Standing hand-assisted laparoscopic treatment of left dorsal displacement of the large colon and closure of the nephrosplenic space.
Authors: Muňoz Juan, Bussy Christian
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Standing Hand-Assisted Laparoscopic Treatment of Left Dorsal Displacement of the Large Colon Left dorsal displacement of the large colon (LDDLC) remains a significant colic emergency in equine practice, with recurrence a persistent challenge—particularly when the nephrosplenic space remains patent postoperatively. Muñoz Juan and Bussy evaluated a combined standing hand-assisted laparoscopic approach in 12 horses (aged 5–14 years) over a three-year period, performing both LDDLC correction and nephrosplenic space closure in a single procedure via a modified grid laparotomy in the left paralumbar fossa. All horses achieved successful initial resolution with only minor postoperative complications; however, medium-term follow-up (mean 23.8 months) revealed recurrent large colon displacement between the spleen and body wall in 2 of the 12 cases, indicating a recurrence rate of approximately 17% in the observed timeframe. Whilst this technique offers the theoretical advantage of addressing both the immediate displacement and a known predisposing anatomical factor in one procedure—potentially reducing repeat surgery risk—the authors appropriately caution that case selection remains critical to optimising outcomes. For practitioners considering this approach, the results suggest standing laparoscopic nephrosplenic closure is technically feasible with acceptable complication profiles, though careful patient selection and realistic owner expectations regarding recurrence risk remain essential components of surgical planning.
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Practical Takeaways
- •Standing hand-assisted laparoscopic technique successfully corrects LDDLC and prevents recurrence via nephrosplenic space closure in a single procedure, reducing recovery time compared to traditional approaches
- •Careful case selection is critical—recurrence occurred in 16.7% of cases, suggesting this technique may not suit all displacement presentations
- •Short-term outcomes are good with minimal complications, but longer-term recurrence rates suggest appropriate patient evaluation before selecting this combined technique over traditional approaches
Key Findings
- •Standing hand-assisted laparoscopic correction of LDDLC with simultaneous nephrosplenic space closure was successful in all 12 horses with only minor postoperative complications
- •On short-term follow-up (mean 23.8 months), 2 of 12 horses (16.7%) developed recurrent large colon displacement between the spleen and body wall
- •Modified grid laparotomy in the left paralumbar fossa combined with laparoscopic closure technique proved feasible for this combined procedure