Abdominal closure and complications

Complications can develop in the ventral median incision in 40% of horses after intestinal surgery, with incisional drainage in 32 to 36% of horses, dehiscence in 3 to 5%, and hernia formation in 6 to 17%. Factors associated with incisional complications include age, size, type of incision, type of suture material, method of closure, the degree of surgical trauma, length of surgery, and the difficulty of anesthetic recovery. For ventral midline closure, polyglycolic acid is significantly stronger than polydioxanone and monofilament nylon, but polydioxanone has better mechanical performance after implantation. A continuous suture pattern in the linea alba is quicker to perform and is stronger than most interrupted patterns. The optimal bite size for adult equine linea alba is 15 mm from the edge, and sutures are usually placed that distance apart. Closure of subcutaneous tissues is optional and skin can be closed with a variety of materials and patterns. A temporary, water-impervious, self-adhesive, plastic drape may reduce incisional contamination in the recovery stall. Bandages are expensive and not used routinely, but can protect the incision from contamination and trauma, and reduce edema. Treatment of infection involves removal of skin sutures and topical cleaning, with or without systemic antibiotics. Dehiscence of the linea alba is usually caused by tearing of the body wall and not suture breakage. Hernias develop slowly and repair by suture closure or by mesh should be postponed for approximately 3 to 4 months after the initial surgery.