Effect of inbreeding on the incidence of retained placenta in Friesian horses

This study was motivated by the hypothesis that the incidence of retained placenta (RP) in Friesian horses is associated with inbreeding. The objectives were to 1) calculate the inbreeding rate in the total registered Friesian horse population; 2) study the association of the inbreeding coefficient of the foal and the mare with the incidence of RP; and 3) study the heritability of RP in Friesian mares after normal foalings. Data from the total registered Friesian horse population from 1879 to 2000 (52,392 individuals) were collected from the registration files of the Friesian Horse Studbook. In 1999 and 2000, 495 parturitions in 436 mares were studied. From 1979 to 2000, the inbreeding rate of the total population was 1.9% per generation. The regression coefficients for the regression of the incidence of RP on inbreeding coefficients of the foal and the mare were 0.12 +/- 0.052 and -0.016 +/- 0.019, respectively. Mean heritability estimates of RP as a foal trait and as a mare trait were 0.046 +/- 0.088 and 0.105 +/- 0.123, respectively. It was concluded that, in order to avoid a further increase in the incidence of RP in Friesian mares, a decrease in the inbreeding rate by increasing the effective breeding population is required. Furthermore, the findings indicate that the high incidence of RP in Friesian horses is at least partly a result of inbreeding.     

Aortic rupture and aorto‐pulmonary fistulation in the Friesian horse: Characterisation of the clinical and gross post mortem findings in 24 cases

Reasons for performing study: In horses, aortic sinus of Valsalva aneurysms or tears in the aortic root are well‐recognised conditions in breeding stallions, often leading to sudden death. A more uncommon form of aortic rupture, located proximal to the ligamentum arteriosum has been reported in 3 Friesian horses. Objectives: The purpose of this study was to phenotypically characterise aortic rupture and aorto‐pulmonary fistulation in Friesian horses in terms of clinical and post mortem data based on 24 cases. Methods: Friesian horses that were diagnosed with aortic rupture and aorto‐pulmonary fistulation over a period of 13 years (1997–2010) at the Department of Equine Sciences of Utrecht University (n = 15) and Wolvega Equine Hospital (n = 9), were included in this study. Case history, results of clinical examination and gross post mortem findings were screened and analysed. Results: Some cases were found dead without prior symptoms, but in several cases signs such as recurrent colic, peripheral oedema and sustained tachycardia were present for several weeks prior to cardiac failure. Clinical examination during hospitalisation revealed increased rectal temperature, peripheral oedema and increased jugular pulse with a bounding arterial pulse. In the majority of horses an aortic rupture of the aortic arch near the ligamentum arteriosum, concurrent with a circumferential cuff of perivascular haemorrhage and aorto‐pulmonary fistulation, was found at post mortem examination. Conclusions: Aorto‐pulmonary fistulation in conjunction with aortic rupture is more common in Friesians than previously estimated. In some cases findings demonstrate a progressive pathology rather than acute cardiac failure and sudden death. An appropriate approach is necessary during post mortem examination of the heart in order not to overlook the diagnosis. Potential relevance: Equine practitioners should realise that in Friesian horses presented with a history of recurrent false colic, coughing, sustained tachycardia and/or peripheral oedema, aortic rupture and aorto‐pulmonary fistulation should be included in the differential diagnosis.     

Surgical treatment of colic in the miniature horse: a retrospective study of 57 cases (1993-2006)

REASONS FOR PERFORMING STUDY: It has been suggested that the rate of post operative abdominal adhesions in miniature horses is higher than that for other breeds. However, few reports exist in the veterinary literature describing complications and long-term survival following surgical treatment of colic in these horses. OBJECTIVES: To determine the prevalence of surgical lesions in miniature horses with acute abdominal disease in terms of clinical signs, surgical management, post operative treatment and complications, as well as short- and long-term survival. METHODS: Medical records of 57 American Miniature Horses undergoing surgical treatment for acute abdominal pain at the Michigan State University Large Animal Veterinary Teaching Hospital 1993-2006 were evaluated for clinical information. Owners and trainers were contacted to gain information regarding long-term survival. RESULTS: The most common surgical lesion was a faecalith (38/57 cases) located primarily within the descending colon and most frequently diagnosed in horses age <6 months (19/38 cases). Short-term survival to hospital discharge for horses recovered from anaesthesia was 98% (55/56) with the most common post operative complications being diarrhoea and inappetance. Intra-abdominal adhesions were identified in 2/8 horses requiring a second celiotomy. Long-term follow-up was available for 45 horses and 87% (39/45) were alive at least 12 months after surgery. CONCLUSIONS: As previously reported, faecalith obstruction is a frequent surgical lesion in the miniature horse and is most common in miniature horses age <6 months. The incidence of adhesion formation may be lower than previously reported.     

