Use of a barbed suture for laparoscopic closure of the internal inguinal rings in a horse.

Abstract

CASE DESCRIPTION: A 4-year-old castrated Arabian horse was evaluated for a history of a right-sided nonstrangulating inguinal hernia that was manually reducable. CLINICAL FINDINGS: Physical examination revealed a right-sided hydrocele and bilateral enlargement of the inguinal rings detectable by both external digital and rectal palpation. TREATMENT AND OUTCOME: Biportal laparoscopic internal inguinal ring closure was performed with a continuous suture line of unidirectional barbed suture applied with a mechanical suturing instrument. The barbed suture contributed to a secure closure with the added benefit of not requiring knots to be tied at either the beginning or end of the suture line. Follow-up physical examination and laparoscopy confirmed healing of the surgical sites and a reduction in size of the inguinal rings. The horse exercised for 20 months following surgery without recurrence of the inguinal hernia. CLINICAL RELEVANCE: In horses, laparoscopic application of unidirectional barbed sutures should be considered among the treatment options for recurrent inguinal herniation. This technique was accomplished with only 2 portals/side, in contrast to the additional 3 to 4 portals that are most commonly required. The use of a barbed suture with a mechanical suturing instrument offered added security to the closure. The difficulties of dual instrument suturing and intracorporeal knot tying were eliminated, dramatically reducing the challenges of performing suture reduction of the internal inguinal ring.