Foramen epiploicum mesh closure (FEMC) through a ventral midline laparotomy.
Authors: van Bergen T, Rötting A, Wiemer P, Schauvliege S, Vanderperren K, Ugahary F, Martens A
Journal: Equine veterinary journal
Summary
# Editorial Summary: Foramen Epiploicum Mesh Closure via Laparotomy Epiploic foramen entrapment (EFE) carries significant morbidity and mortality in equine colic surgery, yet preventive techniques during emergency laparotomy have remained underdeveloped—laparoscopic closure methods exist, but these require a separate procedure post-operatively. Van Bergen and colleagues evaluated a novel technique whereby a three-dimensional expandable diabolo-shaped mesh is introduced through the foramen epiploicum into the omental vestibule during routine ventral midline laparotomy, using 10 cadaver trials followed by six live horses recovering over four weeks. All 16 mesh insertions proved uncomplicated; necropsy confirmed correct positioning in the pilot group, whilst the six surgical cases showed no significant post-operative complications beyond transient leucocytosis and elevated serum amyloid A, with subsequent radiography and laparoscopy at four weeks confirming complete foramen closure and crucially, an absence of intestinal adhesions. This technique offers farriers and surgical teams a straightforward, time-efficient method to obliterate the foramen epiploicum in a single procedure during colic surgery, potentially reducing both re-entrapment rates and the need for follow-up laparoscopic intervention, though application in contaminated surgical fields and clinical colic cases remains to be validated.
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Practical Takeaways
- •FEMC offers a reliable, fast method to close the epiploic foramen during emergency colic surgery via standard ventral midline laparotomy, eliminating the need for subsequent laparoscopic procedures
- •The technique remained effective even after simulated abdominal manipulations typical of colic surgery, making it practical for clinical use
- •Mesh positioning was durable at 4 weeks post-operatively without causing adhesion complications, suggesting this could prevent recurrent epiploic foramen entrapment in surgical colic cases
Key Findings
- •All 16 diabolo-shaped mesh constructs were successfully inserted through ventral midline laparotomy without complications
- •Pilot study (n=10) confirmed correct mesh positioning at necropsy after extensive cadaveric manipulation
- •Six horses receiving the technique showed no significant post-operative complications beyond transient leucocytosis and increased serum amyloid A
- •Four-week follow-up with radiography and laparoscopy confirmed all six epiploic foramina were closed without intestinal adhesions