Surgical repair of rectovaginal fistulae in mares: Twelve cases (1983-1991)

The case records of 12 mares at the Ontario and Atlantic Veterinary Colleges were reviewed to evaluate the success rates of surgical techniques used to repair rectovaginal fistulae. A modified horizontal perineal technique was used in eight mares; it was unsuccessful in one mare, but the fistula was subsequently successfully repaired using the same technique. One rectovaginal fistula that was converted to a third-degree perineal laceration was successfully repaired on the third attempt, using the suture principles of the modified horizontal perineal technique. A modified transvaginal technique was used in three mares, in two of which it failed; their fistulae were subsequently converted to third-degree perineal lacerations and repaired using a one-stage closure. We conclude that the modified horizontal perineal technique is a one-stage procedure that is technically easy to perform, results in less tension on the suture lines, and is effective in modifying poor vulvar conformation.     

A Modified One-Stage Repair of Third-Degree Rectovestibular Lacerations in Mares

A modified one-stage surgical repair was performed on eight mares that suffered from third-degree rectovestibular lacerations. The rectovestibular septum was reconstructed by three lines of sutures using polydioxanone. Primary healing was achieved in seven mares. Four mares got pregnant after the surgery, and no further injury was noticed at subsequent delivery. Complications of the currently used technique included pneumorectum (in one mare) and rectovestibular fistula (in another mare). The obtained results indicated that mares with third-degree rectovestibular lacerations are candidates for this modified one-stage technique with satisfactory outcome for subsequent fertility.     

Surgical management of perineal lacerations and rectovestibular fistulae in the mare: a retrospective study of 47 cases

The case records of 47 mares with third-degree perineal lacerations or rectovestibular fistulae were examined to evaluate their fertility following surgical repair. Of 32 mares bred, 24 became pregnant, suggesting that surgical repair is indicated in any mare with sufficient genetic potential. Perineal trauma after surgical repair was recorded in 3 of 20 mares at subsequent parturition.     

Comparison of endometrium before and after repair of third-degree rectovestibular lacerations in mares.

The endometrial response of mares to repair of third-degree rectovestibular lacerations was evaluated. Endometrial biopsy specimens from 8 mares with third-degree rectovestibular laceration were obtained immediately before surgery and from 9 to 15 days after repair. Presurgical endometrial biopsy specimens were classified as category I for 2 mares; category II, attributable to slight endometritis, for 5 mares; and category III, attributable to moderate-to-severe endometritis, for 1 mare. Within 15 days after rectovestibular repair, all endometrial biopsy specimens were classified as category I. Results indicated that mares with third-degree rectovestibular injuries are candidates for breeding by artificial insemination by 2 weeks after repair of the injury.     

Eversion of the Urinary Bladder: A Sequel to Third-Degree Perineal Laceration in the Mare

Two cases of urinary bladder eversion are described in association with third-degree perineal lacerations in the mare. One case of eversion followed surgical repair of the perineal defect. The other occurred spontaneously in a 5-month postpartum mare awaiting repair of a third-degree perineal laceration. Both everted bladders contained the pelvic flexure of the large colon, and in 1 case a bladder rent allowed evisceration. Surgical intervention was required, and was successful in one case.     

Third-degree perineal lacerations and rectovestibular fistulae in cattle: 20 cases (1981-1988)

The case records of 20 cows with either a third-degree perineal laceration or rectovestibular fistula were reviewed to ascertain the signalment, history, treatment, and long-term result of treatment. Fifteen cows, including 10 first-calf cows, had third-degree perineal lacerations that occurred at calving. Surgery was done in 14 of 15 cows; 10 of the 14 (71%) remained fertile. The cow that was not treated surgically was culled after 24 months because of infertility. Five cows had a rectovestibular fistula; 4 of these were treated surgically. The cow that did not have surgery healed by second intention and remained fertile, and 3 of the 4 cows in which surgery was performed were fertile. None of the cows that produced calves after the initial injury suffered a perineal laceration at subsequent calvings. Single-stage surgical repair of third-degree perineal laceration or rectovestibular fistula appeared to have a good prognosis for subsequent fertility in cows.     

