Laparoscopically Assisted Percutaneous Inguinal Ring Closure for Resolution of Inguinal/Scrotal Hernias in Rams: Cadaveric Study and Three Cases Report

SIMPLE SUMMARY: Indirect inguinal hernia in sheep can reduce the fertility and affected animals may present serious problems that can be life-threatening. The aim of this work is to describe a laparoscopically assisted technique to suture the internal inguinal ring in rams, preserving testicles. In six ram cadavers, both vaginal rings were partially closed. Two methods were tested on each side. The number of sutures required to achieve a satisfactory closure was recorded. After the cadaveric study, the procedure was performed on three rams with inguinal hernia and the occurrence of re-herniation was followed up. In cadavers, the technique could be easily and satisfactorily performed with either of the two systems. In two clinical cases, the procedure was successfully performed without hernia recurrence or alterations in reproductive behavior in the following months. In the third case, problems during laparoscopy prevented hernioplasty and the animal herniated again. This technique can be used as a simple and feasible surgical treatment for rams with inguinal hernias when preservation of the testicles is preferred. Although a larger number of cases are needed to evaluate long-term safety and effectiveness, this technique should be considered as an alternative to castration in rams with inguinal hernia. ABSTRACT: The aim of this study is to evaluate a laparoscopically assisted percutaneous suture (LAPS) procedure to treat inguinal hernia (IH) while preserving testicles in rams. An ex vivo experiment with six ram cadavers and a report of three clinical cases are discussed. In cadavers, both internal inguinal rings (IIR) were partially closed by LAPS. Two LAPS methods were tested: (1) using a laparoscopic portal closure device and (2) using a suture loop inserted through needles in each IIR. After each procedure, the closure was laparoscopically evaluated and the number of U- sutures was recorded. The procedure was also performed on three client-owned rams with unilateral non-strangulated IH and the occurrence of re-herniation was followed up. In cadavers, LAPS of the IIRs could be easily and satisfactorily performed with either of the two systems, requiring one to three U-sutures per IIR. No differences were observed between the two surgical procedures. In two clinical cases, the procedure was successfully performed without reoccurrence of herniation or alterations in reproductive behavior in the following 3 and 6 months. In the third case, the hernia was reduced but a retroperitoneal emphysema during laparoscopy prevented hernioplasty and the animal herniated again. In conclusion, LAPS of IIR can be used as a simple and feasible treatment to preserve testicles in rams with IH.