Body Wall Hernias - Equine

Body Wall Hernias

• A protrusion of an organ or tissue through the wall of the cavity normally containing that organ
• Internal hernias involve incarceration through a rent in the mesentery
• External Hernias are visible

Congenital vs Acquired

• Some hernias are present at birth, while others develop later in life

True vs False Hernia

• There are differences between true and false hernias

Anatomy of a Hernia

• Ring is the opening in the body wall through which the hernia protrudes
• The sack is the pouch of peritoneum that lines the hernia
• Contents are the organs or tissues that protrude through the hernia

Umbilical Hernias in Foals

• Incarceration of the bowel is rare
• Small hernias often spontaneously resolve
• Hernias that are 2 fingers or smaller frequently resolve on their own
• Hernias that are 3 fingers or larger seldom resolve on their own
• If a hernia is unchanged after 2-3 months, spontaneous resolution is unlikely
• Surgery should be postponed until the foal is more than 2 months of age

Hernia Clamp

• A hernia clamp is acceptable for hernias that are less than 3 fingers in size
• Bolt cutters can be used to cut the screws on the clamp

Traditional Umbilical Hernia Repair

• Closed and open techniques exit

Open vs. Closed Herniorrhaphy

• Closed: Safer, Less chance for contamination, Bowel out of surgical field, More likely to perforate bowel
• Open: Able to see needle placement, Less likely to perforate bowel, Bowel in the way

Overlapping vs. Appositional

• Appositional techniques of repair are preferred over overlapping

Suture Material

• Braided absorbable sutures like Vicryl, or monofilament absorbable sutures like PDS or Monocryl in size 1 or 2

Aftercare

• Aftercare involves confinement for 30 days, treatment with phenylbutazone, providing a tetanus toxoid booster, and suture removal

Traumatic Hernias

• Traumatic hernias usually occur from kicks or other blunt trauma
• Not evident until resolution of the edema
• Using CM hernia belt is a good option if possible
• Wait around 4 months before repair should be attempted

Polypropylene Mesh

• This can be used in hernia repairs

Inguinal Hernia / Scrotal Hernia

• Inguinal hernia has several different presentations

Presentation of Inguinal Hernias

• Congenital hernias are non-strangulating and found in foals
• Vaginal tunic can rupture and become strangulating
• Acquired hernias are strangulating and found in older intact males
• Standardbreds and draft breeds are predisposed because of a large deep inguinal ring
• These are considered "indirect" hernias

Inguinal Hernia

• Can be unilateral or bilateral
• Is heritable
• Most spontaneously resolve before 2 months of age
• Multiple daily manual reduction can be attempted
• If decreasing in size, it is likely to be successful
• If increasing in size, it is unlikely to resolve
• It is an emergency if non-reducible or colicky

Congenital Hernia Treatment options

• Conservative management is an option
• Unilateral or bilateral closed castration with Leaving the tunic intact and closed
• Purse-string closure of the vaginal tunic should be considered while preserving the testicle, but is not advocated because it is heritable
• Laparoscopic closure of deep inguinal ring with multiple techniques

Techniques to Preserve Testicle

• Laparoscopic mesh or flap technique of the deep inguinal ring
• The ability to reduce the hernia without surgery is needed so that definitive repair can be performed on an elective basis

Peritoneal Flap over Deep Inguinal Ring

• A peritoneal flap can be created and sutured over the deep inguinal ring

Direct Suturing

• Direct suturing of the vaginal ring using barbed suture is the procedure

Super Glue

• The vaginal ring can be glued via laparoscope

Treatment Options for Acquired Hernias

• Immediate repair may be required
• Manual reduction is possible
• Castration is a treatment option
• Laparotomy with resection and anastomosis
• Manual reduction and Laparoscopic closure of the deep inguinal ring