Long-term assessment of nephrosplenic space closure in horses.

To evaluate outcome after laparoscopic closure of the nephrosplenic space in horses that had previous nephrosplenic entrapment of ascending colon (left dorsal displacement of the left colon; LDDLC). Retrospective study. Horses that had previous LDDLC. Medical records of horses that had LDDLC and subsequent laparoscopic nephrosplenic space closure between 2002 and 2004 were retrieved. Follow-up information was obtained by telephone interview of owners. Preoperative versus postoperative comparisons were: incidence of LDDLC, incidence of colic signs, and incidence of ventral celiotomy. Data were analyzed using a chi2-square test with significance set at P<.05. Ten horses met the inclusion criteria. Mean follow-up was 22 months. No horses had recurrence of LDDLC; however, 3 horses had colic signs subsequently that required surgical intervention. Over the follow-up period there was a significant decrease in the total incidence of colic and ventral celiotomy. Technique modifications included use of different cannula site locations, use of polyglyconate suture material for nephrosplenic space closure, and development of a custom cannula. Laparoscopic nephrosplenic space closure prevented recurrence of LDDLC, and significantly lowered the overall incidence of colic and ventral celiotomy. The custom-designed cannula provided good access to the operative site and no complications were encountered with use of polyglyconate suture material for nephrosplenic space closure. Closure of the nephrosplenic space will prevent LDDLC; however, other surgical lesions can occur.

CASE DESCRIPTION 8 horses (5 geldings and 3 mares) were evaluated for laparoscopic closure of the nephrosplenic space following a history of recurrent left dorsal displacement of the large colon. CLINICAL FINDINGS All horses underwent a physical examination and routine clinicopathologic testing. Transrectal palpation and transabdominal ultrasonography were performed to exclude the presence of organs in the left paralumbar region. TREATMENT AND OUTCOME A left flank laparoscopic approach with the horses standing was used. A continuous suture was placed in a craniocaudal direction between the renal and splenic capsules with unidirectional barbed suture material. This allowed obliteration of the nephrosplenic space without the need for knots to secure the leading and terminal ends of the suture line. In all horses, transrectal palpation was performed 2 months after surgery; at this time, closure of the caudal part of the nephrosplenic space was evident. In 2 horses, follow-up laparoscopy was performed, and complete closure of the nephrosplenic space was confirmed. Telephone follow-up revealed that none of the horses had any signs of recurrent left dorsal displacement of the large colon. CLINICAL RELEVANCE Results suggested that laparoscopic nephrosplenic space closure with unidirectional barbed suture material could be considered as an option for prevention of left dorsal displacement of the large colon in horses. In the horses of this report, barbed suture material allowed secure ablation of the nephrosplenic space and eliminated the need for intracorporeal knot tying.

Simple SummaryThe entrapment of the left large colon in the nephrosplenic space is a common cause of colic in horses but not in miniature horses and pony breeds. Different techniques have been proposed to prevent this problem, such as colopexy, large colon resection or nephrosplenic space (NSS) ablation. The most recent methods involve closing the NSS with a minimally invasive technique with the horse standing. Multiple techniques have been described for laparoscopic NSS ablation, among which are ablation with a barbed suture and ablation with prosthetic mesh. Although these two methods have been proposed as valid and effective, no direct comparison has yet been made between them. In this study, the two techniques are compared in terms of duration of surgery, short- and long-term complications, and costs.Nephrosplenic space (NSS) ablation has been demonstrated to be an effective technique for prevention of left dorsal displacement of the large colon and multiple laparoscopic techniques, among which ablation with mesh or with a barbed suture, have been proposed. Our objective was to compare two laparoscopic techniques for closure of the NSS in twenty-eight horses diagnosed with nephrosplenic entrapment. Medical records of horses that had laparoscopic NSS ablation in two referral centers between 2017–2019 were retrieved. Duration of surgery, complications, and short- and long-term follow-up information were collected and compared. Costs were also calculated and compared. All horses met the inclusion criteria: 9 had NSS ablation with a mesh implant (group M), 19 with barbed suture material (group B). One horse in group B had recurrent colic after discharge. At control laparoscopy after 5 months, the NSS resulted in still not being ablated because of a failure of the suture. In group M, three horses had recurrent colic. One was successfully treated medically, one died of unknown causes and the third required a second laparoscopic suturing at 3–6 months because of failure of the mesh implant. The mean time of surgery and costs were lower in group B compared to group M. The barbed suture technique was faster, more cost-effective and had a lower complication rate than the mesh implant.

