J-incision to approach the cranial abdomen in the adult horse.
Authors: Bauck Anje G, Nelson Elizabeth, McLain Andrew, Cock Gemma, Sanchez Linda C, Freeman David E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: J-incision Approach to Cranial Abdominal Surgery in Horses Surgical access to the cranial abdomen remains challenging in equine practice, particularly for conditions such as gastric impaction and diaphragmatic hernia where traditional ventral midline celiotomy may provide suboptimal visualisation. Freeman and colleagues (2021) evaluated a modified celiotomy incorporating a J-shaped incision that extends cranially along the paracostal arch, aiming to improve exposure of the stomach and diaphragm. In their four-horse case series—three treated for gastric impaction via gastrotomy and one for diaphragmatic hernia repair—the paracostal component healed without infection or dehiscence in all animals, though midline incisional infections occurred in all cases, likely unrelated to the modified approach itself. Three horses achieved good long-term outcomes, demonstrating that the J-incision technique successfully enhanced surgical access without compromising healing of the paracostal tissues. For practitioners managing dorsal gastric or diaphragmatic pathology, this modification warrants consideration as a means of improving visualisation and working space whilst maintaining the structural integrity of the body wall, though the small sample size suggests further investigation into incision management and infection prevention protocols would be prudent.
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Practical Takeaways
- •Consider J-incision modification to ventral midline celiotomy when improved cranial abdominal access is needed for gastrotomy or diaphragmatic hernia repair
- •Paracostal portion of incision appears to heal reliably, though midline incisional infections remain a concern with this approach
- •Technique shows promise for difficult cranial abdominal cases but requires careful postoperative wound management given infection risk
Key Findings
- •J-incision with paracostal component improved surgical access to stomach and diaphragm in 4 horses undergoing cranial abdominal procedures
- •Paracostal component of incision healed without infection or dehiscence in all 4 cases despite midline incisional infections in all horses
- •Three of four horses had good long-term outcomes; one euthanized for reasons likely unrelated to surgical complications