Reconstruction of third-degree perineal lacerations in female camels (Camelus dromedarius) using a modified Goetz one-stage repair technique

This study was designed to evaluate the modified Goetz-one-stage repair technique for reconstruction of third-degree perineal lacerations (TDPLs) in female camels. Fifteen female dromedary camels with TDPL were surgically reconstructed using the modified Goetz one-stage repair using the three-line closure technique. The surgical outcomes, the interval between repair and breeding, and the postoperative conception of the operated female camels were recorded and analyzed. During the 12-month postoperative follow-up period, TDPLs in 14 female camels (93.33%) healed completely by the first intention with mild inflammatory edema and infection in 2 female camels. One camel (6.67%) had a rectovaginal fistula, which was successfully repaired with suturing through the vaginal approach. Of the 15 female camels, 13 (86.67%) subsequently became pregnant through natural mating within 3 to 6 months postoperatively; however, 2 (13.33%) were one was immature and the other was barren which referred for gynecological treatment. The modified Goetz one-stage repair technique was successful in 14 of the 15 female camels after a single surgery, with a low incidence of postoperative complications. This technique is efficient for the repair of TDPLs in female camels, with promising results for subsequent fertility.     

The Effect of Extended Preoperative Fasting in Mares Undergoing Surgery of the Perineal Region

Horses with third-degree perineal lacerations require surgical treatment. To reduce the risk of postoperative dehiscence of the surgical site caused by tension, bacterial contamination, and mechanical abrasion, a preoperative and postoperative fasting up to 14 days was performed. A complete blood cell count, concentrations of electrolytes, urea, creatinine, glucose, lactate, cholesterol, triglycerides, total protein, and the activities of aspartate aminotransferase, glutamate dehydrogenase, γ-glutamyl transferase, creatine kinase, and alkaline phosphatase were determined. Fasting resulted in a marked decrease in intestinal motility and an increase in the concentrations of triglycerides and cholesterol. The activity of the glutamate dehydrogenase increased three-fold during the presurgical period. The other biochemical values showed few fluctuations. Based on these data, we concluded that presurgical and postsurgical fasting causes no severe imbalances in the metabolism in mares.     

A one-stage repair of third-degree perineal lacerations and rectovestibular fistulae in 17 mares.

Third-degree perineal lacerations or rectovestibular fistulae in 17 mares were repaired surgically by a one-stage method. Primary healing occurred in 14 mares; there were one complete dehiscence and two partial dehiscences with fistula formation. Twelve of 13 mares that were bred became pregnant; nine carried foals to term and two are still pregnant. Two mares have each produced one unthrifty foal. One mare repeatedly aborts in the first trimester. Four mares have produced several healthy foals with no further problems. One mare suffered further perineal trauma while foaling.     

Equine Perineal and Vulvar Conformation Correction Using a Modification of Pouret's Technique

An incompetent vulvar seal leads to reproductive failure, and a surgical intervention might be required. The present paper describes modifications to Pouret's surgery. We suggest the use of a simple interrupted vertical mattress suture, which avoids seroma. Eighteen Brazilian Jumping Horse mares, older than 20 years and barren for 3-5 consecutive years, underwent modified Pouret's surgery. A horizontal skin incision of 3-4 cm was made half way between the anus and upper commissure of the vulva. The submucosal and connective tissue were dissected, and the rectovaginal shelf was split horizontally by sectioning the muscular and ligamentous connections between the anus, vulva, caudal portion of the rectum, and vagina until the vulva was oriented vertically. The wound was changed from a horizontal plane to a vertical plane by placing the suture vertically using approximately eight interrupted U sutures distributed in two layers with polyamide thread. The modified Pouret's surgical technique provided a perfect coaptation of the vulvar lips and a correct perineal position. Those mares that presented with horizontally tipped vulvar lips due to advanced age and stretching of the pelvic tissues by multiple foaling had their vulvas replaced. Also, the surgical procedure was easy to perform. As to fertility, of the 18 initial mares, 14 were inseminated, and all became pregnant. Thus, it was possible to conclude that the anatomical changes performed throughout the surgical procedure predisposed to a better vulvar coaptation, correcting the pneumovagina.     