Genetic diversity and population structure of Polish Arabian horses assessed through breeding and microsatellite data

Polish Arabian horses are one of the most important populations of this breed in the world. Their post‐war history can be divided into two periods, with the dominant role of state studs until 1989, and the increasing significance of private breeding in the next years. The goal of the study was to evaluate genetic diversity and structure of the population under a new breeding policy. The analyses of breeding and microsatellite data from 1996 to 2012 provide a coherent picture of the population with constant flow of horses only in one direction from state to private studs. An increase in the number of broodmares was observed, from 396 mares in 1996 to 1021 mares in 2012. The proportion of foreign sires used in Polish studs also increased, from 7.1% to 37.0%. An increasing number of alleles and progressive differentiation in mares were observed. STRUCTURE analysis indicated that the Polish horses were clearly separated from foreign horses used in Polish breeding, although only one of the 75 alleles found can be considered as typically Polish. The high heterozygosity is an important feature of the Polish population; however, the decrease of heterozygosity in state broodmares was noted. This issue needs to be studied further.     

Male, female and management risk factors for non-return to service in Dutch mares

The "effect" of stallion, mare and management-related factors on the odds of pregnancy per cycle in the horse were identified and quantified from the breeding records of Dutch Warmblood (n=4491), Friesian (n=1467) and Shetland-pony mares (n=3267) mated either naturally or by artificial insemination to one of the 88 stallions between 1992 and 1996. A mare was considered to be pregnant when she did not return to oestrous within 28 days of the last insemination. For Dutch Warmblood horses, the percentage of mares that did not return for service within 28 days (NR28) varied between studfarms and ranged from 61 to 82%. The NR28 for mares inseminated with fresh semen ranged from 67 to 74% and for mares inseminated with frozen/thawed semen this percentage was 59. Mares served at a second cycle had lower odds not to return than mares served at the third or subsequent cycle (OR=0.84). For Friesian horses, the NR28 for young mares was higher than that for older mares. Mares served before 1 May in any year had lower odds of non-return than mares served after 1 July (OR=0.69). The NR28 of mares inseminated once per cycle was 6% lower than that of mares inseminated three times or more per cycle. For Shetland ponies, the NR28 also varied between studfarms and ranged from 62 to 78%. Stallions < or =3 years old had lower odds of non-return compared to older stallion (> or =11) (OR=0.57). Mares served before 1 July had lower odds of non-return. Other significant factors for this breed were age of the mare, cycle number and insemination frequency. Stallion factors accounted for 5.9, 2.0 and 14.7% of the variation in the NR28 for Dutch Warmblood, Friesian horses and the Shetland ponies, respectively.     

A survey of reproductive performance in Thoroughbred mares and morbidity, mortality and athletic potential of their foals

A survey was performed to evaluate the reproductive performance of Thoroughbred mares, estimate risks of dystocia and of morbidity and mortality in foals during the first year post partum and their physical acceptability at age one year. The study population consisted of registered Thoroughbred mares and their foals owned by residents of 4 Western Canadian provinces. Owners were identified using information obtained from the North American Jockey Club, and questionnaires were mailed regarding mares bred in 1988 and their foals born in 1989. Eighty-three per cent of mares were reported to be pregnant at some stage following breeding, and 80% of pregnant mares subsequently gave birth to live foals. Estimates of morbidity and mortality were greater than previously reported, 25% of foals had health problems and 5% died during the first 2 weeks postpartum. Twenty-seven per cent of foals surviving 2 weeks were reportedly affected by some health problem between age 15 days and one year, and 6% died during this period. The case fatality rates of horses with upper respiratory tract infections and diarrhoea were much lower than case fatality rates for infectious diseases occurring less frequently. The rate of death or euthanasia among horses with musculoskeletal problems was relatively high after age 2 weeks. Foals with health problems up to age 2 weeks, or between age 15 days and one year were 5 to 7 times more likely to be classified as physically unacceptable for athletic use. Angular limb deformity was the health problem most commonly reported in foals receiving unacceptable physical assessments, and assessments of longterm athletic potential were apparently not affected by the occurrence of infectious diseases.     

