Standing lateral thoracotomy in horses: indications, complications, and outcomes.
Authors: Hilton Hugo, Aleman Monica, Madigan John, Nieto Jorge
Journal: Veterinary surgery : VS
Summary
# Standing Lateral Thoracotomy for Equine Pleural and Pericardial Disease Between 1990 and 2008, 16 standing sedated horses underwent lateral thoracotomy primarily for management of recurrent or chronic pleural infection (94% of cases), with anaerobic bacteria identified in 63% of pleuropneumonia cases. The surgical approach predominantly involved right-sided intercostal access (82%), with some cases requiring intercostal myectomy or rib resection to facilitate adequate drainage and visualisation. Perioperative complications were uncommon—only two horses developed hemipneumothorax—though six developed post-operative thoracotomy site cellulitis or abscessation; crucially, 88% of horses survived to discharge, and nearly half those surviving returned to previous athletic function. The technique's tolerability in standing sedated horses, combined with reasonable long-term outcomes, establishes lateral thoracotomy as a justified surgical intervention for complicated pleuropneumonia when medical management fails. For practitioners managing horses with resistant pleural infections or localised pericardial disease, this procedure merits consideration as a definitive diagnostic and therapeutic approach, though awareness of infection risk at the incision site and realistic expectations regarding performance recovery remain essential when counselling owners.
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Practical Takeaways
- •Standing lateral thoracotomy is a viable surgical option for treating complicated pleuropneumonia in horses with good survival rates and minimal perioperative risk under standing sedation
- •Expect approximately half of surviving horses to return to previous athletic function, so manage owner expectations accordingly regarding recovery and performance potential
- •Monitor thoracotomy sites closely in the post-operative period as infection/abscessation occurred in 43% of cases despite reasonable short-term outcomes
Key Findings
- •Standing lateral thoracotomy was performed successfully in 16 horses with 88% surviving to discharge
- •Recurrent or chronic pleural infection was the indication in 94% of cases, with anaerobic bacteria isolated in 63% of pleuropneumonia cases
- •Perioperative complications were minimal (hemipneumothorax in 2 horses), though short-term complications included thoracotomy site cellulitis and abscessation in 6 horses
- •46% of horses that survived returned to previous level of athletic activity at long-term follow-up (>6 months)