Post‐partum uterine rupture: Standing repair in three mares using a laparoscopic technique

Abstract

Three mares underwent diagnostic laparoscopy because of suspicion of post-partum uterine ruptures. All three horses showed clinical signs of a uterine rupture between 1 and 3 days after parturition and underwent diagnostic laparoscopy. In all cases a full thickness uterine rupture could be detected and was sutured laparoscopically. Availability of suture material and surgeon experience were responsible for the surgical methods chosen for repair. In the first case, a hand-assisted laparoscopic approach was chosen for suturing the ruptured uterus, whereas in the other cases the approach was entirely laparoscopic. In the second case, extracorporeal knots were used for the repair and in the last case described a barbed loop suture was available for closure of the uterus. Two of three mares were alive for at least 12 months after surgery without any abdominal problems. One of these mares delivered a healthy foal 2 years after surgery. The remaining mare died 3 months after surgery but no necropsy was done. Laparoscopy should be considered for post-partum mares with signs of peritonitis to access the uterus and repair a rupture if it is accessible. A laparoscopic approach using intracorporeal knots or barbed sutures for the repair of the uterine rupture as well as a handassisted laparoscopic approach are feasible. The use of the barbed suture for intracorporeal closure makes the minimal invasive laparoscopic technique easier to perform.

Standing laparoscopic repair of an uterine rupture in a post-partum mare

“…Another advantage of this technique is the option to flush the abdominal cavity and viscera from the laparoscopic portals in a dorsal to ventral fashion. As reported in the previous article, this system permits aspiration of the fluid from the abdominal cavity (Diekstall et al 2018), avoiding the placement of an intra-abdominal drainage ventrally, which might have been problematic with the foal in this case and was therefore avoided. Following small full-thickness uterine tears, the smooth muscle surrounding the tear contracts and thus makes any communication between uterine lumen and abdominal cavity difficult to detect (McNally 2012).…”

“…Previously, surgical repair of uterine ruptures have been performed under general anaesthesia via caudal ventral midline celiotomy, a flank approach (Hassel and Ragle 1994) or hand-assisted laparoscopy (Cribb and Chenier 2012, Klohnen 2012, McNally et al 2012. There are only two reported cases of a solely laparoscopy performed in the standing horse so far (Diekstall et al 2018). Minimally invasive techniques are usually related to decreased post-operative morbidity and mortality and ergo a faster return to work (Lee and Hendrickson 2008).…”

“…Although expertise of the surgeon was fundamental when manipulating the two needle holders in the axial abdomen, closure of the uterine defect was achieved without major problems and no penetration of a segment of bowel occurred. Moreover, diagnostic laparoscopy should be considered for post-partum mares with peritonitis as it allows assessment of the uterus and the gastrointestinal tract for concomitant damage (Diekstall et al 2018). Another advantage of this technique is the option to flush the abdominal cavity and viscera from the laparoscopic portals in a dorsal to ventral fashion.…”

“…A solely laparoscopic approach in the standing horse has been recently reported in two mares (Diekstall et al 2018) using extracorporeal knots or barbed sutures. Likewise, a minimally invasive approach was selected in this case because of the location of the lesion and to eliminate the anaesthetic risk.…”

“…In this report, the diagnosis and the surgical treatment via standing laparoscopy using a barbed loop suture to resolve a uterine rupture are described. Moreover, the surgical technique included a laparoscopic flushing of the abdomen as part of the treatment for peritonitis, as mentioned by Diekstall et al (2018).…”