Endoscopically assisted transcutaneous placement of a balloon catheter in the medial guttural pouch compartment of the horse: A surgical approach to local treatment.

Overview

• This study evaluates a surgical technique called transcutaneous guttural pouch catheterization (TGPC) in horses, where a balloon catheter is placed endoscopically through the skin into the medial guttural pouch to deliver local treatments.
• The researchers describe the procedure, analyze anatomical considerations, report clinical outcomes, and document complications in horses treated while standing.

Background and Purpose

• The guttural pouch (GP) is a large air-filled sac in horses, which can develop infections such as empyema or fungal disease (mycosis).
• Treating these conditions often requires direct administration of medication or lavage into the GP.
• Traditional approaches may involve invasive surgery or endoscopy, but local, less invasive methods would be advantageous.
• This study investigated an approach where a balloon catheter is placed transcutaneously into the medial compartment of the GP under endoscopic guidance in standing horses.

Methods

• An ex vivo study was conducted involving dissection of one cadaver horse head to determine the anatomical landmarks and tissues the catheter traverses.
• Ten normal horses’ radiographic images were reviewed to understand anatomic variation, particularly regarding the stylohyoid bone.
• A clinical case series included 14 horses diagnosed with guttural pouch empyema or mycosis that underwent TGPC treatment.
• The catheter used was a 20 French balloon catheter inserted into one or both GP compartments through the skin while the horses were standing.
• Data on complications during and after the procedures as well as postoperative healing were collected.

Results

• The anatomical studies confirmed the path of the catheter and key landmarks, with some variations noted in the stylohyoid bone structure.
• TGPC was successfully performed on 13 horses in one GP and one horse in both GPs (total 15 catheter placements).
• The balloon catheter positioned in the parotid region allowed:
  • Administration of oxygen
  • Lavage with therapeutic solutions
  • Facilitation of drainage, both passive and active
• Reported complications included:
  • Skin hemorrhage in 3 out of 15 procedures (21%)
  • Balloon catheter rupture in 1 case (7%)
  • Development of cutaneous salivary fistula in 1 case (7%)
  • Abrasions under the catheter fixation ring in all cases (100%)
  • Catheter dislodgement was rare, occurring in 3 of 500 treatment sessions
• The balloon catheter remained in place for periods ranging from 4 to 17 days.
• After catheter removal, the guttural pouch sealed within 72 hours and skin wounds healed by secondary intention in under 10 days.

Conclusions

• The study demonstrates that transcutaneous insertion of a 20 Fr balloon catheter into the medial guttural pouch is feasible and effective for local treatment of GP diseases in standing horses.
• Minor complications are common, especially skin abrasions, but these do not prevent successful therapy.
• This approach allows continued local treatment and drainage for over two weeks in a minimally invasive manner without general anesthesia.
• Given the outcomes, TGPC offers a practical alternative to more invasive surgical approaches for guttural pouch conditions requiring local management.