Foramen epiploicum mesh closure (FEMC) through a ventral midline laparotomy.

The research explored a new technique called Foramen Epiploicum Mesh Closure (FEMC) performed through a ventral midline laparotomy, which aims to prevent recurrence of abdominal diseases in horses. This method was described as fast, reliable, and potentially beneficial during surgery to help avoid subsequent laparoscopic procedures.

Introduction and Objective

• The research focuses on introducing a technique called Foramen Epiploicum Mesh Closure (FEMC) for horses. The main objective of the study was to describe the FEMC technique and its outcome when performed through a ventral midline laparotomy under general anaesthesia. Previously, preventive laparoscopic closure of the epiploic foramen (EF) has been discussed, however, methods for EF closure during laparotomy for treatment of colic in horses are limited.

Methodology

• The study implemented a terminal surgical experiment and in vivo study where a standard ventral midline laparotomy was performed on 10 experimental horses under general anesthesia.
• A three-dimensional expandable diabolo-shaped mesh was manually introduced into the omental vestibule through the EF. After the introduction of the mesh, the incision was closed routinely and the horses were euthanized.
• The cadavers were then manipulated extensively and the positioning of the mesh was verified during necropsy.
• The study was then performed on six experimental horses, but this time with simulated abdominal manipulations during colic surgery. Clinical conditions and laboratory parameters were recorded after the operation.
• All six horses underwent abdominal radiography and laparoscopy four weeks after the intervention to examine the effects and assess the positioning of the mesh.

Results

• All 16 diabolo-shaped mesh constructs were inserted successfully during laparotomy. The 10 mesh constructs of the pilot study were all positioned correctly at necropsy.
• No post-operative clinical or laboratory alterations were seen in the other six horses, apart from a slight leucocytosis and a rise in serum amyloid A.
• Consistent positioning of the mesh marker was shown in the four-week abdominal radiography. Furthermore, laparoscopy confirmed that all six EFs were closed without intestinal adhesions.

Conclusion

• The FEMC technique via laparotomy has been shown to be a fast, simple, and reliable procedure to obliterate the EF. However, its use in clinical cases and during clean contaminated surgery was not investigated in this study.
• The technique may be helpful during EFE surgery to prevent recurrence of the disease and to possibly avoid a subsequent laparoscopic procedure.