Ovary: ovariohysterectomy - laparotomy approach in Horses (Equis) | Vetlexicon
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Ovary: ovariohysterectomy – laparotomy approach

ISSN 2398-2977

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Introduction

  • Ovariohysterectomy is rarely performed in horses.
  • It is technically demanding, highly invasive and associated with high morbidity.

Uses

  • Chronic pyometra   Uterus: pyometra   (unresponsive to medical management).
  • Intramural hematoma.
  • Uterine neoplasia (leiomyoma, leiomyosarcoma).
  • Macerated fetus.
  • Mucometra.
  • Chronic uterine torsion   Uterus: torsion  .
  • Uterine rupture.

Advantages

  • Laparoscopic equipment and training not required.
  • May be appropriate for removal of severely enlarged uterus.

Disadvantages

  • Very invasive, large incision.
  • High morbidity.
  • Poor intra-operative visibility.
  • Poor intra-operative exposure.
  • Excessive post-operative morbidity.

Alternative techniques

Requirements

Preparation

Pre-medication

Dietary preparation

  • Fast for 12-14 h prior to surgery to reduce colon fill and improve surgical access to the uterus.
  • Consider nasogastric intubation with laxative   Gastrointestinal: nasogastric intubation  to avoid post-operative impaction.

Site preparation

  • Standard aseptic clip, preparation and draping of the ventral abdomen for a caudal ventral midline approach.

Restraint

Technique

Approach

Step 1 - Caudal ventral midline incision

  • 35-40 cm incision dividing the mammary glands or passing paramedian to avoid the mammary glands.
  • Expose body wall by blunt and sharp dissection of fat.

Step 2 - Body wall incision

  • Incise body wall on ventral midline to prepubic tendon.

Core procedure

 

Step 1 - Ovarian ligation and transection

 
  • Blunt dissection of the mesovarium on broad ligament side.
  • Double transfixed ligation of the ovarian artery.
  • Dissect mesovarium on ovarian side and transect using serra emasculators.
  • Repeat this for the other ovary.

Step 2 - Broad ligament dissection

 
  • Continue dissection of broad ligament caudally, ligating and transecting branches of ovarian and uterine arteries.

Step 3 - Uterine body transection

 
  • An empty TA90 cartridge or Best right angle clamps can be placed across the uterine body to enable retraction of the cervix cranially.
  • Place stay sutures across cervix.
  • Pack off abdomen against spillage of uterine contents.
  • Start inverting suture pattern (Lembert)   Surgery: suture patterns - hollow organs  and transect uterine body in short section, closing each in a stepwise fashion.
  • Complete closure by adding one or more continuous inverting sutures (Cushing)   Surgery: suture patterns - hollow organs  .

Step 4 - Abdominal lavage

 
  • 5-10 l of sterile balance polyionic fluid.

Exit

 

Step 1 - Standard body wall closure

 

Aftercare

Immediate Aftercare

General Care

  • Stable rest with in-hand walking for 6-8 weeks.

Analgesia

Antimicrobial therapy

  • Broad spectrum: penicillin   Penicillin G   22,000 IU/kg IM BID and gentamicin   Gentamicin  6.6 mg/kg IV SID for 5 days.

Special precautions

  • Blood transfusions   Blood: transfusion  may be necessary depending on the disease process.

Potential complications

  • Incisional infection and dehiscence.
  • Decreased appetite and reduced fecal output.
  • Uterine stump infection.
  • Peritonitis   Abdomen: peritonitis  .

Long term Aftercare

Follow up

  • Transrectal ultrasound to evaluate uterine stump and ensure absence of stump pyometra.

Outcomes

Reasons for treatment failure

  • Wound dehiscence.
  • Peritonitis.
  • Uterine stump infection.

Prognosis

  • Good, though technically difficult procedure.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Santschi E M et al (1995) Ovariohysterectomy in six mares. Vet Surg 24 (2), 165-171 PubMed.
  • Rötting A K et al (2004) Total and partial ovariohysterectomy in seven mares. Equine Vet J 36 (1), 29-33 PubMed.
  • Woodford N S, Payne R J & McCluskie L K (2014) Laparoscopically-assisted ovariohysterectomy in three mares with pyometra. Equine Vet Educ 26 (2), 75-78 VetMedResource.

Other sources of information

  • Roetting A K & Freeman D E (2011) Hysterectomy .In: Equine Reproduction. 2nd edn. Eds: Mckinnon A O, Squires E L, Vaala W E & Varner D D. Wiley-Blackwell pp 2575-2577.