporary tube cystostomy was high, especially in goats.

CLINICAL SIGNIFICANCE

Owners should be made aware of the high complication rate after temporary tube cystostomy alone or in combination with other procedures. Investigation of alternative approaches to manage obstructive urolithiasis in goats, sheep, and pigs should be considered.

Use of tube cystostomy in the surgical management of obstructive urolithiasis in a Bactrian camel

CASE DESCRIPTION

A 6-year-old castrated male Bactrian camel was evaluated because of a 14hour history of oliguria and stranguria that progressed to anuria.

CLINICAL FINDINGS

Perineal urethral pulsations and intermittent tail flagging with no accompanying urination were observed. Ultrasonography of the urethra revealed multiple hyperechoic foci with shadowing artifact indicative of calculi present in the penile urethra distal to the sigmoid flexure. Rectal palpation revealed a pulsating hard urethra and intact distended urinary bladder. Further clinical examination was not possible because of challenges associated with handling the camel.

TREATMENT AND OUTCOME

Urethral catheterization through a perineal urethral incision failed to achieve urinary bladder decompression. Tube cystostomy was performed to prevent bladder rupture. Urethrocystography performed 3 days after surgery revealed a urethral rupture at the level of the prepuce. Five weeks after surgery, the camel could urinate a steady stream via the urethrotomy site. Seven weeks after surgery, the cystostomy tube was removed, and the urethrotomy site was modified to provide a permanent urethral opening via perineal urethrostomy. During 6 years of subsequent periodic follow-up by telephone, the owner reported that the camel continued to do well and urinate through the revised opening.

CLINICAL RELEVANCE

To the authors' knowledge, this is the first detailed description of a tube cystostomy in an adult camel with obstructive urolithiasis that includes information on the patient's long-term outcome. This technique was a viable option in the surgical management of obstructive urolithiasis in this camel and may be useful for other large camelids as well.

A pilot study to assess the feasibility of endoscopic placement of a transurethral urinary balloon catheter in male sheep cadavers

Surgery of obstructive urolithiasis in small ruminants is often unsatisfactory due to postoperative development of strictures. The present study aimed to establish an endoscopic technique for the placement of a transurethral urinary catheter into the bladder of rams. This catheter was used as a removable stent-like drainage. The procedure was performed in three sheep rams that were euthanized and placed for surgery in 45° Trendelenburg position. In one ram, cystotomy was performed via right paramedian laparotomy. A 3 mm flexible fiberscope was introduced into the urinary bladder and advanced via urethra to the tip of the penis. Placing a guide wire through the endoscopic working channel into the urethra enabled the retrograde insertion of a transurethral urinary catheter into the bladder. In two rams, retrograde insertion of a fiberscope was performed. Again, a guidewire was used to insert a balloon catheter into the bladder. Paramedian right laparotomy was performed to ascertain the correct position of the balloon. Both techniques, antero- and retrograde endoscopy, were possible and could be successfully performed. Mucous membranes and urinary microliths were easily observed. Repeated advancing of the endoscope or the catheter resulted in marked damage of the mucous membranes. The patency of the urethra may be restored by means of endoscopic placement of a transurethral catheter in male small ruminants. The applicability and clinical outcome of this procedure as well as the effects on stricture formation should be further examined with controlled clinical studies.

Laparoscopic ovariohysterectomy in goats

OBJECTIVE To describe a minimally invasive 3-portal laparoscopic approach for elective ovariohysterectomy and the outcome of that procedure in a population of goats. DESIGN Descriptive clinical study. ANIMALS 16 healthy client-owned goats. PROCEDURES Food but not water was withheld from all goats for 24 hours before the procedure. Goats were anesthetized and positioned in dorsal recumbency. Three laparoscopic portals were created in the caudoventral portion of the abdomen, and the abdomen was insufflated to a maximum pressure of 10 mm Hg. A blunt-tip vessel sealer and divider device was used to transect the left and right mesovarium and mesometrium and uterus, and the resected tissue was removed from the abdomen. After hemostasis was verified, the portals were closed in a routine manner and anesthesia was discontinued. Goats were discharged from the hospital 24 hours after the procedure, and owners were contacted by telephone or email to obtain short- and long-term follow-up information by use of standardized questions. RESULTS All procedures were performed by a surgeon and assistant surgeon. The procedure was not complex and was easily learned. No intraoperative complications were reported, and only 1 goat required rescue analgesia post-operatively. No other postoperative complications were recorded. Median surgery time was 43 minutes (range, 20 to 65 minutes). All owners were satisfied with the outcome of the procedure, and several perceived that the procedure improved goat behavior. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that laparoscopic ovariohysterectomy was a viable alternative for elective sterilization of female goats.

Laparoscopic-assisted urinary bladder marsupialization in a goat that developed recurrent urethral obstruction following perineal urethrostomy

CASE DESCRIPTION

A 5-year-old castrated male Nigerian Dwarf goat with recurrent urethral obstruction after perineal urethrostomy.

CLINICAL FINDINGS

The wether goat was referred for evaluation of a perineal urethrostomy site; perineal urethrostomy had been performed 1.5 years earlier. The site was patent, but a moderate stricture was found just cranial to the perineal urethrostomy site. The goat had obstructed urine flow at the stricture site repeatedly in the previous few months.

TREATMENT AND OUTCOME

Laparoscopically assisted urinary bladder marsupialization was recommended. The procedure was performed with the patient under general anesthesia in dorsal recumbency; food had been withheld for 36 hours prior to anesthesia. Ventral midline and left caudal paramedian portals were made for the laparoscopic camera and instruments. A larger incision in the right caudal paramedian portion of the abdomen was used to create the marsupialization stoma. Laparoscopic observation of anatomic structures within the abdomen was excellent. The goat recovered well from surgery and was discharged the day following surgery. Follow-up examinations were done every few months after surgery, and dermatitis of the abdominal skin secondary to urine scald was the only postoperative complication. At 9 months of follow-up, the goat continued to pass urine through the marsupialization site comfortably.

CLINICAL RELEVANCE

In the goat of this report, laparoscopic urinary bladder marsupialization was a minimally invasive procedure with minimal signs of postoperative pain. The procedure was simple to perform and should be considered as an alternative to marsupialization via laparotomy.

Laparoscopic cystotomy for removal of a large bladder polyp in a juvenile alpaca with polypoid cystitis

OBJECTIVE

To describe a method for laparoscopic cystotomy in an alpaca.

STUDY DESIGN

Case report.

ANIMALS

Female alpaca.

METHODS

An 8-month-old female alpaca was admitted with a 6-week history of straining to urinate and vulvar swelling. Transrectal ultrasound examination revealed a 1.5 x 1.5 x 2 cm polyp within the bladder.

RESULTS

The mass was excised using laparoscopic cystotomy. Leakage from the cystotomy site resolved over 12 days using a Foley catheter. The alpaca was healthy and urinating normally at 9 months after surgery.

CONCLUSION

Minimally invasive surgery by laparoscopic cystotomy can be used to remove large urinary polyps in alpacas.

CLINICAL RELEVANCE

Urinary bladder polyps should be considered as differential diagnosis in alpacas with stranguria.