Surgery

Surgery in elephants usually follows the rules that are applicable to surgery in horses. Standing sedation with or without local anesthesia is required for minor procedures, while general anesthesia (in lateral or dorsal recumbancy) is required for large procedures (such as abdominal surgery) and if standing sedation poses a risk for the surgeons.

See for anesthetic procedures the anesthesia page.

Abdominal surgery in elephants

Access to the elephant's abdomen is restricted to a relatively small area between the last ribs on the cranio-dorsal side, the hind leg on the caudal side fusing together in the ventral midline.

Indications for abdominal surgery described in the literature are limited: cesarean sections have all resulted in the death of the dam. However, a dorso-lateral approach has been used for castration of male African and Asian elephants (Fowler 1973, Byron 1985, Fourner 1994).

Fourteen male African elephants (12–35 years old) were anesthetized with etorphine and supported in a sling in a modified standing position, and positive pressure ventilated with oxygen (Rubio-Martinez 2014). Anesthesia was maintained with IV etorphine. Vasectomy was performed under field conditions by bilateral, open‐approach, flank laparoscopy with the abdomen insufflated with filtered ambient air. A 4‐cm segment of each ductus deferens was excised. Behavior and incision healing were recorded for 8 months postoperatively. Successful bilateral vasectomy (surgical time, 57–125 minutes) was confirmed by histologic examination of excised tissue. Recovery was uneventful without signs of abnormal behavior. Large intestine lacerations (3 elephants; 1 full and 2 partial thickness) were sutured extracorporeally. One elephant that was found dead at 6 weeks, had no prior abnormal signs. Skin incisions healed without complication.

Laparoscopic ligation of the ovarian pedicles has been performed in free ranging African elephants (Stetter 2004). A specially designed 90 cm long operating laparoscope was used to reach for the ovaries.

An umbilical hernia was diagnosed in a 2-wk-old Asian elephant (Elephas maximus) by physical and ultrasonographic examinations (Abou-Madi 2004). Umbilical herniorrhaphy was elected because the defect was large (approximately 7 cm long and 10 cm deep) and could potentially lead to incarceration of an intestinal loop. General anesthesia was induced with a combination of ketamine, xylazine, and diazepam and maintained with isoflurane in oxygen. The hernial sac was explored and contained fibrous tissue, fat, and an intestinal loop but no adhesions. The hernial sac was resected and the body wall closed using the technique of simple apposition. Following a superficial wound infection, the surgical site healed with no further complications.

There is one anecdotal report on successfull abdominal surgery in a 14-month-old African elephant suffering of repeated colics (click here for the case report).

References

Abou-Madi, N., Kollias G.V., Hackett R.P., Ducharme N.G., Gleed R.D., and Moakler J.P. 2004. Umbilical herniorrhaphy in a juvenile Asian elephant (Elephas maximus). J. Zoo & Wildl. Med35(2): 221–225, 2004.
Byron H.T., Olsen J., Schmidt M., Copeland J.F. and Byron L. 1987. Abdominal surgery in three adult male Asian elephants. J. Am. Vet. Ass. 187, 11.
Foerner J.J., Houck R.I., Copeland J.F., Schmidt M.J., Byron H.T. and Olsen J.H. 1994.Surgical castration of the elephant (Elephas maximus and Loxodonta africana). J. Zoo & Wildl. Med. 25 (3), pp 355-359. (Click here for summary)
Fowler M .E., Hart R. 1973. Castration of an Asian elephant, using etorphine anesthesia. J. Am. Vet Ass 163, 6.
Rubio- Martinez L.M. Hendrickson D.A., Stetter M., Zuba J.R. and Marais H.J. 2014. Laparoscopic Vasectomy in African Elephants (Loxodonta africana). Veterinary Surgery 43 (2014) 507–514.
Stetter M.D. 2004. Laparoscopic surgery in elephants. Int. Elephants Res. Symp. Fort worth, Texas. December 2-5, 2004

Non-abdominal surgery in elephants

Surgical procedures not associated with open access to the abdomen are more common. Despite the enormous healing capacity of the elephant skin, wound healing often takes place per secundam, because it is hard to protect the sutured wound against negative mechanical and biological influences. However, even large wounds (like in vaginal vestibulotomy) will heal completely per secundam, leaving at most a 2 mm fistula (click here for wound healing in vaginal vestibulotomy).

Trunk injuries are hard to repair because of the extreme mobility of this organ. Many attempts to suture large perfortaing trunk wounds have have failed or at best resulted in partial adhesion of the sutured sites.

Repair of a perineal hernia has been described (click here to read this case report).