To evaluate the outcome in horses treated with a rolling technique or surgically for nephrosplenic entrapment of the large colon (NSE) and to examine the benefit of phenylephrine (PE) HCl on the efficacy of nonsurgical (rolling) management of NSE. Case series. Horses (n = 211) diagnosed with NSE by rectal palpation with or without ultrasonography, or at the time of exploratory celiotomy or necropsy. Medical records (January 1, 2001-September 1, 2008) were collected from horses diagnosed with NSE at 2 referral centers. Records were used to obtain signalment, physical exam findings, laboratory results, ultrasonographic findings, the use of PE HCl, the specific treatment used, and outcome. Rectal findings indicative of NSE were: (1) palpation of large colon within the nephrosplenic space or (2) palpation of colonic bands coursing dorsally toward the nephrosplenic space in association with ultrasonographic findings suggestive of NSE. Rolling was successful in 50 of 87 (58%) horses, 85 horses (98%) survived to discharge. Horses (n = 155) that were treated surgically (42 of which had previously undergone the rolling procedure) had a 94% short-term survival rate. Premedication with PE resulted in no significant difference (P = .91) in resolution of NSE by rolling. Resolution of NSE by rolling was not significantly affected by premedication with PE in the population studied.

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.

The examination of patients suffering from an acute abdomen routinely comprises both clinical and rectal examinations, and is ever more frequently accompanied by an ultrasonographic abdominal examination. The aim of the study was to compare the findings as defined through rectal examination with the results of the ultrasonographic examination for different forms of colic. In a retrospective study, the patient records of the Large Animal Clinic of the University of Leipzig from 2012 and 2013 were analysed, and those of horses suffering from colic were included. Diagnoses made through rectal and ultrasonographic examination were grouped and compared with the diagnoses made during colic surgery or pathologic examination, which served as the gold standard. Horses that underwent conservative treatment had a definitive diagnosis assigned only in cases where a pathognostic rectal finding defined the diagnosis. Based on these data, sensitivity, specificity and positive and negative predictive values were calculated for both techniques. Ultrasonography was more sensitive than rectal examination in cases of small intestinal occlusion (97.1% vs. 50.7%), torsion of the large colon in the long axis (63.2% vs. 26.3%) and dislocation of the large colon into the nephrosplenic space (90.9% vs. 72.7%). Rectal examination was more sensitive than ultrasonographic examination in cases of other types of dislocation of the large colon (96.5% vs. 8.8%) and of constipations of the large colon (93.6% vs. 29.8%). In cases of severe diseases, including small intestinal occlusions and torsions of the large colon, ultrasonography helps to better identify and more precisely diagnose conditions that in most cases require abdominal surgery than rectal examination. Therefore, under hospital conditions, it is highly advisable to include ultrasonography in the routine examination of the equine acute abdomen. However, this technique does not replace the traditional rectal examination, which is superior in the diagnosis of dislocations and constipations of the large colon as well as diseases of the caecum.