Surgical technique to repair grade IV rectal tears in post-parturient mares

Objective— To describe a surgical technique for repair of grade IV rectal tears after parturition in mares and to report outcome.
Study Design— Clinical report.
Animals— Horses (n=6) with grade IV rectal tears.
Methods— Mares were sedated and restrained in standing stocks. After caudal anesthesia and evacuation of feces from the rectum, the perineal region was aseptically prepared. Four stay sutures were placed through the external anal sphincter before vertical transection (12 o'clock). Caudal retraction of the tear was performed using Allis tissue forceps (5 mares) or stay sutures before accurate apposition of the tear margins with steel staples below the tissue forceps. The mucosal edges were then sharply dissected leaving ∼5 mm edges which were apposed in a single layer (2-0 poliglecaprone 25) before stapler release. In 1 mare, the rectal tear was identified and apposed using a 2-layer hand-sutured closure. Systemic antibiotics and anti-inflammatory agents were administered postoperatively (5 mares) and standing abdominal lavage performed (3 mares).
Results— Four mares survived long term and subsequently became pregnant. Immediately after surgical repair, 1 mare was anesthetized for exploratory celiotomy and abdominal lavage but fractured her pelvis during recovery from anesthesia and was euthanatized. A 2nd mare was euthanatized after 72 h because of severe diffuse peritonitis; however, the repair was still intact.
Conclusion— In standing mares, rectal tears can be exteriorized by prolapse through the anal sphincter after sphincterotomy and repaired in 2 layers with staples oversewn with a continuous suture pattern.
Clinical Relevance— Rectal tears occurring as a result of parturition can potentially be repaired efficiently using an oversewn stapled primary closure technique.     

Surgical Removal of One Conceptus from Fifteen Mares with Twin Concepti

A surgical technique for removal of one conceptus from mares with twin concepti more than 35 days of gestational age was evaluated. One conceptus was removed surgically from each of 15 mares carrying twin concepti that were 41 to 65 days of gestational age. As determined by ultrasonography, eight mares had bicornuate and seven mares had unicornuate twin concepti. For maintenance of pregnancy if surgical trauma should cause prostaglandin release and luteolysis, progesterone was administered prophylactically. Flunixin meglumine was administered perioperatively to minimize prostaglandin release. Five mares with bicornuate twin concepti delivered a single viable foal; in one mare the fetus was alive 4 days after surgery when the mare was euthanatized because of a fractured femur. None of the remaining feti in the seven mares with unicornuate twin concepti survived. The poor survival rate of unicornuate twin concepti was attributed to disruption of the remaining chorioallantois during surgery. Thirteen mares have been rebred successfully.     

Streptomycin-resistant Escherichia coli as a marker of vulvovestibular contamination of endometrial culture swabs in the mare.

To investigate the vulvovestibular contamination of endometrial culture swabs in the mare, a liquid culture of a streptomycin-resistant strain of Escherichia coli was applied to the vulvovestibular area of mares and used as a marker of contamination of endometrial culture swabs. Prior to taking endometrial swabs, the perineal area was washed with soap, rinsed with water, and dried. Endometrial culture swabs were taken from mares that were in anestrus or diestrus and from mares that were in estrus. When a manual transvaginal swabbing technique was used, 22 of 24 endometrial swab specimens from 12 mares were contaminated with the experimental bacterial strain; culture of only one endometrial swab yielded more than nine colonies. When a speculum approach was employed, three of 12 swab specimens from 12 mares yielded between one and three colonies. The stage of cycle had no effect on the extent of contamination, but the proportion of positive cultures was significantly smaller when swabs were taken via a vaginal speculum approach, compared to a manual transvaginal approach. Complete preclusion of vulvovestibular contamination of endometrial swab specimens was not achieved; however, fewer than ten colonies can be expected even in mares in which the vulvovestibular area has been thoroughly contaminated with a broth culture, provided that the perineal area is adequately cleaned prior to swabbing.     

