Endoscopically assisted transcutaneous placement of a balloon catheter in the medial guttural pouch compartment of the horse: A surgical approach to local treatment.
Authors: Lepage Héloïse, de Chaisemartin Charles, Spadaro Rosselo Antonella, Leroy Hélène, Lepage Olivier
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Guttural pouch infections (empyema and mycosis) present a significant therapeutic challenge in equine practice, and traditional endoscopic approaches have limitations for sustained local medication delivery. Researchers developed and evaluated a minimally invasive technique using endoscopic guidance to place a balloon catheter transcutaneously into the medial guttural pouch compartment whilst horses remained standing, based on anatomical mapping from cadaveric dissection and radiographic studies of 10 normal horses. All 14 clinical cases (15 procedures) achieved successful catheter placement, enabling direct oxygen insufflation, therapeutic lavage, and passive or active drainage for 4–17 days, with complete guttural pouch resealing occurring within 72 hours of catheter removal. Whilst complications were common—skin haemorrhage (21%), cutaneous salivary fistula (7%), catheter balloon rupture (7%), and skin abrasions at the fixation site (100%)—they were predominantly minor and self-limiting, with full healing in under 10 days. For practitioners managing refractory guttural pouch disease, this technique offers a practical alternative to repeated endoscopic procedures or surgery under general anaesthesia, though the high rate of local irritation necessitates careful fixation protocols and regular monitoring during the treatment period.
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Practical Takeaways
- •TGPC offers a standing surgical alternative to traditional guttural pouch treatment, enabling prolonged local therapy (up to 17 days) without general anesthesia
- •Expect minor complications as routine (skin bleeding, fixation ring abrasions) but these do not compromise outcome; plan for appropriate wound care management
- •This technique allows effective oxygen insufflation and repeated lavage for empyema/mycosis cases, with predictable rapid healing post-catheter removal
Key Findings
- •Transcutaneous guttural pouch catheterization (TGPC) was successful in all 14 treated horses (15 guttural pouches catheterized)
- •Minor complications occurred frequently: skin hemorrhage in 21% (3/15), catheter balloon rupture in 7% (1/15), cutaneous salivary fistula in 7% (1/15), and abrasions under fixation ring in 100% (15/15) of cases
- •Catheter remained functional for 4-17 days allowing repeated lavage and drainage therapy
- •Complete wound healing achieved within 10 days post-removal with guttural pouch sealing within 72 hours