A surgical approach to the lateral compartment of the equine guttural pouch in the standing horse: modification of the forgotten “Garm technique”.

The research presented in this article explores a modified surgical technique known as Garm’s technique (MGT) for cleansing and draining the lateral compartment (LC) of the horse’s guttural pouch (GP). The researchers found the technique to be useful and generally safe in a small sample of horses, offering potential benefits to those with mild GP infections.

Introduction

• The guttural pouch (GP) in horses is a unique anatomical feature. The GP are two large, air-filled sacs located in the horse’s head. On occasion, these sacs can get infected, leading to guttural pouch empyema.
• Traditional treatment of this condition often involves manually rinsing the GP with large volumes of fluid, which is a process known as lavage, followed by draining of the fluid.
• The “Garm technique” is a less commonly used surgical approach aimed to facilitate greater drainage of the GP. In this study, the researchers evaluated a modification of this technique, which they named the modified Garm’s technique (MGT).

Methodology

• The study was divided into two parts: an examination of cadaver heads (ex vivo study) and a trial in live horses (in vivo study).
• In the ex vivo study, the researchers used six cadaver heads to assess the anatomical boundaries of the surgical technique and to ascertain whether any vital structures might be negatively affected.
• The in vivo study involved placing a drainage tube into each LC of four standing horses using the MGT. The tube was left in place for three days to enable lavage and drainage.

Findings

• In both the ex vivo and in vivo studies, the MGT provided both direct and indirect access to the GP compartments, thereby facilitating the lavage and drainage process.
• The technique provided a point of entrance located rostroventrally (toward the mouth and belly), allowing for thorough drainage of the LC. There were no visible instances of iatrogenic damage, meaning harm caused by the medical intervention itself.
• In the in vivo study, the technique allowed for successful lavage of the entire GP in three healthy horses and one with mild GP empyema.
• The major complication encountered included the development of emphysema in the lateral wall of the LC in one horse, leading to a collapse of the mucous membrane. Secondary wound healing after the procedure took between 12 and 14 days.

Conclusion

• In conclusion, the modified Garm’s technique shows promise as a surgical approach for the lavage and drainage of the GP in standing horses. It might particularly benefit horses with mild guttural pouch empyema.
• The researchers assert that the MGT can be performed safely, but further research should be conducted to confirm its efficiency and safety on a larger sample of horses.