Equine Female Urogenital Surgery Flashcards
What is Episioplasty ?
Correction of a hooded vagina
1) Caslick’s procedure
2) Perineal body reconstruction
3) Perineal body transection
What is another name for Caslikcs operation?
- Vulvoplasty
- episoplasty
What operation should be performed for Pneumovagina?
Caslick’s (vulvoplasty)
-prevent aspiration of air into vagina
What are the causes of Pneumovagina?
- Poor conformation
- injury
Why do we perform episioplasties?
Prevent:
- vaginitis
- Cervicitis
- Metritis
- infertility
- Noise production
What preparation for episioplasty should be done in a mare?
- standing (stocks)
- manual removal of feces
- sedation
- bandage tail
- scrub + disinfect
- local anesthetic infiltration (dorsal 1/3, between mucosa and skin)
What suture pattern should be used for an episoplasty?
Vertical mattress
What aftercare should be considered for vulvoplasty?
Episiotomy (reopening of vulvoplasty BEFORE foaling
What is a breeders stitch ?
-reminder to do episiotomy
What are the indications for a Perineal body reconstruction?
1) ineffective vulvar + vestibular seal
2) failed Caslick’s procedure
3) recto-vestibular injuries
- removal of a triangular piece of mucosa (vestibulum)
- incision mucocutaneous junction of labium
- retract and suture cranially towards yourself
What suture pattern is used for Perineal body reconstruction?
-Deep horizontal mattress sutures
What aftercare must be considered for perineal body reconstruction?
- 4-6 weeks sexual rest
- Episiotomy at Foaling
When is Perineal body transaction indicated?
- Forward sloping of vulva
- no decrease in vulvar and vestibular openings
What closure can be done for Perineal body transaction?
1) suture
2) second intention healing
What is Urovagina?
- Unwind pooling
- Vesicovaginal reflux (VVR)
What are the clinical signs of Urovagina?
- Vaginitis
- Cervicitis
- Endometritis
- Decreased conception rates
What are the causes of Urovagina?
- Ectopic ureter
- Pneumovagina
- Excessive closure of Caslick’s
How would you treat Urovagina?
1) Caudal relocation of transverse fold (Vaginoplasty)
- cut sliver of transverse fold
2) Caudal urethral extension (urethroplasty)
* elongates the urethra
- Brown
- McKinnon
- Shires
- Monin
What is the Shires technique?
Urethroplasty (caudal urethral extension)
- good for older mares
- horizontal mattresses
- simple interrupted
What are some foaling injuries?
- Perineal lacerations
- Rectovestibular fistula
- vaginal contusions
- vaginal rupture
- cervical lacerations
- uterine rupture
- uterine hemorrhage
- uterine prolapse
- uterine bladder (eversion, prolapse, rupture
- GIT injuries
What are the 3 degrees of PERINEAL LACERATIONS?
First degree:
-Only mucosa, vestibule, vulva
Second degree:
-Mucosa + submucosa
Third degree:
-Perineal body, anal sphincter, floor of rectum
What would you treat first degree Perineal laceration?
Basically like a hematoma
LEAVE it alone, NSAIDs
What would you treat SECOND degree Perineal laceration?
Mucosa + Submucosa
Tx: not much to do NSAIDs
What would you treat THIRD degree Perineal laceration?
Perineal body, anal sphincter, floor of rectum
Tx:
- local debridement
- tetanus prophylaxis
- repair in 4-6 weeks postpartum
- after weaning
- diet change (soft feces)
- standing
- tracheostomy
What are the causes of thrid degree Perineal lacerations?
1) Primiparous mares
2) Fetal malposition
3) nose or foot catches vulvovaginal fold
WHy do you not want to suture a THIRD degree perineal laceration straight away?
Make sure you give tetanus but, Delay immediate surgery because:
- its blunt trauma so the tissue will slough
- want to weight for after weaning
What are the 4 basic surgical principles to consider when treating a 3 degrees perineal laceration?
1) minimum tension on suture line
2) branch contact of wound surfaces
3) strong suture material
4) reduce amount of feces
What are the 2 ways to repair rectovestibular lacerations (3 degree perineal lacerations)
1) Aanes method
- two stage repair
2) Goethe or Vaughan method
- Single stage
When correcting a rectovestibular laceration via Aanes method, how long in between stages must you wait?
2-3 weeks
Then second stage repair
What is a rectovestibular fistula?
Laceration of dorsal vestibular into rectum WITHOUT disruption of the perineal body or anal sphincter
How would you treat a rectovestibular fistula?
1) if small —> spontaneous closure
2)Surgicallly via:
— Rectum
— vestibular/ perineal body
3) direct closure of fistula
4) Via third degree laceration
Why do you use a continuous suture pattern for rectovestibular fistula repair?
- disperses tension Evenly along suture site
* might need to be done a second or third time
When would you perform a UNIlateral ovariectom?
1) Granulosa cell tumor
2) Ovarian abscesses
When would you perform a BIlateral ovariectomy?
1) eliminate estrous
2) Eliminate nymphomania
What should be done preoperatively for an Ovariectomy?
- off feed 12-24hrs pre op
- laparoscopy 12-48hrs
-rectal palpation (+ US)
——-size
——-adhesions
——-abscessation - Diestrus or anestrus (not an emergency so time it well)
- Antibiotics/ Tetanus
What approach can be used for an standing ovariectomy?
1) flank
2) colptomy (transvaginal)
3) laparoscopy
What approach can be used for GA ovariectomy?
1) flank
2) ventral midline
3) Paramedian
4) laparoscopy
What is an ecrseur?
Placed over the ovarian pedicle for ovariectomy
- no ligature
What complications can occur with ovariectomy?
- suture dehiscence
- post op pain
- colitis
- laminitis
- etc….
What are the advantages of laparoscopy vs celiotomy?
- smaller incisions
- direct visualization
- tension-free ligation
- shorter pos op recovery
What are the causes for C- section in the mare?
Fetal:
- large foal
- abdnomal Position, Posture, presentation
- deformities
Maternal:
- old pelvic fractures
- cervical stir cures
- uterine torsion
- uterine rupture
In preparation fo C-section: what is the time limit to manually correct the fetus?
15 mins
What Closure do you use for C- section in the mare?
2 layer closure
- Cushing
- Lambert’s
