Comparison of tensile strength and early healing of acute repeat celiotomy through a ventral median or a right ventral paramedian approach.
Authors: Boone Lindsey Helms, Epstein Kira, Cremer Jeanette, Rogers Andrew, Foutz Tim, Quandt Jane, Howerth Elizabeth, Mueller P O Eric
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Repeat Abdominal Surgery Approach in Horses When horses require emergency re-exploration within days of colic surgery, surgeons must decide whether to use the original incision or create a new one—a choice with potentially significant consequences for wound healing and abdominal wall integrity. Researchers compared these approaches by performing initial ventral median celiotomies on 12 horses, then reopening them 72 hours later through either the same midline incision (RVM group, n=6) or a new right paramedian approach (RVP group, n=6); a control group of six unoperated horses provided baseline data. Fourteen days after the repeat surgery, abdominal wall samples were analysed biomechanically and histologically to assess tensile strength, inflammation, and tissue organisation. Both surgical groups showed significantly reduced tensile strength compared to control tissue (approximately 50% reduction), but critically, no differences emerged between the two approaches—incisional healing, inflammatory response, infection rates, and necrosis were comparable, though RVP incisions accumulated more fibrin and haemorrhage whilst RVM incisions showed greater drainage frequency. For practitioners managing horses requiring acute re-exploration, these findings suggest that choosing the original midline incision carries no mechanical or healing disadvantage over creating a new paramedian incision, potentially simplifying surgical decision-making and reducing operative time when rapid reopening is necessary.
Read the full abstract on PubMed
Practical Takeaways
- •If a second celiotomy is needed within 72 hours, surgeons can choose between ventral median and right ventral paramedian approaches based on clinical circumstances rather than concerns about significantly different healing outcomes
- •Both repeat celiotomy approaches will result in reduced abdominal wall strength at 14 days; consider activity restriction and monitoring regardless of approach chosen
- •RVP incisions may show more swelling and blood accumulation, while RVM incisions tend to drain more—monitor accordingly but neither approach is substantially superior for healing
Key Findings
- •Both repeat ventral median (RVM) and right ventral paramedian (RVP) celiotomy approaches resulted in significantly reduced tensile strength compared to control horses at 14 days post-repeat surgery
- •No significant differences in tensile strength or overall healing were observed between RVM and RVP repeat celiotomy approaches
- •RVP incisions showed greater edema and fibrin/hemorrhage accumulation, while RVM incisions had more frequent drainage
- •Repeat celiotomy performed 72 hours after initial surgery did not result in substantially different healing outcomes between surgical approaches