Nephrosplenic space entrapment (NSE) has reported recurrence rates of 8%‒23%, and closure of the nephrosplenic space (NSS) has been shown to lower the incidence. Described techniques for nephrosplenic space closure (NSC) with concurrent left dorsal displacement (LDD) of the colon at the time of surgery consist of reducing the displaced colon prior to closure. A retrospective study was performed to evaluate the medical records of horse undergoing NSC between 2017 and 2024. A total of 18 horses with LDD at time of NSC and 21 without displacement at time of NSC were evaluated. Short- and long-term outcomes were compared. Surgical time was similar for both groups. No significant association was found between LDD at time of surgery and the presence of signs of colic after the surgery. A statistically significant decrease in number of colic episodes after surgery was seen in both groups, and none of the horses were represented with an NSE again. Retrospective study design and the associated potential for bias. Full-laparoscopic closure of the NSS with a left dorsally displaced colon, and without prior repositioning of the colon, in subacute or chronic cases, is technically feasible, and safe and does not increase the total surgical time.

To describe surgical technique and outcome after laparoscopic closure of the nephrosplenic space for treatment of recurrent left dorsal displacement of the left colon (LDDLC) in standing horses. Retrospective study. Forty-four horses with LDDLC. Laparoscopic portals were located in the left flank region. After administration of etilefrin intravenously to contract the spleen, the dorsal splenic margin was sutured to the nephrosplenic ligament to obliterate the nephrosplenic space. Horses were re-examined (< or = 3 years) for history of recurrence. In addition, medical records of 4,852 horses treated for colic over 16 years were evaluated to establish incidence of LDDLC and recurrence after treatment. Splenic contraction facilitated suture placement and closure of the nephrosplenic space was achieved without complications. LDDLC recurrence did not occur although 5 horses had subsequent episodes of colic; 4 horses had displacement of the ascending colon between the spleen and body wall. Review of medical records revealed an incidence of LDDLC of 6% and recurrence of 21% in a population of horses with signs of colic. Laparoscopic closure of the nephrosplenic space, facilitated by etilefrin-induced splenic contraction can be efficiently performed in standing horses. Laparoscopic ablation of the nephrosplenic space should be considered in horses that are predisposed to recurrent LDDLC.

To evaluate use of a knotless suture for laparoscopic closure of the equine nephrosplenic space. Experimental in vivo study. Normal horses without previous history of abdominal surgery (n=8). The nephrosplenic space was closed under laparoscopic visualization using a unidirectional, barbed 0 metric absorbable suture (copolymer of glycolic acid and trimethylene carbonate). Intracorporeal suturing of the nephrosplenic space was performed in a cranial-to-caudal direction in a simple continuous fashion. Repeat evaluation was performed laparoscopically in 2 horses and by necropsy in 6 horses. The length of closure was measured and nature of the healed tissue was evaluate grossly. Total surgery time was 65-167 minutes (mean ± SD, 89.6 ± 22.6). Suturing time was 30-65 minutes (40.4 ± 16.3). Second laparoscopy in 2 horses was performed at days 198 and 227. Necropsy was performed at day 69-229 postoperatively (132.7 ± 63.0) in 6 horses. The closure measured 12-14 cm in length (13 ± 1) and consisted of mature fibrous tissue bridging the splenic capsule and the nephrosplenic ligament. No residual suture material was identified grossly in any horses. The procedure was easily performed; extracorporeal suture management to hold it taut was unnecessary since the barbs had excellent purchase in the apposed tissues, and intracorporeal knot tying was not required. The barbed knotless suture appears to be a valid alternative to facilitate laparoscopic closure of the nephrosplenic space in normal horses; however, further work is necessary to investigate its suitability in clinically affected horses.

To report a standing hand-assisted laparoscopic technique for closure of the nephrosplenic space (NS), and short-term outcome in horses. Case series. Horses (n = 12) aged 5-14 years. Medical records (2007-2010) of horses treated for left dorsal displacement of the large colon (LDDLC) using a hand-assisted laparoscopic correction technique with closure of the NS in the same surgical procedure were reviewed. A modified grid laparotomy in the left paralumbar fossa was used with manual correction of LDDLC, after which the NS was closed with a laparoscopic technique. Follow up was obtained by telephone interview of owners or referring veterinarians. Resolution of LDDLC and closure of the NS was successful, with only minor postoperative complications, in all horses. On short-term follow-up (>10 months; mean, 23.8 months), 2 horses had displacement of the large colon between the spleen and the body wall. Standing hand-assisted laparoscopic correction of LDDLC and closure of the NS in a single surgical procedure is feasible. Appropriate case selection is mandatory when performing this combined technique.

