Elective Surgery Mid-Atlantic Equine Medical Center

Elective Surgical Procedures

The elective surgical procedures we perform include but are not limited to:


Soft-Tissue Surgery

General

  • Routine and Cryptorchid Castration
    • Routine
      • Performed under intravenous or inhalation general anesthesia - Surgical removal of both normally descended testicles as either an open (leaving the scrotal incisions open to heal from the inside out) or as a closed technique with removal of the scrotal sac and closing of the incision.
    • Cryptorchid
      • Surgical removal of a testicle that has failed to descend normally into the scrotal sac. The affected testicle may be retained either in the abdomen or the inguinal canal.
  • Neurectomy
    • Surgical removal of a segment of nerve to a specific area (hind suspensory or heel region of the hoof) to alleviate pain.
  • Fasciotomy
    • Surgically cutting fascia (tissue) that is restricting an area such as seen in the high suspensory area on the hind limbs.

Specialty

  • Tenoscopy
    • Performed under general anesthesia, this technique uses arthroscopic equipment to evaluate the tendon sheath allowing a clear view of the structures and access for treatment via small incisions.
  • Desmotomy/contracture
    • Surgical cutting of ligaments to release excess limb contracture as seen in a club foot. Performed under general anesthesia.

Upper Airway

  • Tieback
    • Surgical procedure performed under general anesthesia to physically tie the most frequently paralyzed left arytenoid cartilage up and out of the airway lumen using 1 or 2 sutures. This optimizes air flow through the larynx during exercise.
  • Tie forward
    • A surgical technique used to aid preventing dorsal displacement of the soft palate in horses in which the problem causes loss of exercise tolerance. Performed under general anesthesia, permanent sutures are placed around the larynx and hyoid apparatus to hold the epiglottis closer to the back edge of the soft palate.
  • Epiglottic entrapment
    • A cause of respiratory noise and exercise intolerance in which a fold of tissue (aryepiglottic fold) envelopes the epiglottis. This typically requires surgical transection of the fold of tissue with endoscopically guided laser transection or via sharp excision. This may be performed under standing sedation or general anesthesia.
  • Ventriculocordectomy
    • A surgical procedure performed to treat inward collapse of the vocal cords. It removes the mucosal lining of the ventricle(an outpouching of the larynx) and the vocal cord to create a smooth laryngeal contour to reduce respiratory noise. This may be performed under standing sedation, general anesthesia or using an endoscopic laser assisted technique.
  • Ethmoid hematoma
    • A progressive mass that grows off of the ethmoid turbinates of the nasal passage or from the sinus floor causing intermittent nasal bleeding and eventually enlarging enough to cause obstruction in air flow. These are typically resolved with surgical excision using laser therapy, scalpel excision or intratumoral serial formaldehyde injections.
  • Sinusitis/dental disease
    • Sinusitis
      • Primary sinusitis is an inflammatory reaction of the sinus lining to bacterial or fungal infections. It is typically treated with sinus lavage and systemic antibiotics or anti-fungals.
    • Sinusitis secondary to dental disease
      • Typically secondary to a tooth root infection contaminating the sinus, or a fractured tooth allowing direct communication with the mouth and subsequent contamination.
  • Guttural Pouch Mycosis
    • Typically a fungal infection most commonly caused by Aspergillus spp in which plaques of the fungus grow along one of the arterial walls in the guttural pouch(internal carotid artery or branches of the external carotid artery may be involved). Frequently this infection requires balloon or coil embolization of the affected artery to prevent the risk of severe hemorrhage and possible death while the fungal infection is treated.

Laser Surgery

  • Ventriculocordectomy
    • Typically performed under standing sedation and endoscopic guidance, the laser energy is used to transect the vocal fold and obliterate the ventricular mucosa.
  • Palatoplasty
    • Performed under standing sedation and endoscopic guidance, the laser energy stimulates fibrosis or scarring of the soft palate to treat dorsal displacement of the soft palate.
  • Facilitated ankylosis
    • Performed under general anesthesia, the laser energy is directed into the affected osteoarthritic joint via hypodermic needles to vaporize the synovial fluid, heat the cartilage and joint capsule lining causing cell death with eventual joint fusion and alleviation of pain and lameness
  • Mass removal
    • The laser can be used to remove upper airway masses under standing sedation and endoscopic guidance and is frequently used to remove small skin tumors to minimize bleeding, reduce swelling and vaporizes areas around the tumor site to reduce the chance of tumor metastasis. It is used after sharp excision in larger tumors to cauterize the wound surface and reduce the potential for tumor metastasis.

