Surgical repair of ruptured trachea in a horse

An Arabian mare was referred with traumatically induced complete transection of the trachea. A temporary airway was established through the open wound at the site of the rupture. Resection of devitalized tissue including 3 tracheal ring segments, and anastomosis of the tracheal ends was subsequently performed under general anesthesia. Wound healing was complicated by a peritracheal abscess, which responded successfully to drainage and antibiotic administration.     

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.     

Elevating the uterus (uteropexy) of five mares by laparoscopically imbricating the mesometrium

Reasons for performing study: There is a need for study of a method for restoring a ventrally positioned uterus to a horizontal position involving fertility of mares with delayed uterine clearance. Hypothesis: A ventrally‐angled uterus can be elevated to a horizontal position using a laparoscopic technique. Objective: To develop a laparoscopic technique of imbricating the mesometria to elevate the uterus to a horizontal position. Methods: The right and left mesometria of 5 pluriparous mares, all barren for 1–8 years (mean 3.8 years), with a pendulous, ventrally‐angled uterus were shortened laparoscopically, by imbrication, with the mares standing, to raise the uterine body and horns to a horizontal position. Sutures were placed through the dorsal aspect of the uterine body and uterine horn and the adjacent region of the mesometrium using a simple continuous suture pattern. Results: The uterus of all 5 mares was elevated successfully to a horizontal position. Three of the mares became pregnant the same year, without other treatment, after the procedure. Conclusions: A pendulous, ventrally‐angled uterus can be returned to a normal, horizontal position by imbricating the mesometria, using a laparoscopic technique. Potential relevance: Elevating a ventrally‐angled uterus to a horizontal position may improve egress of uterine debris, thereby improving fertility.     

Endometrial candidiasis in five mares

Five cases of endometritis caused by yeast were seen at Texas A & M University, and are presented in this paper. Possible methods of diagnosis and therapy are discussed. A guarded prognosis for future reproductive performance should be expected if this syndrome occurs in concert with poor perineal conformation.     

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.     

Laparoscopic repair of ruptured urinary bladder in a stallion

A 12-year-old stallion was evaluated because of pollakiuria; endoscopy of the urinary tract during general anesthesia revealed that the urinary bladder was intact. After recovery, the stallion developed clinical and biochemical signs of bladder rupture, which was confirmed by endoscopy. Cystoplasty in adult stallions represents a unique surgical dilemma; the large distance between the incision site and the bladder necessitates the repair be accomplished under maximum tension with minimal exposure. Because traditional surgical approaches through ventral midline or paramedian incisions provide limited access and viewing, laparoscopy was used to provide a definitive diagnosis, good viewing, easy access, tension-free dissection, and a secure repair. Lack of surgical complications and postoperative discomfort, rapid and uncomplicated healing, and patient-client satisfaction make laparoscopic cystoplasty the preferred method for surgical repair of ruptured urinary bladder in adult stallions.     

Surgical reconstruction of a ruptured medial collateral ligament in a foal

An avulsed carpal medial collateral ligament was diagnosed by clinical and radiographic examination in a 1-day-old foal that was unable to bear weight on the affected limb. The foal had a valgus deviation originating at the carpus and medial to lateral instability of the affected carpus. The ligament was reconstructed with screws and suture tape. Surgical reconstruction is a viable alternative to long-term casting or splinting for treatment of a ruptured carpal medial collateral ligament in a foal.     

Laparoscopic repair of a ruptured bladder in an adult mare

A bladder rupture suffered by an adult mare during parturition was repaired, using a laparoscopic approach with the mare in dorsal recumbency. During the laparoscopic approach, the bladder was empty, inverted and had a rent on the dorsal apical surface. The bladder was located far caudally within the pelvis. By grasping the left lateral ligament and exerting gentle traction, it proved possible to manoeuvre the bladder more cranially where the rupture could be sutured. The benefits of the laparoscopic approach are reduction in incision size, visualisation of the tear, reachability of the empty bladder and the tear, and reduced reconvalescence time.     

