Mare Reproductive Surgery

Question 1

Pneumovagina

Answer 1

Air being allowed into the repro tract

• old, underweight, pluriparous mares
• vulvovaginal sphincter incompetence
• sunken perineal body/anal sphincter
• leads to chronic inflammation/endometritis and reduced fertility

Question 2

Pneumovagina repair

Answer 2

Caslick’s (vulvoplasty)

• requires local anesthesia, and/or sedation
• small band of tissue removed from labia
• closed with simple continuous, continuous interlocking, horizontal mattress
• vulva is sutured down to the level of the ischium
• breeding stitch can be used to protect the incision during breeding –> large gauge suture on ventral edge of vulvar closure

Question 3

Perineoplasty - procedure

Answer 3

• local/regional anesthesia
• retraction sutures
• dorsal commissure to ventral anal sphincter (apex of triangle)
• 1/2 of that distance to the right and left of dorsal commissure (base of triangle)
• suture vertically

Question 4

Modified perineoplasty

Answer 4

Transect connection between rectum and vagina to allow for more normal confirmation

Question 5

Urovagina

Answer 5

Older, pluriparous mares

• conformational defect: cranial displacement of urethral opening, inability to urinate uphill
• irritation and infection
• endometritis
• urine scalding
• seen w/ neurological conditions (EPM) that affect micturition control

Question 6

Urovagina - repair

Answer 6

Urethral extension procedure

• tunnel from urethral orifice caudally along vesibule
• elliptical incision thru mucosa
• 3 layer closure
• caslick
• antibiotics given for 3-5 days
• NSAIDs for pain/inflammation

Question 7

Perineal lacerations

Answer 7

• 1st degree: skin and mucous membrane of dorsal commisure of vulva
• 2nd degree: disruption of mucous membranes and involves deeper muscular layer –> suture or wait until swelling and bruising decreases
• 3rd degree: complete tear involving all layers and communicating with the anus, creating a cloacae –> delayed closure until after 1 month of healing, stool softeners

Question 8

3rd degree correction

Answer 8

Dissection thru scar tissue laterally, dorsally, ventrally

• continue dissection 1-1.5 inches past cranial end of defect
• 2 layer closure

Question 9

Rectovaginal fistula

Answer 9

Perineal body intact, will find during breeding, speculum exam (will see feces in vagina)

• horizontal dissection midway thru perineal body
• longitudinal halsted sutures in submucosa of rectal defect
• transverse Halsted in vaginal defect
• close dead space and perineal body skin

Question 10

Cervical lacerations

Answer 10

If internal os intact, may not need correction

• scar tissue may result in tearing at future parturitions
• retention sutures in external cervical os
• mucosa debrided
• 3 mucosal layers
• caslick
• antibiotics

Question 11

Ovariectomy via colpotomy

Answer 11

• standing sedation
• epidural anesthesia
• colpotomy incision
• chain ecrasuer is used to remove ovaries

Question 12

Ovariectomy - procedure

Answer 12

• take a guarded blade into the vagina
• make a stab incision
• remove blade
• enlarge rent manually
• chain ecrasuer
• rent in vagina does not need to be closed!
• cross tie mare in stall for 3-4 days to help prevent herniation