Laser fenestration of the mesial septum for treatment of guttural pouch chondroids in a pony.
Authors: Gehlen Heidrun, Ohnesorge Bernhard
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Laser Fenestration for Guttural Pouch Chondroids Guttural pouch chondroids—mineralised concretions within the pouch—can cause significant clinical problems when they obstruct the pharyngeal opening, leading to inflammation and secondary infection. Gehlen and Ohnesorge describe a novel endoscopic approach in a pony with left-sided obstruction: using a neodymium:yttrium aluminium garnet (Nd:YAG) laser to create a fenestration (opening) through the median septum separating the two pouches, thereby gaining access from the unaffected side. The 15–25 W laser (contact method, 4-second exposures) successfully created a persistent opening, through which multiple chondroids were removed and the pouch flushed repeatedly using electrosurgical instrumentation. Post-operatively, mucosal inflammation resolved markedly, weekly lavage via the fenestration prevented recurrence, and the pony returned to competitive carriage driving within two months with no clinical signs. This technique offers a valuable alternative to traditional external approaches, particularly when the primary ostium is sealed by adhesions, reducing surgical trauma and allowing ongoing transendoscopic management; however, case reports remain limited, and application in larger equines or chronic cases warrants further investigation.
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Practical Takeaways
- •Laser fenestration of the mesial septum offers a minimally invasive endoscopic alternative when guttural pouch chondroids are associated with pharyngeal ostium adhesions that prevent normal drainage
- •This technique allows creation of a permanent communication between pouches for improved drainage and easier future access if needed
- •Consider this approach before pursuing more invasive external surgical procedures for complicated guttural pouch disease
Key Findings
- •Transendoscopic Nd:YAG laser fenestration of the mesial septum successfully provided access to remove multiple chondroids from an obstructed guttural pouch
- •Pony remained clinically normal and free of abnormal signs at 2-month follow-up while competing in carriage driving
- •Permanent septal fenestration was established, allowing cross-chamber access and drainage