Laparoscopic Closure of the Nephrosplenic Space for Prevention of Recurrent Nephrosplenic Entrapment of the Ascending Colon in the Standing Horse

Laparoscopic ablation of the nephrosplenic space should be considered in horses that are predisposed to recurrent LDDLC (left dorsal displacement of the left colon) with entrapment into the nephrosplenic space. Rocken et al, Vet Surg. 2005 Nov-Dec;34(6):637, reviewed the medical records of 4,852 horses treated for colic over 16 years to establish the incidence of LDDLC and recurrence after treatment. Review of his medical records revealed an incidence of LDDLC of 6% and recurrence of 21% in a population of horses with signs of colic. Other authors reported recurrence rates from 7.5 % to 8% (Baird et al, JAVMA 1991, Hardy et al, EVJ supplement 2000).
Our hospital policy at the moment is to treat the nephrosplenic entrapments (LDDLC) with phenylephrine hydrochloride infusion. Surgical treatment is only performed if the left colon is very gas distended and the horse suffers from a lot of abdominal pain. Laparoscopic closure of the nephrosplenic space was not performed standard after a first LDDLC but owners were informed of this type of surgery in case of a recurrent colic due to nephrosplenic entrapment.
We only operated horses, which suffered from a recurrence of the LDDLC.
Between 2000 and 2006, the medical records of 805 colic horses admitted to the hospital De Bosdreef/De Morette with a known follow-up were reviewed. Ninety (11%) horses suffered from a nephrosplenic entrapment and in 715 (89%) horses the colic was not caused by a LDDLC in the nephrosplenic space. The age varied from 1 to 23 years old, ± 9.5 years old, mean 9 years old. There was no sex predilection (55% mares, 45% males).
The majority of the 90 horses suffering from an entrapment in the nephrosplenic space were treated medically, the percentage of recurrence of the nephrosplenic entrapment are shown.

The laparoscopic technique was first described by Marien et al, Vet Surg. 2001 Nov- Dec;30(6):559-63, but some technique modifications have been reported since (Rocken et al, Vet Surg 2005, Fartsvet et al, Vet Surg 2005). Recently, Epstein et al, Vet Surg 2006 described the laparoscopic obliteration of the nephrosplenic space using a polypropylene mesh.
Over the years we also made some modifications to the original described technique and the following points are important:

• Always check pre operatively is the left colon is not displaced and located between the spleen and the left abdominal wall. This can be the case in horses with recurrence of LDDLC without causing clinical symptoms of abdominal discomfort. Perform an ultra sound examination if in doubt. One has to be 100% sure there is no left colon between spleen and left abdominal wall to prevent accidentally puncturing the colon when introducing the first trocar.
• The surgery is performed on the standing horse without CO2 insufflation.
• We do not routinely use phenylephrine intravenously pre- or per operatively to contract the spleen.  [...]