Thoracic aortic rupture in horses

The aorta can rupture at the aortic root or aortic arch. In most breeds, the aortic root is the likely site and rupture leads to aortocardiac fistula with communication between the aorta and the right atrium, right ventricle and/or the interventricular septum. There is a high prevalence of aortic rupture in young Friesian horses and rupture occurs at the aortic arch with pseudoaneurysm and potentially aortopulmonary fistulation. Echocardiographic and post‐mortem techniques must be adapted to identify aortic arch rupture that is not generally identified with standard approaches. Given the narrow genetic base of the Friesian breed and the significant differences found in extracellular matrix composition and metabolism between Friesians and Warmbloods, genetic factors are likely to contribute to the condition in the Friesian breed.     

影响马胚胎移植成功率的关键因素分析

旨在探讨影响马胚胎移植效率的几种关键因素。本研究统计了国内北京马场、河北马场和山东马场2013-2018年胚胎移植数据,3个马场供体马数量分别为15、21和25匹,受体母马数量分别为56、50和75匹。所有母马年龄为3~12岁。统计供体马冲胚时间对胚胎回收率的影响;胚胎日龄对移植后受体马妊娠率的影响;供、受体母马排卵同期化程度对移植后妊娠率的影响;受体母马居住移植基地时间对移植后妊娠率的影响。结果显示,母马在配种季节注射前列腺素（PG）+GnRH类似物或PG+hCG诱发排卵,发情周期分别为（14.5±0.8）和（14.3±1.1）d,显著低于对照组的（（20.5±2.6）d,P<0.05）;排卵后第8天冲洗子宫的胚胎回收率均高于第7天,但差异不显著;8日龄胚胎移植后受体马的妊娠率均高于7日龄,差异不显著;供体母马排卵比受体母马早1 d时,胚胎移植后的妊娠率最高;受体母马在移植基地居住时间大于1年时,移植后妊娠率高于居住时间小于0.5年的受体马。根据以上结果,本研究得出如下结论,PG与hCG或GnRH类似物联合使用可缩短母马发情周期,母马排卵后第8天的胚胎回收率和移植后妊娠率较高,胚胎移植时选择居住时间大于1年且排卵时间比供体晚1 d的母马作受体。     

Distichiasis causing recurrent corneal ulceration in two Friesian horses

Two cases of distichiasis with subsequent recurrent superficial corneal ulceration are described in Friesian horses. Case 1 was a 9‐year‐old Friesian stallion with distichiae on the superior and inferior eyelids of both eyes corresponding to areas of recurrent superficial corneal ulceration. Case 2 was a 5‐year‐old Friesian gelding with a single distichia on the inferior lid associated with recurrent superficial corneal ulceration in the right eye. Case 1 underwent cryotherapy and epilation twice under standing sedation without resolution of distichiasis. A partial tarsal plate excision was then performed on the inferior left lid, which was the most severely affected. Cryotherapy was repeated one and 4 months post operatively due to recurrence. Cryotherapy was associated with skin depigmentation and repigmentation several months following the procedure. No recurrence has been reported up to 3 years following the fourth cryotherapy procedure. Case 2 was treated with epilation. Distichiasis should be included as a differential diagnosis when presented with a horse experiencing recurrent superficial corneal ulcerations. There has been no established breed association for Friesian horses and distichiasis but, due to the inherited nature of this condition in some human patients and dogs, this possibility should be investigated.     

