To avoid risks associated with general anesthesia and to reduce surgical trauma, laparoscopic-assisted nephrectomy can be performed in the standing sedated horse using a 2 portal technique and a mini-laparotomy.
This paper describes the clinical findings and treatment of 67 sheep and goats with listeriosis. In 55 of them the diagnosis was made on the basis of the typical signs, which included vestibular ataxia, circling, head tilt and unilateral cranial nerve deficits, but in 12 animals a definitive diagnosis was made only after postmortem examination. The most significant haematological and biochemical findings were a high haematocrit in 16 animals, a high concentration of total protein in 33, a high concentration of bilirubin in 39 and a high concentration of urea nitrogen in 28 animals. Twenty-eight of the animals had a metabolic acidosis. Thirty-nine animals were treated with antibiotics, intravenous sodium chloride and glucose solutions and sodium bicarbonate. Ten of them survived and the others were euthanased because their condition deteriorated. Of the 10 that survived, nine were able to stand when they were first examined and one was in lateral recumbency. Of 15 animals treated with chloramphenicol, one survived; of 11 animals treated with oxytetracycline, two survived; and of nine animals treated with gentamicin and ampicillin, six survived.
Laparoscopic-assisted cystotomy combines the advantages of the parainguinal laparocystotomy with laparoscopic technique for removal of cystic calculi while avoiding their disadvantages.
Zusammenfassung Ziel der Untersuchung war, die Effizienz der transendoskopischen Staphylektomie bei Pferden mit einer Dorsalverlagerung des Gaumensegels (DDSP) darzulegen. Material und Methoden: In der tierärztlichen Klinik für Pferde und Kleintiere Starnberg wurden im Zeitraum von 1998 bis 2002 insgesamt 23 Pferde mit einer habituell bestehenden Dorsalverlagerung des Gaumensegels laserchirurgisch operiert. Mit einem 980-nm-Diodenlaser erfolgte eine transendoskopische Staphylektomie. Ergebnisse: Postoperativ konnte bei 82,6% der Patienten die Dorsalverlagerung nicht mehr ausgelöst werden. Sieben Pferde (30,4%) waren nach der Operation ohne Symptomatik und Leistungsdefizit wieder einsetzbar. Weitere sieben Pferde (30,4%) zeigten nach dem Eingriff eine deutliche Verbesserung der klinischen Symptome. Bei neun Pferden (39,1%) konnte im Vergleich zur präoperativen Symptomatik keine klinische Verbesserung beobachtet werden. Demzufolge verlief die Operation bei 60,9% der Patienten erfolgreich, d. h. es ließ sich ein vollständiger oder befriedigender Therapieerfolg erzielen. Bei den Pferden, die keine Besserung zeigten, lag zusätzlich eine bereits chronische Lungenerkrankung vor. Schlussfolgerung und klinische Relevanz: Die transendoskopische laserchirurgische Operation des DDSP stellt nach heutigem Wissensstand das Therapieverfahren der Wahl dar.
ZusammenfassungIn der Literatur werden für die Nephrektomie beim Pferd neben der konventionellen Technik in Allgemeinanästhesie zwei laparoskopische Operationsmethoden am stehenden Pferd beschrieben. Im Rahmen von experimentellen Arbeiten publizierten Marien (2002) eine laparoskopische und Keoughan et al. (2003) SummaryIn the literature several surgical techniques for nephrectomies in the horse are described. In addition to the conventional surgical methods, two experimental studies about laparoscopic nephrectomies in the standing horse have been published. This study presents the first clinical case of laparoscopic nephrectomy of a patient with nephrolithiasis of the left kidney. A 12 year-old warmblood gelding was referred to the clinic with an exercise related haematuria of 8 weeks duration. Presurgical examinations led to a diagnosis of nephrolithiasis affecting the left kidney. No other clinical abnormalities were detected. For the surgical procedure the horse was restrained in standing stocks and sedated with detomidine hydrochloride (0,01 mg/kg iv) and levomethadone (0,05 mg/kg iv) and the sedation was maintained with romifidine (0,01 mg/kg iv) throughout the procedure. Paravertebral anaesthesia was undertaken and lokal infiltration was performed with 20 ml lidocaine 2% at each surgical site in the left paralumbar fossa. A laparoscopic nephrectomy requires 3 separate portals. The first portal for the optic trocar was placed in the 17th intercostal space at the ventral border of the tuber coxae. The instrument portal was created 2-3 cm caudal to the 18th rib again level with the ventral margin of the tuber coxae. Through this portal, the laparoscopic injection needle was inserted and subperitoneal infiltration of the perirenal peritoneum was performed using 20 ml of local anaesthetic (2% lidocaine). The perirenal peritoneum was then incised at the caudo-ventral aspect of the left kidney with laparoscopic scissors. To allow a handassisted surgical procedure at this point a third portal (as a mini-laparotomy) was created 5 cm caudal to the second one. With the inserted hand the peritoneal incision was bluntly enlarged under visual control so that the kidney could be detached from the retroperitoneal fat to expose the ureter and the renal vein and artery. As the renal vein and artery could not be separeted from each other they were ligated manually and using instruments as a bundle in 4 places and transected. The ureter was sutured in 3 places and transected. The mobilized and because of the nephroliths enlarged kidney was exteriorized through the third portal which had to be extended vertically (21 cm). The three surgical sites were closed in multiple layers, the intra-abdominal retro-peritoneal wound was not sutured. A 10 day course of ceftiofur-sodium (2,2 mg/kg im once daily) and flunixin-meglumine (0,5 mg/kg im twice daily) and 10 ml Phytorenal ® (Selectavet) per os once daily was initiated pre-operatively. One day post surgery the horse`s general demeanour was slightly reduced but improved the next day...
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