BackgroundNephrosplenic space closure is commonly used to reduce relapse of nephrosplenic space entrapment in cases of left dorsal displacement of the left colon (LDDLC). Nevertheless, studies documenting the effectiveness of...

Ultrasonography of the abdomen in the horse with colic

Torsion and displacement of the large colon

Left dorsal displacement of the large colon (LDDLC) is a common cause of colic in horses and it is frequently associated with recurrent episodes, with significant implications for horse management, athletic performance, and owner satisfaction. Laparoscopic nephrosplenic space (NSS) ablation is a preventive surgical technique aimed at reducing recurrence in horses with a history of medically or surgically treated LDDLC. This retrospective study evaluated 48 horses that underwent laparoscopic NSS ablation in two Italian Veterinary Teaching Hospitals between 2016 and 2024. Short-term outcomes, including immediate postoperative complications and discharge status, were assessed. Long-term follow-up data were collected via owner questionnaires, focusing on survival, recurrence of colic, post-surgical complications, return to athletic or breeding activity, and owner satisfaction. Most horses were discharged without complications (91.7%), while postoperative colic occurred in 8.3%. Kaplan-Meier estimated one-year post-discharge survival was 83.3%, and 81.3% of horses were alive at last follow-up (range 0.7 months to 8.8 years). Post-discharge complications were reported in 31.2% of horses, most commonly recurrent LDDLC. Return to preoperative athletic or breeding activity was reported in 70.8% of cases, and owner satisfaction was high (83.3%). Time-to-event analysis indicated markedly reduced survival in horses requiring laparotomy during follow-up. Bayesian logistic models suggested lower mortality and fewer post-discharge complications in horses with prior colic surgery, whereas a history of recurrent colic and laparotomy during follow-up was associated with higher mortality and complications. These results indicate that laparoscopic NSS ablation is an effective and safe procedure for long-term management of horses at risk of LDDLC, allowing a high rate of survival, functional recovery, and owner satisfaction, despite the persistence of occasional colic episodes.

Manual and ultrasonic evaluation of the the reproductive organs of 62 dairy cows and heifers belonging to smallholder farms was conducted. The objective was to assess the efficiency of visual estrus detection method in the dairy animals that were presented for artificial insemination. Data were collected on reproductive status, body condition, estrus signs, and findings of rectal examination. Thirty-three animals were inseminated after ultrasonic evaluation while 29 animals were inseminated after manual evaluation through rectal palpation. Pregnancy diagnosis was performed using ultrasound 30 days post insemination. The most frequently observed estrus signs by the dairy owners were mucus discharge (83.9%) and mounting (67.7%) while the most frequently confirmed physical signs of estrus by rectal examination were cervical opening (88.7%), and uterine turgidity (82.3%). The overall mean (±SD) diameter of the largest follicle was 12.9 ± 3.4 mm with an average number of 3.5 follicles per ovary. The overall pregnancy rate was 29%. Evaluation of post-insemination records showed a significant difference (P < 0.05) in the diameter of largest follicle between the pregnant (14.7 mm) and non-pregnant (12.1 mm) animals. The mean (±SD) time interval between the first observed estrus sign to service were 10.5 ± 7.0 hrs and 14.5 ± 10.0 hrs for pregnant and non-pregnant, respectively. The low pregnancy rate, delayed time of insemination, and the difference in the size of dominant follicle indicate the incompatibility between visual estrus detection and optimal time of insemination. This confirms the significance of improving estrus detection and the need for combining estrus signs with pre-service evaluation of the reproductive organs either manually or using ultrasound.