Reproduction

  • Dystocia
    • Refers to difficulty in giving birth, or inability to give birth. This is estimated to occur in 1-2% of the foal population. The problem may arise from malposition of the fetus, an oversized fetus, fetal death in utero or when the mare cannot initiate normal contractures to expel the fetus.
  • Caesarian section
    • Performed under general anesthesia. Surgical delivery of a foal through an abdominal incision either electively or as an emergency procedure during a dystocia.
  • Foaling damage repair
    • Cervical laceration/tear
      • A laceration of the cervix of the mare during foaling that causes loss of normal architecture of separation between the uterine environment and the vaginal vault and potential inability to become pregnant.
    • Rectovaginal fistula
      • An injury sustained during foaling in which the hoof of the foal penetrates the roof of the vagina and the wall of the rectum creating a direct communication between the 2 structures and subsequent contamination of the vagina with manure.
    • Perineal laceration
      • An injury sustained during foaling in which the vulvar tissue and Anus are torn or lacerated as the foal is expelled, once again causing direct communication between the rectum and vagina.
  • Ovariectomy
    • Surgical removal of a mare's ovaries or ovary as in the case of a granulosa cell tumor or for managing behavioral issues in performance horses. This procedure may be performed standing under laparosocopic guidance or under general anesthesia through a routine abdominal incision.


Orthopedic Surgery

Conformation

  • Angular limb deformity
    • Periosteal transection/elevation
      • Also known as periosteal "stripping", the periosteum over the growth plate on the concave side of the angular deformity is cut and lifted from the bone, accelerating growth on that side of the physis.
    • Transphyseal screw
      • A bone screw is placed temporarily across the growth plate on the convex side of the angular deformity, slowing growth on that side. The screw is removed (standing: local anesthesia and sedation; no general anesthesia) when the limb is straight (2-4 weeks later, on average).
    • Transphyseal screw/wire bridge
      • For more extreme angular deformation, the growth plate on the convex side of the deformity is restricted with a screw and wire bridge. The construct is removed (standing: local anesthesia and sedation; no general anesthesia) when the limb is straight.
  • Contracted Tendons
    • "Club foot" - Inferior check desmotomy
      • Upright, or "club foot", hoof conformation is caused by contraction of the deep digital flexor tendon. The inferior check ligament attaches the lower part of this tendon to the back of the cannon bone. Surgical transection of this tether releases contraction by allowing tension to diffuse into the deep digital flexor muscle belly. Therapeutic shoes with toe extensions are applied at the time of surgery to maximize correction. Ideally, surgery is performed when the horse is young (4-12 months old, depending on severity).
    • "Over at the knee" - Superior check desmotomy
      • Carpal contraction, or "over at the knee" conformation, is caused by contraction of the superficial digital flexor tendon. The superior check ligament attaches the upper portion of this tendon to the back of the radius. Surgical transection of this tether releases contraction by allowing tension to diffuse into the superficial digital flexor muscle belly. Therapeutic shoes are applied at the time of surgery to maximize correction. Ideally, surgery is performed when the horse is young (6-12 months old, depending on severity). This surgery can be done via an open approach or a tenoscopic approach through the carpal canal.

Arthroscopy/Tenoscopy

  • All joints, tendon sheaths and bursae
  • Chip fractures
    • Minimally invasive removal of articular chip fractures improves athletic prognosis.
  • Osteochondrosis dissicans (OCD) lesions
    • Surgical removal of OCD lesions stops the cycle of chronic inflammation in the joint, cycle prevents cartilage destruction, and eliminates the chance of the osteochondral fragment breaking inside the joint. If removed before a young horse commences work or turn out, the classic effusive "bogged" joint appearance may be avoided. Early removal improves athletic prognosis.
  • Annular desmotomy
    • The annular ligament passes around the flexor tendons as they pass down behind the fetlock through the digital flexor tendon sheath. In some cases of chronic tendon sheath effusion, this ligament restricts the gliding function of the flexor tendons, exacerbating lameness and effusion. Transection of this ligament can restore soundness and athletic function. This surgery should not be considered for simple "wind-puffs" in a sound horse.
  • Surgical management of septic synovitis
    • Endoscopic debridement is the gold standard for treatment of infected synovial structures (joints, tendon sheathes and bursae). Minimally invasive (endoscopic) lavage and debridement of the material (fibrin) that accumulates inside the synovial structure maximizes the chances of successful treatment. Addressing the infection less than 36 hours after contamination or on-set is of the utmost importance. Prognosis drops precipitously after that time period.
  • Fracture repair
    • The arthroscope is inserted into the joint for an unsurpassed view of the articular surface during fracture reconstruction. Use of the scope eliminates the need for a large incision into the joint. Direct view guides accurate reconstruction for a perfectly congruent joint surface, minimizing the chances of future osteoarthritis.

