Surgical technique and short-term outcome for experimental laparoscopic closure of the epiploic foramen in 6 horses.

OBJECTIVE: To describe a laparoscopic technique for, and short-term outcome after, closure of the epiploic foramen (EF) in horses. STUDY DESIGN: Descriptive, experimental study. ANIMALS: Healthy, adult horses (n = 6). METHODS: Laparoscopic portals to approach the EF were identified in standing horses. Under laparoscopic observation, the gastropancreatic fold and right lobe of the pancreas were grasped with Babcock forceps and secured to the caudate hepatic lobe using helical titanium coils to obliterate the EF. Surgical procedure time and intra- and postoperative complications were recorded. Serial analysis of select serum enzymes was used as an indication of involvement of the pancreas and liver. Closure was reevaluated at 4 weeks using repeat laparoscopy, and necropsy was performed immediately after. RESULTS: At initial surgery, EF closure was successful in all 6 horses; median surgical time was 40.5 minutes (range, 22-110 minutes). Serum gamma-glutamyl transferase (GGT) and sorbitol dehydrogenase (SDH) were not significantly altered by the surgical procedure; however, aspartate aminotransferase (AST) and amylase (AMY) were transiently increased. At repeat laparoscopic reevaluation, closure was complete in 5 horses, with partial closure of the EF observed in 1 horse. No complications related to the procedure were noted during or after surgery in any horse. CONCLUSIONS: EF closure in the standing horse can be accomplished without complications to the surrounding organs and vessels.

Evaluation of gastric pressures as an indirect method for measurement of intraabdominal pressures in the horse.

OBJECTIVE: To develop an indirect method for measurement of intraabdominal pressures in the standing horse using measurement of gastric pressures as a less invasive technique, and to compare this method with direct intraabdominal pressures obtained from the peritoneal cavity. DESIGN: Prospective, experimental study. SETTING: University-based equine research facility. ANIMALS: Ten healthy adult horses, 7 geldings and 3 mares. INTERVENTIONS: Gastric pressures were measured using a nasogastric tube with a U-tube manometry technique, while intraperitoneal pressures were measured with a peritoneal cannula. Measurements of intraabdominal pressure were obtained by both methods, simultaneously, and were evaluated using 5 increasing volumes of fluid infused into the stomach (0, 400, 1,000, 2,000, and 3,000 mL). Bias and agreement between the 2 methods were determined using Bland-Altman analysis and Lin's concordance correlation coefficients. MEASUREMENTS AND MAIN RESULTS: Mean gastric pressure was 14.44 ± 4.69 cm H(2)O and ranged from 0 to 25.8 cm H(2)O. Intraperitoneal pressure measurements were generally subatmospheric, and ranged from -6.6 to 3.1 cm H(2) O (mean ± SD, -1.59 ± 2.09 cm H(2)O). Measurements of intraperitoneal pressures were repeatable; however, intra- and interindividual variance was significantly larger for measurements of gastric pressures. The mean and relative bias for comparison between the 2 techniques was 15.9 ± 5.3 cm H(2)O and 244.3 ± 199.2%, respectively. The Lin's concordance correlation coefficient between gastric and intraperitoneal pressures was -0.003 but this was not statistically significant (P=0.75). CONCLUSIONS: There was no statistical concordance between measurements of intraabdominal pressure using gastric and intraperitoneal pressure measurement, indicating that gastric pressures cannot be substituted for intraperitoneal pressure measurement. Direct measurement of intraperitoneal pressures may be a more consistent method for comparison of intraabdominal pressures between horses, due to less variability within and between individuals.