Comparison of Mesh and Barbed Suture for Laparoscopic Nephrosplenic Space Ablation in Horses

Abstract

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.

Minimally invasive repair of congenital inguinal hernias in nine foals using an automated laparoscopic suturing device and barbed suture

“…Reports about the use of barbed sutures in equine laparoscopic procedures in clinical cases are not abundant but promising. For example, laparoscopic nephrosplenic space ablation using barbed suture has been successfully employed (Gandini et al, 2017; Gialletti et al, 2021) and was evaluated advantageous over mesh ablation (Gialletti et al, 2021). Corsalini and colleagues used unidirectional barbed suture for laparoscopic uteropexy in three mares (Corsalini et al, 2016).…”

“…In equine surgery, the use of barbed sutures has been investigated ex vivo as well as in clinical cases for different open and laparoscopic applications (Adler et al, 2020;Albanese et al, 2016;Corsalini et al, 2016;Gandini et al, 2017;Gialletti et al, 2021;Giusto, Caramello, et al, 2019;Kamus et al, 2022;Major et al, 2017;Nelson & Hassel, 2014;Ruzickova et al, 2016;Sinovich et al, 2020). Ragle and colleagues first described laparoscopic vaginal ring closure with an automated suturing instrument and barbed suture in an adult gelding with an acquired inguinal hernia (Ragle et al, 2013).…”

“…After their initial introduction in human medicine for cosmetic procedures and cutaneous closure (Murtha et al, 2006; Ruff, 2013), barbed sutures gained wider acceptance in various surgical fields (Lin et al, 2016) and they proved to be especially beneficial for different laparoscopic procedures, including the urogenital (Einarsson et al, 2010; Gardella et al, 2018; Massoud et al, 2013) and gastrointestinal (Tsukada et al, 2016; Velotti et al, 2022) fields. In equine surgery, the use of barbed sutures has been investigated ex vivo as well as in clinical cases for different open and laparoscopic applications (Adler et al, 2020; Albanese et al, 2016; Corsalini et al, 2016; Gandini et al, 2017; Gialletti et al, 2021; Giusto, Caramello, et al, 2019; Kamus et al, 2022; Major et al, 2017; Nelson & Hassel, 2014; Ruzickova et al, 2016; Sinovich et al, 2020). Ragle and colleagues first described laparoscopic vaginal ring closure with an automated suturing instrument and barbed suture in an adult gelding with an acquired inguinal hernia (Ragle et al, 2013).…”

Role of Laparoscopy in Diagnosis and Management of Equine Colic

“…Many different techniques and materials are described to close the space: these include simple suture material, barbed sutures and various implants. 14,16,17 A standard left laparoscopic approach allows for visualization of the nephrosplenic space. A large diameter (25-30 mm) cannula is introduced through the most dorsal left flank portal to allow for direct vision of the nephrosplenic space and to facilitate suturing.…”

“…It is first attached to the renal fascia and then to the splenic capsule using laparoscopic staples or tacking devices. 16,19 Gialletti and colleagues compared the use of mesh and barbed suture for nephrosplenic space ablation and concluded that the suture was faster, more cost-efficient and caused fewer complications. 16 Spagnolo and colleagues described the use of homologous pericardium implants harvested from horses euthanized for orthopedic disease.…”