Surgical treatment of guttural pouch disease is indicated in horses with guttural pouch mycosis and/or chronic guttural pouch empyema that fail to respond to medical therapy. A revolutionary approach to treatment of guttural pouch mycosis involves transarterial coil embolization of the underlying artery. This technique combines fluoroscopy and selective occlusion of necessary vasculature. This procedure can be successful, although specialized equipment and extensive experience with the technique areessential. Traditional ligation techniques are also effective but can be difficult to perform. The vessels to be ligated depend, to some extent, on the site of the lesion as determined by endoscopy or arteriog-raphy. Lateral (i.e., hyovertebrotomy and Viborg's triangle) and ventral (Whitehouse, modified Whitehouse) surgical approaches can be used in treating horses with chronic guttural pouch empyema. Each approach may cause at least temporary dysphagia. Another potential therapy for chronic empyema includes creation of a fistula in the pharyngeal opening of the guttural pouch using a neodymium:yttrium-aluminum-garnet laser.
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