Fracture Fixation

  • Routine (e.g. condylar, carpal/tarsal slab and proximal phalanx fractures, etc.)
    • These fractures are simple in configuration and are repaired with bone screws alone.
  • Foals
    • Physeal (growth plate) fractures
      • Fractures involving active growth plates in young animals are describe according to the Salter-Harris classification system. Different principles must be taken into consideration when working with or around growth plates.
    • Rib fractures
      • Foals sustain rib fracture during birth or shortly thereafter. All rib fractures should be evaluated but few need to be repaired. When the sharp bone ends puncture the lung or overlay the heart (threatening cardiac puncture) the rib fractures should be stabilized immediately.
  • Arthroscopically-guided articular fracture repair: See "arthroscopy"
    • Major fracture
    • Major fracture repair is a challenge in the horse. Mid-Atlantic Equine Medical Center stocks a full complement of fracture repair instrumentation and uses state-of-the-art locking compression bone plate/screw technology made by DePuy-Synthes.
  • Arthrodesis
    • Arthrodesis refers to surgical fusion of a joint. The two most common indications for arthrodesis are severe (end-stage) osteoarthritis and high-energy (comminuted) fractures that damage an articular surface beyond repair. Any remaining cartilage is removed and locking compression plates and bone screws are applied to stabilize the joint as it fuses. In some cases of advanced osteoarthritis, the procedure can be done with a minimally invasive approach. It is the motion of bone-on-bone contact that is so painful. Once the arthritic/damaged joint fuses motion is eliminated and the horse regains comfort. Fusion of low-motion joints (i.e. pastern and distal hock joints) does not eliminate the possibility of advanced athletic activity. Fusion of high-motion joints (i.e. fetlock, knee) offers comfort but alters the gait enough to preclude any real athletic activity.

Our surgical team also performs dental and sinus surgery, ophthalmic surgery and coil embolization of the carotid arteries for guttural pouch mycosis.


Laparoscopic Procedures

A list of procedures performed and conditions addressed laparoscopically includes but is not limited to:

Female Reproductive Tract

  • Ovariectomy
    • Surgical removal of one or both ovaries.
      • Granulosa cell tumor; other neoplasia
      • Behavioral issues
  • Uterine tears
  • Uteropexy
    • This procedure is performed to improve uterine clearance of fluid.
  • Deposition of prostaglandin E2 on oviducts

Male Reproductive Tract

  • Cryptorchid castration
    • With local anesthetic and sedation or under general anesthesia, a small camera is introduced through a small incision in the body wall and can help in localization of a retained testicle within the abdomen. After localization of the testicle, state-of-the-art instrumentation (LigaSure) is used to safely ligate the vascular supply and facilitate removal of the testicle through the small incision. Minimally invasive, faster return to work/training, decreased complication rate.
  • Physiologic castration
    • With local anesthetic and sedation or under general anesthesia, a small camera is introduced through a small incision in the body wall to visualize the spermatic cord, which contains the vascular and nerve supply to the testis. After localization of the cord, electrocautery and transection of the spermatic cord to eliminate the testicular blood supply is performed without removal of the testicles. This results in a loss of reproductive function and, eventually, the testicles begin to shrink. The benefits of this procedure include a fast return to athletic function and an excellent cosmetic outcome.
  • Inguinal Hernia Repair with Testicle-Sparing
    • Replacement of intestine that has herniated into the scrotum through the inguinal ring with partial closure of the inguinal ring and without removal of the testicle can be performed using "keyhole" surgery in both foals and adult horses. This procedure allows for maintenance of the reproductive potential of the patient.
  • Scrotal Hernia
    • Testicle-sparing repair

Urinary Tract

  • Bladder tears
    • Foals
    • Adults (hand-assisted)
  • Urolithiasis
    • Bladder stone removal
  • Hand-assisted nephrectomy
    • Removal of a diseased kidney

Abdominal/Gastrointestinal Surgery

  • Exploration
  • Adhesiolysis
    • The removal of adhesions within the abdomen.
  • Biopsy
  • Body wall hernia
  • Ablation/closure of the nephrosplenic space
    • Reduces the incidence of large colon entrapment within this space thus reducing the risk of this form of colic.
  • Ablation/closure of the epiploic foramen
    • Reduces the incidence of small intestinal entrapment within this space thus reducing the risk of this form of colic.

Chest/Lungs (Thoracoscopy)

  • Lung biopsy
  • Adhesiolysis
    • Removal of adhesions within the chest cavity after severe inflammation/infection within the chest.
  • Diaphragmatic hernia
    • Closure of a defect in the diaphragm that improves respiration and prevents herniation of intestine into the chest cavity.
  • Pleuropneumonia
    • Thoracoscopic removal of fibrin, purulent materia and necrotic tissue from the pleural space.


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