• The Bühner procedure involves placing a buried suture to constrict the vestibule region.
• It is believed to aid in the prevention of vaginal or uterine eversion.

Uses

• A Bühner suture is used to treat:
  • Eversion of the vagina/cervix (Vaginal prolapse Vaginal prolapse).
  • Eversion of the uterus (Uterine prolapse Uterine prolapse).
    • Opinions differ as to whether the Bühner suture should be used for uterine prolapse cases - see disadvantages.

Advantages

• Relatively easy procedure to carry out.
• Minimally invasive procedure.

Disadvantages

• The cow will require assistance at parturition if the Bühner’s suture is still in place.
• There is some controversy as to whether Bühner sutures should be used on cattle with uterine prolapse. The author and reviewer themselves disagree on this point!
  • The author's opinion is that it is a safe technique to use on selected prolapsed uterus cases. The author feels that most uncomplicated cases do not re-prolapse after replacement. The author feels that the Bühner is a useful technique for cows that remain recumbent or continue to strain after uterine replacement.
  • The reviewer feels that this is not an appropriate technique for uterine prolapses.  The reviewer has had to deal with a number of cases whereby a cow has re-prolapsed and has badly damaged the uterus and vagina when prolapsing with a Bühner suture in place.

Technical problems

• If the tape used is implanted superficially, and tenesmus continues, the tape may tear through the skin and re-eversion may occur.

Alternative techniques

• Caslick procedure Caslick procedure.
• Bootlace technique:
  • Several (4 to 5) small eyelets composed of umbilical tape are inserted along each side of the vulva at the haired and hairless junction.
  • Tape is then laced through the eyelets (similarly to how shoelaces are laced).
  • As the tape is tightened, the labia tend to invert into the vulva, disrupting the labial seal.
• Horizontal mattress suture (Halstead) technique .
  • A suture needle and suture are passed through the deep tissues at the base of the dorsal aspect of the labium and then across the vulvar cleft,  through the base of the contralateral labium.
  • The needle is then reinserted through the labia in the same plane, approximately 2-3 cm ventrally to the previous stand.
  • This process is repeated with several 2-3 more horizontal mattress sutures placed ventrally to one another, until the opening from the ventral commissure is a 2 – 3 finger sized opening.
• Deep vertical mattress suture technique .
  • This technique is similar to the horizontal mattress suture (Halstead) technique described. The technique differs only in that vertical mattress sutures are inserted, rather than horizontal mattress sutures.

Time required

Preparation

• 1 - 5 min for epidural anesthetic to be administered and 5 min for aseptic preparation.

Procedure

• 5 min.

Decision taking

Criteria for choosing test

• Technique to be used to retain the vagina after it has been replaced back into the birth canal.
• Technique to be used to retain the uterus after it has been replaced back into the birth canal particularly when cow is unable to rise or tenesmus commences post uterine replacement.

Risk assessment

• The prolapsed tissue (whether it is vaginal or uterine) should be thoroughly examined to assess for evidence of trauma and viability.