Laparoscopic obliteration of the nephrosplenic space using polypropylene mesh in five horses.
Authors: Epstein Kira L, Parente Eric J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Laparoscopic Mesh Obliteration of the Nephrosplenic Space Entrapment of small intestine in the nephrosplenic space remains a significant cause of colic in horses, yet surgical prevention has not been systematically evaluated. Epstein and Parente developed and tested a minimally invasive laparoscopic technique using polypropylene mesh to permanently obliterate this anatomical potential space, operating on five healthy mature horses via two instrument portals and one laparoscope on the left flank, securing the mesh to the splenic capsule and perirenal fascia with helium titanium coils. The procedure proved straightforward, requiring a mean operative time of 104 minutes, with all horses remaining free from colic; by four weeks post-operatively, fibrous tissue had fully encapsulated the mesh, and subsequent necropsy at 4–14 weeks revealed robust adhesion between the mesh-covered surfaces and adjacent structures. Although one horse developed an adhesion between the descending colon and mesh (a potentially serious complication), the technique reliably obliterated the nephrosplenic space and appeared well tolerated overall. For practitioners managing recurrent nephrosplenic entrapment or working with high-risk horses, this laparoscopic approach offers a preventative surgical option that merits consideration, though the mesenteric adhesion risk warrants careful case selection and appropriate client counselling regarding potential post-operative complications.
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Practical Takeaways
- •This laparoscopic technique offers a minimally invasive method to prevent nephrosplenic entrapment colic in at-risk horses, with reliable tissue incorporation and space obliteration within 4 weeks
- •While generally well-tolerated, surgeons should be aware of potential mesenteric adhesion formation and consider this in case selection and client counselling
- •The procedure requires advanced laparoscopic skills and appropriate mesh sizing but appears feasible for equine practitioners with standing surgical capability
Key Findings
- •Laparoscopic polypropylene mesh placement in the nephrosplenic space was completed in a mean of 104 minutes with no colic observed in any horse
- •All mesh implants were covered by fibrous tissue within 4 weeks, providing complete obliteration of the nephrosplenic space
- •One horse (20%) developed a descending colon mesenteric adhesion to the mesh, representing the primary surgical complication