Thoracoscopic-assisted diaphragmatic hernia repair using a thoracic rib resection.
Authors: Malone E D, Farnsworth K, Lennox T, Tomlinson J, Sage A M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Diaphragmatic hernias in horses present a challenging surgical problem, particularly when viscera become entrapped and require delayed definitive repair after initial colic management. This case report documents the successful treatment of a dorsal diaphragmatic hernia in a six-year-old warmblood that had become complicated by colonic incarceration, demonstrating a combined thoracoscopic and flank approach to guide precise rib resection for hernia exposure and closure. The surgical team utilised thoracoscopy alongside a flank incision to identify the hernia margins and determine that resection of the 14th rib would provide optimal visualisation; the stomach, which had adhered to the defect edges, was carefully managed to allow complete closure of the remaining defect. This technique offers equine surgeons a practical alternative for accessing dorsal diaphragmatic hernias in adult horses where standard approaches may prove inadequate, with the added benefit of minimally invasive imaging to reduce unnecessary rib resections and associated morbidity. For practitioners managing horses with recurrent or complicated herniation, this case illustrates the value of combining endoscopic guidance with selective skeletal access to achieve good outcomes in a notoriously difficult anatomical region.
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Practical Takeaways
- •Thoracic rib resection is a viable surgical approach for accessing and repairing diaphragmatic hernias in adult horses when conservative management fails
- •Use thoracoscopy and/or flank incision pre-operatively to map the hernia and plan the optimal rib resection site, improving surgical efficiency
- •Be aware that adhesions between abdominal organs and the hernia defect are likely; gentle dissection and identification of these structures is essential before closure
Key Findings
- •Thoracic rib resection (14th rib) provided excellent surgical exposure for repair of a dorsal diaphragmatic hernia in an adult horse
- •Thoracoscopy and flank incision were effective in pre-operative identification of hernia location and determining the optimal rib for resection
- •Stomach adhesion to hernia defect edges was present, with successful closure achieved after rib resection