Surgical

Our soft tissue surgical procedures include those involving the abdomen and upper respiratory tract, as well as general wound surgery and open and standing castrations. Soft tissue surgeries may include colic surgery, tieback and tie-forward and caesarean.

Colic is the term often used to describe abdominal pain in the horse. A colic not responding to analgesics (pain relief) would be our main reason for performing abdominal surgery (exploratory laparotomy).

The majority of our surgical cases are horses belonging to our clients, but many are referrals from other practices in the area.

The cause of abdominal pain almost always originates in the gut, and there are multiple reasons for gut pain ranging from simple gaseous distension to conditions that require resection of devitalised intestine. Differentiating between medical and surgical cases can be difficult, especially in youngstock. An early and accurate diagnosis by the vet with the appropriate treatment is paramount for cure and survival.
Diagnosis of colic often relies mostly on careful observation of the horse including assessing the heart rate, mucous membranes and hydration. More often than not, a rectal examination will be carried out to feel for internal distension and a stomach tube will be passed to search for gastric reflux or to administer an electrolyte solution. Occasionally ultrasound of the abdomen will be carried out to further assess the intestinal tract.

A belly tap will be sometimes taken to assess the white cell count and the peritoneal fluid in the abdomen, along with a blood sample to assess hydration. By assessing the patient thoroughly, and carefully observing behaviour displayed once analgesics are administered, we can usually determine whether the horse requires surgical treatment.

It is imperative that the vet examines the horse in its initial state and no drugs are administered prior to the vet’s arrival. In most cases horses are treated with analgesics and anti-spasmodic drugs, which in some cases can resolve the issue.

By no means is the surgical option to cure colic an easy procedure. General anaesthesia comes with its own risks, and requires a full team to monitor the patient and assist with the induction and recovery process. Almost all cases of abdomen surgery are entered via an incision on the ventral midline.

Surgery can take from two to five hours, depending on the problem that is encountered once the surgery begins. All patients are given fluids, antibiotics, anti-inflammatories and intestinal stimulants. The veterinary surgeon will have a good idea of the outcome when the problem is found, and whether the continuation of surgery is viable.

Common problems may be encountered including classical twists, intussusceptions, displacements or physical obstruction. In most cases, correction can be achieved. In cases where the intestine has lost function due to grass sickness, it is usually fatal and cannot be corrected.

Once surgery has been completed and the horse has recovered, the lengthy process of intensive aftercare begins. This requires re-introducing food and encouraging motility by exercise, gastric emptying (via stomach tube) and medication. Post operative blood samples are taken to carefully monitor recovery.

We carry out approximately 50 emergency abdominal surgeries under general anaesthesia per year, and we are pleased to report that more than 80% of patients return home in full health. In the majority of cases, the on-call veterinary team receive patients during the night and it is all hands-on deck to ensure the horse has the best chance of survival by acting quickly and efficiently.

Other reasons for abdominal surgery include emergency caesareans, castration, elected exploratory surgery, hernia repair and biopsy.

Respiratory procedures at the clinic can include diagnosis and management of upper respiratory tract infections to laryngeal and soft palate surgery.

There are many different procedures which can be carried out for the management and treatment of upper respiratory tract disorders. Many of the diagnostics necessary can be performed in either an ambulatory setting or at our clinic.

The most common procedures we perform out on the road are upper and lower airway fluid samples including tracheal washes, bronchoalveolar lavages and guttural pouch washes.  We are also able to perform endoscopy (using a videoscope) to visualise the upper airway and investigate the cause of any respiratory noise heard at rest or during exercise.

Acute and chronic equine asthma, strangles, pneumonia and IAD (inflammatory airway disease) are diagnosed by visualising the airway and performing tracheal, bronchoalveolar and guttural pouch washes. The fluid sample obtained is then analysed to finalise the diagnosis. These conditions can be treated at home.

The use of video endoscopy to inspect the upper airway during rest and exercise is frequently performed in racehorses and sports horses. Recurrent laryngeal neuropathy (RLN) and dorsal displacement of the soft palate (DDSP) are the most frequently diagnosed conditions associated with respiratory noise, both of which require surgical correction in order to maintain and improve performance.

Surgical corrections of many upper airway conditions can be performed under standing sedation. This reduces the risk to the patient and decreases recovery time.

Ventriculocordectomy (hobday) and laryngoplasty (tieback) are performed in order to correct for paralysis of the cartilage on the left side of the larynx (recurrent laryngeal neuropathy, RLN). This reduces abnormal patterns of airflow in the airway and helps to ensure that adequate airflow reaches the lungs. The overall success rate is good, and horses return to normal work.

Soft palate cautery and/or a ‘tie forward’ can be performed to return the soft palate to its intended position. The soft palate functions to separate the mouth from the back of the nose, and should lie under the epiglottis. Cautery is intended to reduce the flexibility of the soft palate, and therefore reduce the likelihood of it becoming dislodged. The ‘tie forward’ moves the larynx forwards to make a more secure seal between the soft palate and epiglottis. Again, the overall success rate is good, and horses return to normal work.

