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Foramen epiploicum mesh closure (FEMC) through a ventral midline laparotomy
T van Bergen1, A Rötting2, P Wiemer1,3
1Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Background:
Preventive laparoscopic closure of the epiploic foramen (EF) has previously been described, but methods for EF closure during laparotomy for treatment of colic are lacking.
Objectives:
To describe the foramen epiploicum mesh closure (FEMC) technique through a ventral midline laparotomy in horses under general anaesthesia and its outcome.
Study Design:
Terminal surgical experiment and in vivo study.
Methods:
In a pilot study, a standard ventral midline laparotomy was performed under general anaesthesia in 10 experimental horses and a three-dimensional expandable diabolo-shaped mesh construct was manually introduced through the EF into the omental vestibule. The laparotomy incision was routinely closed after which the horses were subjected to euthanasia. Subsequently, the cadavers were extensively manipulated and finally mesh position was verified during necropsy. Thereafter, a ventral midline laparotomy, with simulation of abdominal manipulations during colic surgery was performed on six experimental horses. A three-dimensional expandable diabolo-shaped mesh with a radiological marker was introduced as in the pilot study. Clinical and laboratory parameters were recorded during the post-operative period. Four weeks after the intervention, abdominal radiography and laparoscopy were performed in all six horses.
Results:
Insertion of all 16 diabolo-shaped mesh constructs during laparotomy was uneventful. The 10 mesh constructs of the pilot study were positioned correctly at necropsy. No post-operative clinical or laboratory parameter alterations were noticed in the other six horses, apart from a transient leucocytosis and an increase in serum amyloid A. Abdominal radiography at 4 weeks revealed consistent positioning of the mesh marker. Laparoscopy confirmed that all six EFs were closed, without intestinal adhesions.
Main Limitations:
Mesh insertion in clinical cases and during clean contaminated surgery was not investigated.
Conclusion:
The FEMC technique via laparotomy provides a fast, simple and reliable procedure to obliterate the EF and may be useful during EFE surgery to prevent recurrence of the disease, avoiding a subsequent laparoscopic procedure.
Insights
This study introduces a new mesh technique for closing the epiploic foramen (EF) during colic surgery in horses. The foramen epiploicum mesh closure (FEMC) technique is fast, simple, and effective in obliterating the EF.
Area of Science:
- Veterinary Surgery
- Equine Surgery
- Surgical Innovation
Background:
- Laparoscopic closure of the epiploic foramen (EF) is established.
- Methods for EF closure during laparotomy for colic treatment are lacking.
Purpose of the Study:
- To describe the foramen epiploicum mesh closure (FEMC) technique.
- To evaluate its outcome in horses undergoing laparotomy.
Main Methods:
- A pilot study involved introducing a mesh construct into the EF via laparotomy in 10 horses, followed by euthanasia and necropsy.
- A subsequent in vivo study used the FEMC technique in 6 horses, with clinical monitoring and imaging (radiography, laparoscopy) at 4 weeks.
Main Results:
- Mesh insertion was uneventful in all 16 horses.
- Correct mesh positioning was confirmed in the pilot study.
- No significant post-operative alterations were noted in the in vivo study, with consistent mesh positioning and successful EF obliteration without adhesions at 4 weeks.
Conclusions:
- The foramen epiploicum mesh closure (FEMC) technique is a fast, simple, and reliable method.
- It may prevent recurrence of epiploic foramen entrapment (EFE) by closing the EF during colic surgery.
- This avoids the need for a separate laparoscopic procedure.
