Description of a Modified Two-Step Omphalectomy Technique Using the LigaSure™ Device to Remove the Whole Extrahepatic Umbilical Vein: A Case Series Study in Equine and Donkey Foals

Abstract

Umbilical disorders are common in equids, although scarce information is available in donkeys compared to horses. Foals with these disturbances have high morbidity and mortality rates. The conventional omphalectomy technique does not remove the whole umbilical vein, which can lead to infection in the remnant vein or even liver abscess. At the moment, if the whole umbilical vein needs to be removed, a longer ventral midline incision must be performed, which is linked with several complications. This retrospective case series study focused on a modified two-step omphalectomy using the LigaSure^TM device in each step in five neonate foals (4 horses and 1 donkey) with umbilical disorders. Using this modified technique, the whole umbilical vein (from the stump to the liver) can be removed without the need of incision extension. Two foals in this series had complications not related with the surgery and had to be euthanized. In the surviving foals (three of five), no long-term complications have been reported. Therefore, this modified two-step technique using the LigaSure^TM device could be a suitable surgical option to decrease short- and long-term complications in neonate foals undergoing umbilical surgery. However, a multicentric prospective study on a larger number of animals is required.

Keywords: donkey; omphalitis; septic foal; umbilical vein abscess; urachus.

Figure 1

Modified two-step omphalectomy technique description. (A) Donkey foal placed on dorsal recumbency. (B) Aseptically prepared surgical area. (C) Double ligation of the umbilical vein cranial to the stump prior to vein transection using LigaSure™. Note that the stump has been grasped with forceps (yellow asterisk). (D) Dissection of the abdominal wall in order to isolate the internal umbilical structures and bladder while the stump is grasped (yellow asterisk). Note the previously transected umbilical vein has been clamped to the abdominal wall to keep the tension (white asterisk). (E) Double ligation of the left umbilical artery prior to artery transection with the Ligasure™ device (blue asterisk). (F) Both LigaSure™ and the surgeon’s hand are placed inside the abdominal cavity to remove the entire umbilical vein. Note the silicone sheet protecting the abdominal viscera (orange asterisk).

Figure 2

Ultrasound and macroscopic views of the internal umbilical structures removed using the modified two-step omphalectomy. (A) Internal umbilical remnant ultrasound showing an enlarged umbilical vein (higher than 1 cm, dotted white line) with a hyperechogenic foci displaying acoustic shadow (white asterisk). (B) Enlarged abscessed umbilical vein (yellow asterisk) in a donkey foal. Compare the size of the umbilical vein (yellow asterisk) with the rest of the internal umbilical stump and the bladder apex (white asterisk). (C) Internal umbilical remnant ultrasound showing an enlarged umbilical artery (greater than 1 cm, white dotted line) compared to a normal-sized and ultrasonographic artery (red dotted line). Bladder and urachal communication (patent urachus) can also be seen in the image (green asterisk). (D) Macroscopic view of an enlarged, congestive, and edematous umbilical artery (yellow asterisk). Note the external stark and bladder apex (yellow spotted line) and an umbilical vein of normal size and appearance (white asterisk). (E) Ultrasound of the abdominal cavity showing a rounded mass (approx. 2.6 cm) close to the liver displaying an echogenic wall with an hypoechogenic content compatible with a liver abscess (white dotted line). (F) Macroscopic image of the abscessed umbilical vein remnant forming an abscess in the entry of the liver.