Laparoscopic closure of the vaginal rings in the standing horse using a tacked intraperitoneal slitted mesh (TISM) technique

Background Indirect inguinal herniation (IIH) is a potentially life‐threatening condition in stallions. The ideal preventive measure for breeding stallions ensures a minimally invasive closure of the vaginal ring that avoids recurrence of IIH while preserving both testicles. Objectives To describe a minimally invasive laparoscopic tacked intra‐peritoneal slitted mesh (TISM) technique in the standing horse to close the vaginal rings and to evaluate its efficacy in preventing recurrence of IIH in stallions. Study design Retrospective case series. Methods Medical records of 17 stallions with a history of IIH were reviewed retrospectively. The surgical procedure was performed on the standing horse through a flank approach using four laparoscopic portals. The vaginal ring was covered with a commercial mesh. The mesh was partially cut to create a slitted mesh with two flaps: the dorsal flap was passed under the spermatic cord and ductus deferens and the ventral flap above. The mesh was secured in place with laparoscopic tacks. Long‐term follow‐up was obtained by a structured telephone interview of the owners. Results A total of 32 laparoscopic vaginal rings closures were successfully performed in 17 horses. No major intra‐ or postoperative complications occurred. None of the horse suffered from re‐occurrence. Nine of the 13 active breeding stallions were breeding again with similar semen quality as before treatment, 4/13 will resume their breeding activity during the next breeding season. None of the horses were castrated and none of the owners reported abnormal size or shape of the testicles. In three stallions, post‐operative pain and activity limitations were noted that gradually resolved after 6 months. Main limitations The lack of large numbers to compare the results of different mesh and tack combinations, the lack of follow‐up veterinary examinations and the limited number of laparoscopic rechecks. Conclusion The TISM technique is an effective minimally invasive technique to surgically reduce the size of the vaginal ring and thereby prevent recurrence of IIH.