The Athletic Performance of Thoroughbred Racehorses out of Mares with Suspected Placentitis during Gestation

Thoroughbred mares treated for signs of placentitis are potentially costly to farms and owners. Although these treatments often are effective, the resulting foal may require expensive aftercare. The current study investigated the future racing performance of foals from mares treated for clinical and subclinical signs of placentitis compared with matched control mares that had no signs of placentitis producing foals on the same farms. In total, 190 horses born from mares with suspected placentitis met the criteria for analysis and were matched with 190 horses born on the same farm. Mare data and percentage of stakes winners in each group were analyzed with Student t test. Analysis between pairs of horses was done using a paired t test for number of starts, wins, places, shows, and amount earned. Significance was set at a P value of <.05. Mares with suspected placentitis were slightly older than control mares, had slightly shorter lengths of gestation, and had a longer interval to subsequent pregnancy than control mares (P < .05). Horses out of suspected placentitis mares that were racing as 2 year olds in the study had no difference in starts, wins, places, shows, and percentages of black-type race winners; however, this group earned more than their matched control pairs (P < .05). Older horses (3 year olds) out of suspected placentitis mares had no differences in number of starts, wins, places, shows or amount earned; however, the matched control older horses had more black-type race winners (P < .05). The information from this study may aid owners when making decisions about treatment options.     

Factors Affecting the Incidence of Postpartum Fever in Heavy Draft Mares

Postpartum metritis is a common problem in many animal species. In equine medicine, sequelae of postpartum metritis vary from delay in uterine involution to development of systemic acute metritis (SAM), toxemia, and laminitis. Heavy draft mares potentially have higher risk of suffering from SAM than light breed mares. Postpartum fever (PF) mostly appears as a sign of SAM. The purpose of this study is to analyze the factors affecting the incidence of PF in 158 foalings from 62 heavy draft mares by multiple logistic regressions. The objective variable was the incidence of PF, and the explanatory variables were year foaled, month foaled, age of mare, breed of mare (crossbred heavy draft horse vs. Percheron), gestation length, foaling difficulty (easy delivery vs. dystocia), retained fetal membranes, stillbirth, and sex of offspring. Twenty-four out of 158 mares were diagnosed with PF. Stepwise regression analysis showed that breed of dams and foaling difficulty were significant risk factors for PF. Percheron mares had higher risk than crossbred mares (odds ratio: 3.4). Dystocia had higher risk than easy delivery (odds ratio: 3.3). Percheron mares had higher incidence of PF than crossbred mares even in the cases of easy delivery. Risks for damage and contamination of birth canal will be increased especially if the fetal delivery needs assistance. The results of this study suggest that it is necessary to consider the foaling difficulty and the breed of dams for earlier detection of PF in peripartum heavy draft mares.     

Pharmacokinetics of carbetocin,a long‐acting oxytocin analogue,following intravenous administration in horses

Reason for performing study: Current therapy protocols to treat persistent post mating endometritis and retained fetal membranes in mares typically include the administration of ecbolic drugs. Evaluation of the pharmacokinetics and tolerability of carbetocin, a long‐acting oxytocin analogue, after i.v. administration is required. Objectives: To determine the pharmacokinetic parameters (principally half‐life) of carbetocin in horses. Methods: Five mature mares and one gelding received 0.175 mg carbetocin i.v. All animals were monitored periodically throughout the study for elevation in rectal temperature, heart rate, respiratory rate and signs of pain or discomfort. Plasma samples were collected for determination of carbetocin concentrations by radioimmunoassay. Results: Administration of carbetocin was well tolerated by all horses and its half‐life was 17.2 min. Conclusions: The half‐life of carbetocin is greater than that previously reported for oxytocin (6.8 min). Potential relevance: Carbetocin is an attractive alternative to oxytocin therapy in broodmare management.     

Diagnostic and prognostic use of L‐lactate measurement in equine practice

Lactate concentrations can now be measured rapidly and inexpensively in equine hospitals or in the field with a degree of accuracy that is acceptable when compared to laboratory analysers. Arterial or venous blood samples can be used. Short‐term storage of samples for up to 4 h at room temperature does not appear to affect the result. Taking a sample in the field and returning to the practice to analyse it is therefore feasible. Lactate measurement is useful in horses with colic to aid in the diagnosis of an ischaemic lesion and to determine the probability of a successful outcome if surgery is undertaken. Lactate concentrations are also useful as an indicator of hypoxia and/or circulatory disturbances associated with intra‐, or post partum abnormalities including dystocia, prematurity, dysmaturity, neonatal encephalopathy, sepsis, systemic inflammatory response syndrome or enteritis. Measuring lactate concentrations may assist in determining the severity of these conditions and the need for intensive care. Initial lactate concentration and increases or decreases in blood lactate concentration following a period of treatment can provide useful prognostic information. Lactate may also be measured during training to monitor fitness and performance.     

