Standing Thoracoscopic Diaphragmatic Hernia Repair Using a Dual-Facing Mesh in a Horse

The purpose of the report, is to describe the surgical procedure adopted in a horse, to repair a diaphragmatic hernia by using a dual facing meshA 6-year-old Warmblood gelding was referred for colic surgery. Exploratory laparotomy revealed a small intestine strangulation in a 8-10 cm left dorsal diaphragmatic tear. A jejuno-jejunal anastomosis following resection of the strangulated intestine was accomplished. The horse recovered uneventfully and five days after surgery, a left sided thoracoscopy in standing position was performed. The diaphragmatic defect was repaired by using a dual facing mesh anchored with synthetic absorbable screws and permanent titanium helicoidal tacks.At follow-up thoracoscopy, 30 days later, the mesh was in the correct position, pleural tissue was covering 90% of the mesh surface, and signs of shrinking were absent. The surgical procedure performed by the authors is minimally invasive and presents some advantages compared to conventional thoracotomy as it gives an excellent visualization of the thoracic cavity combined with decreased perioperative morbidity and pain.Standing thoracoscopic application of a mesh should be considered as a reasonable option while planning the closure of a dorsal diaphragmatic tear in horses.