Laparoscopic Anatomy of the Abdomen and Laparoscopic Ligating Loops,Electrocoagulation, and a Novel Modified Electroligation Ovariectomy in Standing Mare

The purpose of this study was to provide a detailed laparoscopic anatomy of the caudal abdominal region of mare in a standing position and to evaluate and modify a technique for standing laparoscopic ovariectomy using combination between hand-tied ligating loop and electrocoagulation techniques, as the ligating loops, electrocoagulation, and modified electroligation laparoscopic ovariectomy were applied using nine adult mares. Laparoscopy was practical and effective for direct visual examination of internal abdominal organs in the mare. Ventral dislocation of abdominal viscera after pneumoperitoneum was established with the mare in standing position, which provided an excellent inspection of the dorsal and ventral structures in the peritoneal cavity on the right and left sides. Standing laparoscopic ovariectomy using an electroligation modified method was considered a safe and effective method for hemostasis of the mesovarium, technically easy, time saving, and economical. The mean surgical time for bilateral ovariectomy was 40 ± 7.63, 60 ± 5.25, and 85 ± 6.43 minutes for electroligation-modified technique, ligating loops technique, and electrocoagulation technique, respectively.     

SURGICAL REPAIR OF RECTO-VAGINAL FISTULAE IN MARES

SUMMARY A modified method for the repair of recto-vaginal fistulae in mares is described. Mares are given a general anaesthetic and the fistula is repaired directly through the vulva leaving the anus and perineal body intact.     

Analgesic, hemodynamic, and respiratory effects induced by caudal epidural administration of meperidine hydrochloride in mares.

OBJECTIVE: To determine the analgesic, hemodynamic, and respiratory effects induced by caudal epidural administration of meperidine hydrochloride in mares. ANIMALS: 7 healthy mares. Procedure: Each mare received meperidine (5%; 0.8 mg/kg of body weight) or saline (0.9% NaCl) solution via caudal epidural injection on 2 occasions. At least 2 weeks elapsed between treatments. Degree of analgesia in response to noxious electrical, thermal, and skin and muscle prick stimuli was determined before and for 5 hours after treatment. In addition, cardiovascular and respiratory variables were measured and degree of sedation (head position) and ataxia (pelvic limb position) evaluated. RESULTS: Caudal epidural administration of meperidine induced bilateral analgesia extending from the. coccygeal to S1 dermatomes in standing mares; degree of sedation and ataxia was minimal. Mean (+/- SD) onset of analgesia was 12 +/- 4 minutes after meperidine administration, and duration of analgesia ranged from 240 minutes to the entire 300-minute testing period. Heart and respiratory rates, rectal temperature, arterial blood pressures, Hct, PaO2, PaCO2, pHa, total solids and bicarbonate concentrations, and base excess were not significantly different from baseline values after caudal epidural administration of either meperidine or saline solution. CONCLUSIONS AND CLINICAL RELEVANCE: Caudal epidural administration of meperidine induced prolonged perineal analgesia in healthy mares. Degree of sedation and ataxia was minimal, and adverse cardiorespiratory effects were not detected. Meperidine may be a useful agent for induction of caudal epidural analgesia in mares undergoing prolonged diagnostic, obstetric, or surgical procedures in the anal and perineal regions.     

Hand-assisted laparoscopic ovariohysterectomy in the mare

OBJECTIVE: To develop a minimally invasive, hand-assisted laparoscopic ovariohysterectomy (HALS-OHE) technique in the mare and to evaluate safety and any associated complications. STUDY DESIGN: Experimental study. ANIMALS: Eight, 11-24-year-old mares with anatomically normal urogenital tracts. METHODS: The surgical technique was developed in 2 non-survival mares and subsequently evaluated in 6 survival procedures. Food was withheld for 48 hours, then mares were anesthetized and positioned in dorsal recumbency for laparoscopic surgery. A hand access device (Omniport) was placed followed by 4 laparoscopic portals. Transection of the ovarian pedicles and broad ligaments was achieved using a combination of a laparoscopic stapling instrument (Endo GIA II), an ultrasonically activated instrument (Harmonic Scalpel), and endoscopic clips (Endo Clip II ML). The genital tract was exteriorized through the laparotomy, and the uterus transected and sutured in a conventional pattern. Horses were evaluated through postoperative day 14 when a necropsy was performed. RESULTS: Four mares recuperated well after surgery, 1 mare was euthanatized because of bilateral femur fracture during anesthetic recovery, and another developed severe pleuropneumonia. At necropsy all but 1 abdominal incision was healing routinely. One mare had abscessed along the celiotomy incision and developed visceral adhesions. Uncomplicated healing of transected mesovarial, mesometrial, and uterine remnants was observed. CONCLUSIONS: Ovariohysterectomy in horses can be accomplished using HALS technique. CLINICAL RELEVANCE: HALS-OHE technique represents a minimally invasive and technically feasible alternative for conventional OHE. Careful patient selection and preparation may reduce the complications observed. The HALS technique may be useful in other laparoscopic surgical procedures.     

