Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse.

A surgical technique known as hand-assisted laparoscopic surgery (HALS) was successfully used to repair an abdominal defect in a horse suffering from acute abdominal pain. Doctors were unable to fully treat the horse with traditional methods, so they turned to HALS, a less invasive procedure which allowed them to identify and fix the problem. The horse fully recovered, suggesting that HALS could be a useful method for these kinds of surgeries in horses in the future.

Context and Initial Treatment

• A 7-year-old Swiss Warmblood gelding was brought in for examination due to signs of acute abdominal pain. Upon examination, the horse’s abdomen was found to be markedly distended, with decreased gut sounds in all abdominal quadrants. A large and gas-distended part of the intestine was discovered at the pelvic entrance, which prevented further internal examination.
• Due to the severity of the horse’s abdominal pain, an ultrasonographic evaluation could not be safely performed as part of the initial examination.
• First, a ventral midline celiotomy, a surgical procedure where an incision is made along the midline of the abdomen, was performed. During this procedure, a right dorsal displacement of the ascending colon was found and corrected.

Further Complications and the Use of HALS

• Despite the initial surgery, the horse showed progressive signs of abdominal pain, prompting a repeat ventral midline celiotomy. In this procedure, the small intestine was found to be trapped in a large, radial mesojejunal rent (a tear or defect in the connective tissue that holds the small intestine in place).
• The trapped intestine was released, but the defect couldn’t be fully accessed for repair via the celiotomy. There was an attempt to manage the situation conservatively without surgical repair. However, the horse’s colic symptoms returned.
• A less invasive surgical approach, standard laparoscopic surgery, was first attempted in the standing horse, but the small intestine couldn’t be adequately moved, limiting full evaluation of the tear.
• Ultimately, hand-assisted laparoscopic surgery (HALS) was used, allowing for the identification and reduction of the trapped part of the small intestine and the repair of the mesenteric tear. Despite minor complications with the ventral midline incision, the horse made a complete recovery.

Conclusion

• The successful use of the HALS technique in this case suggests that it should be considered for the repair of mesenteric tears in horses. HALS was able to facilitate the identification, evaluation, and repair of a large radial mesenteric tear that couldn’t be fully accessed from a ventral median celiotomy.