Closure of the Equine Nephrosplenic Space Using a Single LED Powered Trocar via Standing Mini-Laparotomy

Christian Bussy,Kossay Benredouane,Juan Munoz,Diane Petat

doi:10.4236/ojvm.2019.92002

Christian Bussy, Kossay Benredouane + Show 2 more

Open Access

https://doi.org/10.4236/ojvm.2019.92002

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Abstract

Objective: To evaluate a technique using a custom-developed LED powered Single Port Trocar for closure of the nephrosplenic space via a standing mini-laparotomy. Design: Prospective case series. Animals: 60 client-owned horses with a history of nephrosplenic entrapment. Procedures: The nephrosplenic space was closed under direct visualization through a specifically designed LED powered Single Port Trocar in standing sedated horses having experienced recurrence or previous surgical correction of a nephrosplenic entrapment. Obliteration of the space was performed in a cranial to caudal direction in a simple continuous fashion. Time required for suturing the nephrosplenic space, as well as per and post-operative complications were recorded. Clients and referring veterinarians were asked to communicate any complication that occurred after discharge. Results: Surgical time ranged from 23 to 45 min. No complication except for self-limited spleen capsule bleeding occurred during the procedure. Minor wound discharge was noted in 2 cases, and another 2 horses developed post-surgical sweating patches close to the incision. All horses were allowed to progressively resume exercise, starting 1 month post discharge from the hospital. Cosmetic results were considered satisfactory and no recurrence of left dorsal displacement of the colon was reported post-surgery. Conclusions and clinical relevance: A Single Port LED powered Trocar is a technique that allows effective, fast, and safe closure of the nephrosplenic space in the standing horse with minimal instrumentation.

Highlights

Left dorsal displacement of the large colon (LDDLC), or nephrosplenic entrapment, occurs when the ascending colon displaces dorsally in the nephrosplenic space, over its ligament [1] [2] [3], with a reported incidence ranging from 6% to 9% of colic cases [2] [3] [4]
Two horses presented to the clinic for an elective closure of the nephrosplenic space had an undiagnosed nephrosplenic entrapment of the large colon [13]
The horse underwent exploratory laparotomy through the linea alba to break down the adhesions from the nephrosplenic space

Summary

Introduction

Left dorsal displacement of the large colon (LDDLC), or nephrosplenic entrapment, occurs when the ascending (left) colon displaces dorsally in the nephrosplenic space, over its ligament [1] [2] [3], with a reported incidence ranging from 6% to 9% of colic cases [2] [3] [4]. The procedure can be performed through under general anesthesia or standing through a flank incision with resection of the last rib [5] [7] Another standing laparoscopic technique was described by Marien and others with improved visualization and post-operative cosmetic appearance, and less convalescence time and post-operative morbidity [6] [8]-[13]. This procedure, considered a standard, requires specialized equipment and training with a high learning curve for developing proficiency [14], mostly depending on developing specific laparoscopic experience [8]. The purpose of this manuscript is to describe the technique and the equipment developed and used for that technique, and to report on the results of a large number of horses treated with this technique

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