Incisional complications following ventral median coeliotomy in horses. Does suturing of the peritoneum reduce the risk?
OBJECTIVE
Despite advances in surgical technique in abdominal surgery, incisional complications are frequently reported following ventral midline laparotomy in horses. The aim of this study was to determine the incidence of incisional complications at our clinic and to identify possible risk factors. Furthermore, we investigated whether suturing the peritoneum leads to a reduction of incisional complications.


METHODS
In this retrospective study, records of patients of the Large Animal Clinic for Surgery of the University of Leipzig from January 2010 to December 2015 were analysed. Horses with ventral midline laparotomy following colic were included in the study. Evaluated parameters comprised breed, sex, age of the horse, localisation of the colic disease, invasiveness of the surgical intervention, duration of general anaesthesia, suture pattern of the laparotomy wound and postoperative fever or leukopenia. Incisional complications included suture dehiscence, exudation from the wound and incisional hernia formation. Wound oedema formation was evaluated separately.


RESULTS
Incisional complications in the form of exudation and suture dehiscence occurred in 8.9% (18/202) of the horses. Postoperative hernia formation was observed in 5.2% (9/173) of patients. Breed, sex, localisation of the colic disease, invasiveness of the surgical intervention, duration of general anaesthesia and postoperative leukopenia did not influence the frequency of incisional complications. An increased risk of incisional complications was found in horses aged 20 years and older (odds ratio [OR] 17.90), in animals with postoperative fever (OR 7.48) and in horses with unsutured peritoneum (OR 7.68). Furthermore, patients with moderate and severe wound oedema displayed a significantly increased risk for the development of incisional complications.


CONCLUSIONS
Suture pattern is the only risk factor that can be directly influenced by the surgeon. Because a peritoneal suture is associated with a decreased risk of incisional complications, it should be standard practice when closing a laparotomy wound in the horse.
PD Dr. Doreen Scharner, Chirurgische Tierklinik, Veterinärmedizinische Fakultät der Universität Leipzig, An den Tierkliniken 21, 04103 Leipzig, E-Mail: scharner@vetmed.uni-leipzig.de.
Doreen
D
Scharner
Karsten
K
Winter
Walter
W
Brehm
Madlen
M
Kämpfert
Claudia
C
Gittel
D000005:Abdomen / Q000601:surgery*; D000818:Animals; D003085:Colic / Q000601:surgery / Q000662:veterinary; D005260:Female; D006734:Horse Diseases / Q000601:surgery; D006736:Horses / Q000601:surgery*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods / Q000662:veterinary*; D008297:Male; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control / Q000662:veterinary*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000662:veterinary*
Abdominal surgery; complication; suture dehiscence; suture pattern; wound infection