Total and partial ovariohysterectomy in seven mares

REASONS FOR PERFORMING STUDY: Ovariohysterectomy appears to have a low mortality rate in mares, but the procedure needs to be reviewed because of the high risk of life-threatening complications. HYPOTHESIS: That ovariohysterectomy can be effective treatment for a variety of uterine diseases in mares and carries a good prognosis. METHODS: Diagnosis, clinical data, surgical technique, post operative care, complications and outcome were recorded from medical records of 7 mares that underwent total (6) and partial (1) ovariohysterectomy at the University of Illinois from 1994 to 2001. RESULTS: The indications for ovariohysterectomy were chronic pyometra (4 mares), chronic uterine torsion (n = 2) and chronic intramural haematoma (n = 1). Surgical exposure was difficult but was improved by traction on stay sutures and right-angled clamps. In some cases, application of the TA-90 autosuture instrument as a right-angled clamp to the caudal part of the uterus improved access to the uterine stump. The most common post operative complications were decreased faecal output, decreased intestinal sounds (4 mares) and mild abdominal pain (2). Two mares had mild to moderate incisional infections. Other previously reported complications, such as haemorrhage, septic peritonitis, uterine stump infection or necrosis, and diarrhoea, did not occur. All mares survived over follow-up periods of 6 months to 5 years and were used for riding (6 mares) and embryo transfer (1 mare, after partial ovariohysterectomy). CONCLUSIONS AND POTENTIAL RELEVANCE: According to this study, the prognosis for mares after ovariohysterectomy appears to be good, despite the technical difficulties of the procedure. The prevalence of life-threatening complications can be lower than reported.     

Repair of urinary bladder rupture through a urethrotomy and urethral sphincterotomy in four postpartum mares

OBJECTIVE: To report the clinical findings, surgical technique, and outcome after repair of urinary bladder rupture through a urethral incision in postpartum mares. STUDY DESIGN: Retrospective study. ANIMALS: Four Thoroughbred broodmares. METHODS: Medical records were reviewed for clinical signs, surgical technique, medical therapy, and outcome. The bladder was everted into the vagina through a urethral incision that included a sphincterotomy. The bladder defect was repaired with absorbable suture material in a single-layer, full thickness, simple, continuous pattern. The urethral incision was closed similarly. RESULTS: Depression, inappetence, signs of shock, dehydration, azotemia, and serum electrolyte abnormalities were consistent findings that increased temporally after bladder rupture. Each bladder defect was repaired successfully, and metabolic derangements were corrected with supportive medical therapy. All mares survived, conceived, and had more foals without further complications CONCLUSION AND CLINICAL RELEVANCE: Bladder rupture associated with parturition in mares can be repaired in a standing position by eversion of the bladder through a urethrotomy and urethral sphincterotomy.     

Vestibuloplasty for Persistent Pneumovagina in Mares

Occasionally Caslick vulvoplasty does not resolve the condition of pneumovagina. This study aimed at evaluating the validity of surgical construction of artificial vestibular valve in standing mares. For 10 sedated mares with history of chronic pneumovagina, upside down U-form incision was made on the vestibular mucosa and sutured together to form a large valve after the cover. The surgical site was opened for another cover or foaling and sutured again. The condition of air aspiration into the vagina was monitored ultrasonographically after the surgery. In 9 of the 10 mares, the signs of pneumovagina improved after the surgery and 8 mares had normal foaling the next year. In addition, all mares which had the second surgery after the surgical site was incised for the second cover or foaling were conceived and had normal foaling in the following breeding season. The results revealed that construction of the vestibular valve can be a potential surgical option for the treatment of persistent pneumovagina.