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Proceedings of the
51st British Equine Veterinary
Association Congress
BEVA
Sep. 12 – 15, 2012
Birmingham, United Kingdom

Next Congress:

11th-14th September 2013 – Manchester, UK

Reprinted in IVIS with the permission of the British Equine Veterinary Association – BEVA
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Thurs Hall 9_Layout 1 08/08/2012 14:28 Page 70

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Hall 9 n Thursday 13th September

How to manage hernias, on farm and in the surgery

External abdominal hernias include umbilical, inguinal, ventral Congenital inguinal (scrotal) hernias in foals cause no
midline (incisional) and lateral abdominal (traumatic). discomfort, are reducible, do not usually strangulate and usually
resolve spontaneously in the first months of life. Reducing the
Umbilical hernias hernia manually several times daily or applying a bandage truss
The most common hernia seen in practice. Usually become may expedite resolution. If these do not resolve they can be
apparent at 5–6 weeks of age and represent a weakness in the surgically repaired by an open technique or laparoscopically. There
fibrous umbilical plate. Umbilical body wall defects palpable at is a hereditary component to congenital inguinal hernias.
birth usually close within 3–4 days and are not an accurate Ruptured inguinal hernias may also occur in foals. These
predictor of umbilical hernia development. There is a hereditary present with colic and swelling of the inguinal region. Immediate
component to their occurrence. Shown in some studies to be surgical repair must be carried out. In open surgery the intestines
related to umbilical infection and more common in fillies, however are returned to the abdominal cavity via the torn edges of the
this has not been the author’s experience. Must be differentiated vaginal tunic. Castration then allows proximal closure of the
from umbilical infection by palpation, and possibly vaginal tunic. Laparoscopic repair of ruptured inguinal hernias has
ultrasonographic examination. Small umbilical hernias (<3 cm) been described.
may go unnoticed and most resolve spontaneously by 5–6 months Inguinal hernias in adults strangulate the affected intestines,
of age. present with colic, and are a surgical emergency. These can be
Larger hernias may require intervention. A suitable time to do reduced by a closed technique with the horse under general
so is at 3–4 months of age, prior to weaning and when umbilical anaesthetic in dorsal recumbency. Traction on the testicle,
remnants are small. followed by firm squeezing of the spermatic cord, moving
A convenient way to manage one to three ‘finger’ (2–8 cm) proximally and alternating hands allows the intestine to be
hernias is by placing elastic Elastrator rings on the hernial sac. This reduced back into the abdomen. The horse should then be
is performed standing in a well restrained foal, using sedation as monitored very closely for signs associated with devitalised bowel,
required. Passing your fingers within the stretched elastic ring on when a laparotomy is necessary. Although recurrence of inguinal
the applicator, the skin of the hernial sac is grasped and twisted hernia is uncommon, castration or subsequent laparoscopic
to reduce the contents into the abdomen. The first ring is then
closure of the vaginal ring (e.g. by peritoneal flap hernioplasty)
placed close to the abdominal wall, keeping to the midline and
can be utilised to prevent recurrence. Nonreducible hernias,
taking care to ensure no sac contents are caught. A further 3–4
ruptured inguinal hernias and inguinal ruptures will require open
rings are then placed ventral to the first ring. Tetanus prophylaxis
surgical repair, usually with castration.
is administered. Foals do not normally display discomfort
following ring application. If any colic occurs, the rings should be
immediately removed and the foal monitored closely for
Ventral midline (incisional) hernias
complications. Although unlikely, intestine may be entrapped by Mair and Smith (2005) reported an 8% ventral hernia incidence
the rings. Some swelling around the umbilicus occurs for 10 days following a single laparotomy, with a significant association with
following ring application. After 2–3 weeks, the hernial sac incisional drainage/infection. Reduction of wound infection rates
sloughs. This leaves a small granulation bed that should heal will reduce incisional hernia incidence. When incisional hernias
uneventfully. occur, most can be managed conservatively, by appropriately
Small (<4 cm) hernias can be managed with abdominal treating wound infection, if present, and the use of a hernia belt.
bandages. Two rolls of 10 cm Elastoplast can be used at 8 weeks The CM Hernia1 belt is used in conjunction with controlled
of age for 2–3 weeks, with the foal confined to a box or barn. exercise for chronic incisional hernias. If surgery is deemed
Bandage rubs can occur. necessary, this should be delayed for 5–6 months from the original
Large (>10 cm) umbilical hernias require surgical intervention laparotomy. Most can be repaired (following suitable feed
under general anaesthetic if not healing spontaneously by 4 restriction) open or closed in simple continuous fashion with 5 or
months. Open repair involves resecting the hernial sac and allows 6 metric polyglactin 910 or polydioxanone. If the use of a
evaluation and resection of any umbilical remnants and polypropylene mesh is required, this can be placed subperitoneally
adhesions. The author prefers to examine the umbilical remnants or subcutaneously.
ultrasonographically and, if normal, repair with a closed
technique. This involves inverting the hernial sac into the Lateral (traumatic) abdominal hernias
abdomen and closing the hernial ring with simple continuous 4 If open, these require immediate repair to prevent evisceration. If
or 5 metric polyglactin 910. If the hernial ring is ‘tight’, I use closed these can be treated with abdominal bandaging and
overlapping vertical Mayo mattress sutures of 5 metric polyglactin repaired surgically, if required, after 2–3 months.
910, followed by a simple continuous apposition of the edge of
the hernial ring to the external rectus sheath. Subcutaneous
Manufacturer’s address
closure with 3 metric poliglecaprone 25 and intradermal closure 1
CM, Norco, California, USA.
with the same suture material complete the surgery. Foals are kept
stabled for 4–6 weeks following surgical repair.
References
Mair, T.S. and Smith, L.J. (2005) Survival and complication rates in 300 horses
Inguinal hernias
undergoing surgical treatment of colic. Part 3: Long term complications and
The second most common hernia in horses. survival. Equine Vet. J. 37, 310-344.

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Proceedings of the 51st British Equine Veterinary Association Congress 2012 - Birmingham, United Kingdom