Incisional infections associated with ventral midline celiotomy in horses

Abstract

Objective To review the veterinary literature regarding healing and complications associated with equine celiotomy including anatomy and physiology, risk factors for incisional infection and hernia, and treatment. Etiology Celiotomy is the most common approach to treat horses with surgical colic. Incision through the linea alba provides exposure to most of the abdomen for exploration, exteriorization, and correction of surgical lesions. Incisional apposition relies on suture strength during anesthetic recovery and for the first 30 days postoperatively. Factors associated with the patient, surgical lesion and procedures, anesthesia, and recovery put the horse at risk for surgical site infection. Infection is the most important risk factor for incisional hernia formation. Diagnosis A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage. Definitive diagnosis is based on positive bacteriologic culture of the incisional discharge. Incisional hernia is diagnosed by palpation of the incision, usually 30–60 days after surgery. Ultrasound of the incision may aide in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent. Therapy No objective data exist to assess the efficacy of specific therapies for surgical site infections following celiotomy. Principles of treatment include the establishment of drainage, bandaging, antimicrobial therapy based on culture and sensitivity, and extended rest in an attempt to avoid incisional hernia or dehiscence. Treatment for incisional hernia includes prolonged circumferential bandaging, open or minimally invasive hernia repair, or no treatment. Prognosis Incisional complications are associated with prolonged convalescence and diminished prognosis for return to athleticism. Limiting risk factors for surgical site infections, prompt treatment, and incisional support may optimize celiotomy healing and timely return to function. Horses compete in many disciplines with incisional hernias.

Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature

“…Avoiding complications [9] (4) Recovery of horses from anesthesia [10] Postanaesthetic myopathy (5) Equine postanesthetic myopathy-An update [16] Pulmonary function GA (6) Pulmonary function in the horse during anaesthesia: A review [17] Upper airway during recovery (7) Post-anaesthetic pulmonary oedema in horses: A review [7] (8) Mitigating the risk of airway obstruction during recovery from anaesthesia: The way is far from clear [18] Complications during GA (9) Complications in equine anesthesia [19] (10) Equine anaesthesia-associated mortality: where are we now? [2] (11) Anaesthesia-related complications in horses-results of the last few years [20] (12) Editorial: Anesthetic risk and complications in veterinary medicine [21] (13) Mortality and morbidity in equine anaesthesia [22] Complications during GA in the clinically ill horse (14) Anesthesia in horses with colic syndrome: Analysis of 48 cases and literature review [23] (15) Anesthesia of the critically ill equine patient [24] (16) Incisional infections associated with ventral midline celiotomy in horses [25] Complications during GA in orthopaedics (17) Anesthetic management and recovery of large orthopedic patients [26] (18) Fracture fixation in horses: Recent developments in implants, management and recovery-A rewiew [27] (19) Bog spavin: Recognising the problem is the first step towards recovery [28] Complications during GA in late-term mares (20) Anesthesia and sedation for late-term mares [29] Effects of α 2 -agonists (21) Pre-anesthetic medication in the horse part IV. Sedative-hypnotics and drug mixtures [30] (22) The responses to the use of detomidine (Domosedan) in the horse [31] (23) Use of the alpha-2 agonists xylazine and detomidine in the perianaesthetic period in the horse [32] (24) Is there a place for dexmedetomidine in equine anaesthesia and analgesia?…”

“…Sedative-hypnotics and drug mixtures [30] (22) The responses to the use of detomidine (Domosedan) in the horse [31] (23) Use of the alpha-2 agonists xylazine and detomidine in the perianaesthetic period in the horse [32] (24) Is there a place for dexmedetomidine in equine anaesthesia and analgesia? A systematic review (2005-2017) [33] Effects of other IV drugs (25) Sedation in equine practice-Indications and choice of the methods [34] (26) Clinical insights: Equine anaesthesia and analgesia [35] Effects of NMBAs (27) Neuromuscular blocking agents [36] Table 3. Cont.…”

“…Four reviews focused on specific complications during recovery such as post-anaesthetic myopathy (PAM) [16] and respiratory tract problems [7,17,18]. Eleven publications described the complications of all the phases of general anaesthesia, focussing on the recovery in general [2,[19][20][21][22] and in particular cases such as sick patients [23][24][25], orthopaedics [26][27][28] and pregnant mares [29]. The other 21 narrative reviews/expert opinions focussed on the effects of different drugs in anaesthesia with references to the recovery phase .…”

“…Forty-one publications reported other factors that might influence recovery and seven narrative reviews (Table 3) provided additional information [23][24][25][26][27][28][29].…”

Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies

“…Although rarely life threatening, laparotomy incision morbidities (IMs) are of concern as they increase hospitalisation cost and duration and may prevent return to athletic function 1 2. Numerous studies have investigated preoperative, intraoperative and postoperative techniques that influence the rate of incisional complications and have put forward various protective and risk factors 1–5. Perioperative antibiotic protocol, anaesthesia time, relaparotomy, wound lavage, abdominal bandaging, surgeons experience, subcutaneous suture layers, wound protection and type of suture material used are among the factors most often reported to influence the complication rates 1…”