Survival of horses following strangulating large colon volvulus

Reasons for performing study: The pattern of long‐term survival and specific factors associated with long‐term survival have not previously been evaluated in horses with a strangulating large colon volvulus (LCV). Objectives: To provide data on the long‐term survival of horses with LCV and to identify pre‐, intra‐ and post operative variables associated with survival. Methods: Clinical data and long‐term follow‐up information were obtained from 116 horses with a strangulating LCV (≥360°) undergoing general anaesthesia. Two multivariable Cox proportional hazards models for post operative survival time were developed: Model 1 included all horses and evaluated preoperative variables and Model 2 included horses that survived anaesthesia and evaluated pre‐, intra‐ and post operative variables. Results: The study population comprised 116 horses. Eighty‐nine (76.7%) survived general anaesthesia. Of these, the percentage that survived until discharge, to one year and to 2 years was 70.7%, 48.3% and 33.7%, respectively. Median survival time for horses that survived general anaesthesia was 365 days. In Model 1 increased preoperative packed cell volume (PCV) was significantly associated with reduced post operative survival (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.05–1.11). However, this effect changed over time. In Model 2 abnormal serosal colour intraoperatively (HR 3.61, 95% CI 1.55–8.44), increased heart rate at 48 h post surgery (HR 1.04, 95% CI 1.02–1.06), and colic during post operative hospitalisation (HR 2.63, 95% CI 1.00–6.95), were all significantly associated with reduced post operative survival. Conclusions: Survival time in horses with a LCV was associated with preoperative PCV, serosal colour, heart rate at 48 h post operatively and colic during post operative hospitalisation. Potential relevance: This study provides evidence‐based information on the long‐term survival of horses with LCV and identifies parameters that may assist decision‐making by clinicians and owners.     

Survival rate and short-term fertility rate associated with the use of fetotomy for resolution of dystocia in mares: 72 cases (1991-2005)

OBJECTIVE: To determine survival rate, complications, and short-term fertility rate after fetotomy in mares. DESIGN: Retrospective study. ANIMALS: 72 mares with severe dystocia. PROCEDURES: Records from 1991 to 2005 were searched for mares with dystocia in which a fetotomy was performed. Data relating to presentation and position of foals; survival rate, complications, and short-term fertility rate in mares; and 45-day pregnancy rate in mares bred 2 to 3 months after fetotomy were recorded. RESULTS: Anterior fetal presentation was detected for 54 of 72 (75%) mares, posterior presentation was detected for 13 (18.1%), and transverse presentation was detected for 5 (6.9%). One fetus in anterior presentation was hydrocephalic. Survival rate after fetotomy was 95.8%. Complications included retained fetal membranes (5.5%), laminitis (6.9%), vaginal and cervical lacerations (2.8%), and delayed uterine involution (2.8%). Mares bred 2 to 3 months after fetotomy had good short-term fertility, with a mean pregnancy rate of 79.4% at 45 days after breeding. CONCLUSIONS AND CLINICAL RELEVANCE: The survival rate was high, compared with rates reported after cesarean section, and short-term fertility rate was similar to those reported for mares that had a controlled vaginal delivery or cesarean section. Fetotomy performed by a skilled veterinarian on a nonviable fetus should be considered as a means of quick and safe correction of dystocia that does not necessarily impair short-term fertility in affected mares.     

