Standing Laparoscopic Peritoneal Flap Hernioplasty Technique for Preventing Recurrence of Acquired Strangulating Inguinal Herniation in Stallions

Abstract

To describe a standing laparoscopic peritoneal flap hernioplasty (PFH) technique for closure of the vaginal ring, and to evaluate its effect on prevention of recurrent herniation in stallions, previously treated for acquired strangulating inguinal hernia (SIH). Case series. Stallions (n = 30) aged 3-15 that had previous acquired SIH. Bilateral standing laparoscopic PFH was performed on 30 stallions that had previous acquired SIH treated without castration. The vaginal rings were approached from 3 portals, 2 in the paralumbar fossa and a 3rd between the 17th and 18th ribs on the ipsilateral side. A large inverted U-shaped peritoneal flap was dissected from the abdominal wall proximal and cranial to the vaginal ring, reflected caudally over the vaginal ring, and secured to the abdominal wall with laparoscopic staples. In the first 11 stallions, only the cranial and mid third of the vaginal ring was covered. For the next 19 stallions, complete closure of the vaginal ring including the entire caudal aspect of the vaginal ring was achieved. SIH recurrence occurred in 4 of 11 stallions with incomplete ring closure whereas no SIH recurrence occurred when the entire vaginal ring was closed. No major complications occurred and cosmetic outcome was excellent. All breeding stallions were successfully used for breeding. Standing laparoscopic closure of the vaginal ring using a PFH is an effective way to prevent recurrence of SIH provided the entire vaginal ring, including the caudal aspect is covered by the flap. There seems to be no effect on subsequent fertility.