Equine sinusitis is another commonly diagnosed upper airway condition in the horse. Most commonly, this presents with foul smelling nasal discharge from one nostril, facial swelling, loss of performance and change in demeanour. The primary causes of sinusitis are upper respiratory tract infection or virus, upper cheek tooth root infections possibly due to fracture, and cysts or tumours within the sinus.

Investigating the cause of sinusitis must be carried out before it can be treated and antibiotics often do not solve the problem.  This usually involves a dental examination, x-rays of the head and endoscopy of the upper airway. In some cases, more advanced imaging is required and the horse will be referred for a CT scan in this case.

Surgery to lavage the infected sinus is performed under standing sedation and the sinus is visualised using a video-endoscope via a small hole made into the frontal bone of the horse’s head, known as a ‘trephine’. The endoscope is passed through the hole enabling thorough examination of the sinus, and then repeated flushing if required.

If dental issues are the underlying cause of the sinusitis, the tooth can be extracted under sedation either orally or if more difficult repulsed through a bone flap, however this is avoided where possible. A bone flap may also be used to remove sinus masses or cysts or deep pus which cannot be accessed using a small trephine.

It can take up to six weeks for full recovery from sinus surgery and for the infection to be fully cleared.

Our team offers methodical evaluation of wounds to enable effective management and treatment and ensure the best outcome for every patient.

Our veterinary surgeons are able to effectively manage and treat many types and sizes of wounds in the clinic or in an ambulatory setting. In some cases, patients may be referred into the clinic if the wound requires further surgical treatment and monitoring to ensure the tissues are healing well.

Many wounds are from the occurrence of the horses ‘fight or flight’ instinct, and they often react quickly with complete disregard for their limbs and other body parts. Some wounds are as a result from companions or owners or during exercise whether at home or away at competition.

Wounds can range from shallow superficial cuts and abrasions to large lacerations involving deep tissues, which can include muscle, tendon, ligament and bone. The wound location and the type of tissues involved are more critical than the overall appearance of the wound. Even some tiny wounds that are close to the joint can be serious, and can involve deeper structures which require further diagnostics and surgical treatment.

Depending on the area of the wound, and the length of time since it occurred, the majority of wounds will require a thorough physical exam which will be most practical for the patient, cleansing and if only a minor wound may require stitching which requires the horse to be heavily sedated.

In some cases it is advisable to x-ray and ultrasound the areas depending on which structures may have been damaged. If there is the possibility that the wound has opened a joint capsule or muscle sheath, synovial fluid will be taken from the area for laboratory processing to ascertain if infection is present.

Once the wound has been thoroughly assessed, a treatment plan will be put into place, which can include surgical flushing and debriding under general anaesthetic.

Following the stabilisation of the wound, an appropriate and practical post treatment care plan will be put into action. This may include a course of antibiotics, dressing changes, box rest and re-examinations to ensure the wound heals as quickly as possible.

Laparoscopy under standing sedation is the method of choice for removing ovarian tumours in mares.

In the past this was a surgery inherent with problems and post-operative complications, but the use of visualisation with a laparoscope, an efficient blood vessel sealing device and the avoidance of general anaesthesia have dramatically reduced these issues.

Laparoscopy is also employed for mares with fertility problems, cryptorchids  and on occasion investigation of horses with chronic colic.

Castration is the most common surgical procedure; the majority being performed in the field under standing sedation using the ‘open’ technique.

‘Closed’ castrations are carried out on some horses under general anaesthetic at the clinic. This technique is usually done on more valuable colts / stallions, older animals or those which have covered mares.

There are advantages and disadvantages to both techniques (standing/open versus general anaesthetic/closed) which the owner needs to appreciate in order to make an informed choice.

Our surgical team can perform equine orthopaedic surgeries involving arthroscopy, tenoscopy and fracture repair.

These types of surgery require the highest level of theatre and surgical hygiene, which we are proud to have, under the watchful eyes of their highly disciplined nurses.

The most common indications for arthroscopy are infection or contamination of joints.

This keyhole surgery allows for excellent visualisation of the affected structure, so that foreign material such as fragments of wood or blackthorn can be removed and the site can be flushed with a large volume of saline.

When these cases are treated early the response is dramatic with a horse transformed from being non weight bearing to sound in a matter of hours.

Arthroscopy is also used for the removal of bone chips and the assessment and treatment of some OCDs, whilst tenoscopy is used to examine and treat flexor tendon injuries that occur within the digital flexor tendon sheath as well as tendon sheath sepsis.

The majority of fracture repairs of the lower limb are now performed under standing sedation with regional anaesthesia of the affected area.

Our radiography system allows for immediate assessment of screw placement and position during surgery.

The huge advantage with this technique is that the risk of reinjury to the horse with a newly repaired fracture whilst recovering from general anaesthesia is abolished.