Incisional hernia repair in horses: A cadaveric study of endoscopic component separation

Objective To report a technique for endoscopic component separation in horses and quantify the amount of body wall advancement obtained. Study Design Descriptive study. Animals Fresh cadaveric horses (n = 14). Methods After a preliminary anatomic study, 7 horses had unilateral endoscopic component separation involving transection of the external abdominal oblique fascia lateral to the rectus abdominis muscle. A laparoscope, placed using a balloon dissector, was used to create an intermuscular working space between the external abdominal oblique fascia and internal abdominal oblique muscle. A single instrument portal was created 10–12 cm medial to the laparoscope portal. Laparoscopic scissors were used to transect the external abdominal oblique fascia, lateral to its insertion to the external rectus sheath, from ∼20 cm cranial to the costochondral junction to the level of the superficial inguinal ring. Subsequently, a 30 cm ventral median celiotomy was created and the myofascial advancement was quantified at points 10 and 20 cm cranial to the umbilicus. Results Endoscopic component separation was successfully completed in all horses. Component separation provided a net mean (±SD) abdominal wall advancement of 3.5 ± 1.3 cm and 3.4 ± 0.5 cm, 10 cm, and 20 cm cranial to the umbilicus, respectively. Conclusion Endoscopic component separation in horses is technically feasible but, as conducted, results in modest abdominal wall advancement.