Acute upper respiratory failure, digestive colic and bleeding from the guttural pouches are conditions that require emergency surgery, as do individuals with septic arthritis or certain lacerations or fractures. To respond to these emergencies, specialized centers have been created around the world. These infrastructures are heavy to set up because they require a lot of equipment and personnel to anesthetize, operate and manage the intensive care of the horses admitted.
Tracheostomy in horses
Tracheotomy will be performed in case of acute upper respiratory tract failure. This can be caused by smoke inhalation, fire, a foreign body, a peri-pharyngeal mass, a traumatic tracheal collapse, or a snake bite. The diagnosis and prompt treatment of this condition is vital for the horse. The diagnosis will be based primarily on visual and auditory inspection. The actual cause of the obstruction will often be investigated after the upper airway has been made patent and this will be done by endoscopic examination. To restore patency, either nasotracheal intubation (passage of a tube through the nostril into the trachea) or tracheotomy will be used. The latter is a surgical procedure that is performed where the horse is in distress, on a standing or lying horse, often without any prior chemical restraint given the urgency of the problem. Tracheotomy consists of making an opening between two tracheal rings to allow the passage of air through a tubular structure such as a tracheal tube or a piece of garden hose.
Laparotomy and laparoscopy in the horse
The veterinarian must recognize in the field not only colic (abdominal pain) but also differentiate between individuals who are candidates for medical treatment and those who are candidates for surgical treatment. It is well recognized that early operation of a horse with a surgical condition increases the chances of success. There can be very rapid degeneration (within hours) of segments of the digestive tract, requiring an extensive resection (enterectomy). Thus, it is possible to remove up to 60% of a horse’s small intestine, i.e., about 15 meters. In other cases, it is only necessary to make an opening in a digestive organ to empty its contents (gas, food, sand, etc.); this is called an enterotomy.
The approach to the abdomen as such, to have access to the different digestive organs of a horse, is done in most cases under general anesthesia in favor of a laparotomy by ventral approach and on selected cases, or a laparoscopy on the flank, on the animal standing and tranquilized.
These techniques are also used for extra digestive colic such as uterine torsion in pregnant mares or bladder rupture in newborns.
Embolization of the carotid and maxillary arteries in horses
The presence of blood in the nasal passages (epistaxis in the broad sense) may indicate either an upper respiratory tract hemorrhage or a deep respiratory tract hemorrhage. In the first case, it must be established quickly whether the hemorrhage is due to a mycosis of the guttural pockets. If this diagnosis is established, we are in the presence of a surgical emergency, not only to eliminate the mycotic agent but to prevent a fatal hemorrhage that can be triggered at any moment.
The surgical treatment consists of occluding the artery in front of which the mycotic plaque is located, rostral and caudal to the lesion. Indeed, the right and left carotid arterial networks are in communication and the hemorrhage can come from blood coming from the heart (norm grade flow) or from the opposite arterial network (retrograde flow). The most effective surgical technique currently used is intra-arterial embolization of the involved arteries. This is performed by implanting emboli into the affected arteries using special instruments and under the visualization of an image intensifier. There is no post-operative care unless there are concomitant neurological problems, and the final aesthetic appearance is very satisfactory.
The evolution of equine surgery
Equine surgery is growing rapidly, and this is made possible by improved training and research in both surgery and related disciplines such as internal medicine, anesthesia, and clinical pathology. The American and European Colleges of Veterinary Surgery are constantly working to improve training, exchange experiences and therapeutic advances throughout the world. Overall, the horse benefits from improved management. It started with the evolution of daily care and then with the development of referral, emergency, and intensive care centers, which now allow the horse to be operated on for colic or certain fractures with an ever increasing success rate.
During the last decade, technological improvements have allowed surgeons to better see the lesions (arthroscopy, laparoscopy, thoracoscopy, endoscopy). The sometimes striking images now allow him to locate a lesion with precision, to evaluate its size, its depth. The problem to be treated can therefore be more clearly identified, allowing the surgeon to be more precise in his actions. In the future, the limits of repair will be pushed back with the advent of new biomaterials and a better understanding of the etio-pathogenesis of diseases. Today, in France as in the rest of the world, we are also working on improving prevention and reducing the invasive aspect of surgery, keeping in mind that, in horses, the vital and sporting prognosis is at stake and that, in most cases, the cost remains a limiting factor.
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