Standing surgical repair of cystorrhexis in two mares

Two surgical techniques were used to evert the bladder into the vagina for observation and repair of bladder tears that were associated with parturition. One technique involved an incision through the vaginal floor into the peritoneal cavity just caudal to the cervix, and prolapse of the bladder into the vagina. The second technique involved a 3-cm incision through the urethra, 5 cm cranial to the urethral orifice, and digital exploration of the tear and finger traction to evert the bladder through the urethral incision. In both mares, the bladder defects were repaired in two layers, with use of 2-0 polyglycolic acid in a simple continuous pattern. After repositioning, the vaginal and urethral incisions were closed in single layers using absorbable suture material. A standing vaginal approach eliminates the need for general anesthesia and allows excellent observation and repair of bladder tears in adult mares.     

Treatment of haemoperitoneum secondary to ruptured granulosa cell tumours in two mares

This report describes two cases of successful surgical management of granulosa cell tumours (GCT) in mares presenting with haemoperitoneum (HP). Controlled abdominal drainage was initially attempted in Case 1 but was not successful. A ventral midline exploratory laparotomy allowed removal of a haemorrhaging 13 kg GCT. The mare made a full recovery and returned to normal work as a driving pony 11 months post-operatively. In Case 2 controlled abdominal drainage was followed by standing left flank laparoscopic visualisation of the bleeding ovary and transection of the ovarian pedicle by electrocautery. The GCT was then removed via a ventral midline incision due to its large size. Haemoperitoneum can be associated with GCTs and in some cases is severe enough to prompt emergency treatment. Stabilisation of the patient and removal of the haemorrhaging GCT can lead to a successful outcome.     

Surgical treatment of uterine torsion using a ventral midline laparotomy in 19 mares

OBJECTIVE: To report on the outcome of surgical treatment of uterine torsion in preterm mares. DESIGN: Retrospective case series of pregnant mares with uterine torsion presented to the Clinic for Obstetrics, Gynaecology and Andrology of Large and Small Animals. METHODS: Hospital records of all pregnant mares that underwent ventral midline laparotomy for uterine torsion between 1998 and 2004 were reviewed. The signalment, history, clinical signs, results of diagnostic procedures, direction and degree of the uterine twist, treatment and outcome were retrieved from each case record. RESULTS: This study comprised 19 mares between months 5 and 11 of pregnancy (8.7 +/- 1.9) and suffering from uterine torsion. In all cases ventromedian laparotomy was carried out under general anaesthesia. Gastrointestinal disorders were also present in 52.6% of horses. Postoperative complications included subcutaneous seromas (five mares), peritonitis (one mare) and abortion (two mares). In four mares (21%) the operation was unsuccessful (i.e. these mares had to be euthanased intra- or postoperatively). Of the surviving 15 mares, 13 (86.6%) gave birth to viable foals at full term. The foals developed normally. Only two mares aborted. CONCLUSIONS: Because of its versatility the ventral midline approach should be considered for correction of uterine torsion. The approach has many advantages, including rapid and clear access to the abdominal cavity, safety, visual assessment of uterine wall viability, correction of concomitant gastrointestinal tract problems, and performance of hysterotomy or hysterectomy, if indicated. In this study, managing uterine torsion in this way resulted in a high percentage of cases (86.6%) in which pregnancy was maintained, with the birth of a viable, mature foal.     

Standing laparoscopic repair of a ruptured urinary bladder in a mature draught horse

Rupture of the urinary bladder, although relatively common in foals, is an infrequent occurrence in adult stallions. Standing laparoscopic repair of a ruptured urinary bladder offers significant advantages over other treatment options, and to date, there are no reports describing this technique in treating adult stallions. This case study details the treatment of a mature draught horse for uroperitoneum secondary to a ruptured urinary bladder. Standing laparoscopic repair of the ruptured bladder was performed. No major post operative complications developed, and the horse has not had any recurrence of problems with the urinary bladder. Successful standing laparoscopic repair in this horse demonstrated the method's viability, which offers superior intraoperative visualisation and access to the bladder, while eliminating the risks of general anaesthesia.     

Surgical repair of a thoracic meningocele in a foal

A 6 week old American Paint filly was admitted for evaluation of a dorsal thoracic mass suspected to be a meningocele. The diagnosis was confirmed by plain and contrast enhanced computed tomography. Surgical repair was performed by dissection of the base of the meningocele followed by ligation. No postoperative complications occurred. Contrast enhanced computed tomography was useful to confirm the diagnosis of meningocele and rule out a meningomyelocele.