Surgical technique and short-term outcome for experimental laparoscopic closure of the epiploic foramen in 6 horses.
Authors: Munsterman Amelia S, Hanson Russell Reid, Cattley Russell C, Barrett Elizabeth J, Albanese Valeria
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Laparoscopic Epiploic Foramen Closure in Horses Epiploic foramen herniation remains a surgical emergency in equine practice, yet preventative closure techniques have received limited investigation. Munsterman and colleagues developed and refined a standing laparoscopic approach to obliterate the epiploic foramen using helical titanium coils to anchor the gastropancreatic fold and pancreatic right lobe to the caudate hepatic lobe in six healthy adult horses. All horses achieved successful initial closure within a median operative time of 40.5 minutes (range 22–110 minutes), with serum enzyme analysis revealing only transient elevations in aspartate aminotransferase and amylase—suggesting minimal hepatic and pancreatic trauma—whilst liver-specific markers remained unaffected. Follow-up laparoscopy at four weeks demonstrated complete foramen closure in five horses and partial closure in one, with zero intraoperative or postoperative complications across the cohort. Whilst this small experimental study requires validation in larger populations and longer follow-up periods, it suggests that standing laparoscopic epiploic foramen closure is technically feasible and safe, potentially offering a minimally invasive prophylactic option for high-risk horses, though the clinical efficacy and durability of titanium coil fixation warrant further investigation before widespread adoption in practice.
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Practical Takeaways
- •Laparoscopic epiploic foramen closure is a technically feasible and safe procedure in standing horses, though this remains an experimental technique not yet standard practice
- •Surgical time varies considerably (22-110 minutes), suggesting a learning curve; surgeons should budget adequate time when first adopting this technique
- •While short-term outcomes are favorable, long-term efficacy and whether this prevents epiploic foramen entrapment require further study before clinical application can be recommended
Key Findings
- •Laparoscopic closure of the epiploic foramen was successful in all 6 horses using helical titanium coils to secure the gastropancreatic fold to the caudate hepatic lobe
- •Median surgical time was 40.5 minutes (range 22-110 minutes) with no intraoperative or postoperative complications
- •At 4-week follow-up laparoscopy, closure was complete in 5 of 6 horses with only transient elevations in AST and amylase observed
- •The procedure did not cause significant alterations to pancreatic or hepatic function as evidenced by unchanged GGT and SDH levels