Dystocia in a referral hospital setting: approach and results

REASONS FOR PERFORMING STUDY: Dystocia in the mare is an emergency in which duration has a profound effect on survival of the foal. Specific examination of the effects of dystocia duration on foal survival provides information to enable horse care personnel and veterinarians to manage these cases more effectively and maximise the chances of obtaining a live foal. HYPOTHESIS: Dystocia duration would have a negative impact on foal survival while method of dystocia resolution would not have an effect on foal survival. Additionally, we were interested in determining the effects of dystocia on subsequent fertility. METHODS AND RESULTS: In the years 1986-1999, 247 dystocias were admitted. Of these, 91 % resulted in survival and discharge of the mare, 42% in delivery of a live foal, and 29% of foals survived to discharge. Period from hospital arrival to delivery for foals alive at discharge (23.0 +/- 14.1 mins) was not significantly different than for foals not surviving (24.8 +/- 10.6 mins) (P > 0.05); and from chorioallantoic rupture to delivery for foals alive at discharge (71.7 +/- 343 mins) was significantly less than for foals not surviving (853 +/- 37.4 mins) (P < 0.05). Average predystocia live foaling rates for all mares with available records was 84%. Overall post dystocia live foaling rates over the entire period of this study were 67%. Of mares bred in the year of the dystocia, 59% had a live foal in the year following. CONCLUSIONS: Based on these results, dystocia duration has a significant effect on foal survival and resolution methods should be chosen to minimise this time, as the difference between mean dystocia duration for foals that lived and those that did not in this study was 13.6 mins. Post dystocia foaling rates reported here are higher than previously reported for both same-season and overall breedings, indicating same-season breeding may be rewarding for select dystocia cases. POTENTIAL RELEVANCE: Dystocia resolution methods that minimise delivery time may maximise foal survival. Post dystoicia breeding may be rewarding in select cases.     

Observations on the long term effects of Brucella abortus infection in the horse, including effects during pregnancy and lactation

Five mares and a stallion were studied from three to 30 months after experimental infection with Brucella abortus strain 544. The mares bred normally. No organisms were recovered from horses or from pregnant Friesian heifer contacts. Titres of serum antibody in the antiglobulin (Coombs) and complement fixation tests fell more slowly than those assessed by other tests. The serum of one foal yielded maternal antibody. An intradermal test was positive in infected adults only, and negative in all foals.     

Gastric and small intestinal ileus as a cause of acute colic in the post parturient mare

REASONS FOR PERFORMING STUDY: Ileus (functional obstruction of aboral gastrointestinal transit) is an uncommon cause of gastrointestinal dysfunction and colic in the horse. A number of specific conditions have been previously reported in association with ileus. This report describes the recognition of primary gastric and small intestinal ileus of undetermined cause in a series of post parturient mares. OBJECTIVES: To describe the clinical features, treatment and outcome of a series of episodes of primary gastric and small intestinal ileus. METHODS: A retrospective study was performed of colic episodes seen in an equine practice in Newmarket, UK over a 6 year period (2002-2007). RESULTS: Seventeen episodes of gastric and small intestinal ileus were identified, which occurred in 15 horses. All episodes occurred in post parturient mares. No previously reported cause of ileus was identified in any of the episodes. Fifteen of the 17 episodes received medical treatment (medical support and nasogastric decompression) and, in addition, surgical decompression was performed in 9 episodes. Two mares were subjected to euthanasia before treatment due to the presence of gastric rupture and the remaining 13 mares survived with a follow-up period of at least 10 months. Two mares suffered a further episode of gastric and small intestinal ileus, one 4 days and the other 2 years after the initial episode. CONCLUSIONS: Gastric and small intestinal ileus of, as yet, unknown aetiology appears to be a potential cause of acute colic in the post parturient mare. The outcome following treatment by decompression is good.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival

REASONS FOR PERFORMING STUDY: Few studies have evaluated long-term survival and complication rates in horses following surgical treatment of colic, making it difficult to offer realistic advice concerning long-term prognosis. OBJECTIVE: To review the complications occurring after discharge from hospital and survival to >12 months after surgery of 300 horses undergoing exploratory laparotomy for acute colic. Pre-, intra- and post operative factors that affected long-term complications and long-term survival were assessed. METHODS: History, clinical findings, surgical findings and procedures and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners. RESULTS: The long-term (>12 months) survival rate for 204 horses discharged after colic surgery and for which follow-up information was available was 84%. The most common complication after discharge was colic, affecting 35.1% of horses following a single laparotomy. Colic was most common in horses that had had small intestinal obstructions, bowel resection or post operative ileus. Abdominal adhesions were most common in horses that presented with severe colic due to strangulation of small intestine. Ventral hernia formation occurred in 8% of horses, and was most common in horses that had had post operative wound drainage or infection. CONCLUSIONS: This study identified various factors that appear to predispose horses to long-term complications after colic surgery. POTENTIAL RELEVANCE: Further evaluation of strategies that might reduce the incidence of such complications are needed; in particular, the value of intraperitoneal heparin should be evaluated, and procedures designed to reduce the rates of wound drainage and infection assessed.