Laparoscopic repair of a traumatic ventral abdominal hernia using a mesh

Ventral herniation in horses is most frequently seen in the form of incisional hernias after colic surgery (Gibson et al. 1989; van der Velden and Klein 1994) and in pregnant mares (Kawcak and Stashak 1995), but may also occur after trauma (Hilbert et al. 1978; Hanson and Todhunter 1986). In the latter category, there may be a perforation of the skin, but after blunt trauma this is most often not the case. The peritoneum may be ruptured, and entrapment of viscera in the hernia can occur. In most cases of ventral herniation there is extensive oedema, making palpation of the traumatised area difficult. Therefore, rectal examination and ultrasonography are frequently necessary to make a definitive diagnosis. Surgical repair is typically undertaken after the oedema has resolved unless visceral incarceration has occurred. Support bandaging of the area may help reduce oedema and support the body wall during this period. The conventional approach is by herniorrhaphy via an open technique. If the defect is too large for closure with sutures alone, mesh herniorrhaphy is necessary. In man, laparoscopic hernia repair has developed into a viable alternative for herniorrhaphy (Reddick 1994; Vargo et al. 1996; Frantzides and Carlson 1997; Franklin et al. 1998; Chowbey et al. 2000; Szymanski et al. 2000; Thoman and Phillips 2002). Patients appear to have less pain and can return to activities more quickly than with conventional surgery. The technique has also been described in the pig, because this animal serves as a model for human surgeons to train in laparoscopic ventral hernia repair (Garcia-Ruiz et al. 1998). In the horse, closure of inguinal hernias using laparoscopy has been described (Fischer et al. 1995; Marien 2001). However, although the diagnostic use of laparoscopic techniques in abdominal trauma has been described previously (Peroni 2002; Rijkenhuizen and van Dijk 2002), no reports of laparoscopic repair of a ventral hernia in the horse have been published so far. This report describes the successful laparoscopic repair of a traumatic ventral hernia in a foal with the use of a polypropylene mesh. Case details