Effects of Leaving Amputated Ovaries Intra-Abdominally during Elective Bilateral Standing Laparoscopic Ovariectomy in Equids.

There is risk of dropping an amputated ovary within the abdomen during standing laparoscopic ovariectomies in mares. If the ovary can no longer be directly visualized with the laparoscope, the procedure is then converted to a flank laparotomy for manual retrieval of the ovary which negates the minimally invasive nature of the laparoscopic procedure. The objective was to identify if ovaries left in the abdomen after amputation would atrophy or if they re-vascularize. Standing bilateral ovariectomies were performed in mature mares, but after transection of the ovarian pedicle, the ovaries were intentionally dropped and left within the abdomen. Post-operative endocrine values were at basal levels and an improvement in all mare's behavior and general herd dynamics was observed. While this study does not encourage to leave ovaries in the abdomen after amputation, we report no complication related to their voluntary release into the abdomen.

Ovarian histopathology, pre- and post-operative endocrinological analysis and behavior alterations in 27 mares undergoing bilateral standing laparoscopic ovariectomy.

Determining if ovariectomy will abolish unwanted behaviors can be challenging in mares without ultrasonographic ovarian abnormalities and/or endocrine values not consistent with a granulosa cell tumor. The objective of the study was to identify mares that have a positive improvement in unwanted behaviors after elective standing laparoscopic ovariectomy and to determine if the change is associated with any pre- and post-operative endocrine profiles and/or with ovarian histological findings. During the study period 27 mares underwent a bilateral standing laparoscopic ovariectomy. Pre- and post-operative questionnaires and endocrine profiles, along with ovarian histopathology were performed and data were analyzed. Eighty-nine percent of clients were satisfied with the change in behavior after surgery. There were no significant associations between specific elevated hormones or absent luteal tissue with any specific unwanted behaviors. Pre-operative endocrine values were not predictive of post-operative owner satisfaction but bilateral ovariectomy for the treatment of unwanted behaviors in mares had a high likelihood of achieving owner satisfaction.

Histopathologie ovarienne, analyse endocrinienne pré- et post-opération et modifications du comportement chez 27 juments soumises à une ovariectomie bilatérale laparoscopique en position debout. Déterminer si une ovariectomie éliminera les comportements non-désirés peut représenter un défi chez les juments sans anomalie ovarienne détectable par échographie et/ou ayant des valeurs endocrines non cohérentes avec une tumeur des cellules de la granulosa. L'objectif de la présente étude était d'identifier les juments avec une amélioration positive des comportements non-désirés à la suite d'une ovariectomie élective par laparoscopie en position debout et de déterminer si le changement était associé avec un quelconque profil endocrinien pré- et post-opération et/ou avec des trouvailles histologiques dans les ovaires. Durant la période d'étude 27 juments ont été soumises à une ovariectomie laparoscopique bilatérale en position debout. Des questionnaires pré- et post-opération ainsi que des profils endocriniens et des analyses histopathologiques des ovaires furent réalisés et les données analysées. Quatre-vingt-neuf pourcents des clients étaient satisfaits avec le changement dans le comportement après la chirurgie. Il n'y avait pas d'association significative entre des niveaux élevés d'hormones spécifiques ou l'absence de tissu lutéal et des comportements non-désirés spécifiques. Les valeurs endocrines pré-opération n'étaient pas prédictives de la satisfaction post-opération des propriétaires mais l'ovariectomie bilatérale pour le traitement de comportements non-désirés chez les juments avait un grand potentiel d'obtenir la satisfaction du propriétaire.(Traduit par Dr Serge Messier).

Left paralumbar fossa approach combined with mesocolon fenestration for bilateral equine ovariectomy.

OBJECTIVE: To describe a standing left paralumbar fossa approach combined with mesocolon fenestration for bilateral equine ovariectomy. STUDY DESIGN: Prospective experimental clinical study. ANIMALS: Four healthy client-owned mares and 1 client-owned Molly mule. METHODS: Mares were restrained in standing stocks and sedated with an α2 -agonist continuous infusion to effect. The abdominal cavity was approached via a left paralumbar fossa approach, and the contralateral right ovary was accessed through an incision in the mesocolon. The location of the window was adjusted to allow triangulation, adequate visualization, and manipulation of the contralateral right ovary. Each ovarian pedicle was ligated with extracorporeal ligatures prior to sharp transection. The ovaries were dropped and left within the abdomen as part of another study. The incision in the mesocolon was closed with laparoscopic staples. Mares were monitored hourly while hospitalized, and a questionnaire was completed by the owners 90 days after surgery. RESULTS: Both ovarian pedicles were successfully ligated and transected in all mares through the left paralumbar fossa approach and mesocolon fenestration. The only complications consisted of mild incisional emphysema in 2 of 5 equids, with all resolving spontaneously. All equids returned to intended use at 90 days. CONCLUSION: The left paralumbar fossa approach combined with mesocolon fenestration provided adequate access to both ovaries with minimal morbidity in this small population. CLINICAL SIGNIFICANCE: A unilateral left paralumbar fossa approach and fenestration of the mesocolon should be considered as an alternative to traditional approaches for bilateral laparoscopic ovariectomies in equids.

Evaluation of post-operative pain after active desufflation at completion of laparoscopy in mares undergoing ovariectomy.

The cause of transient post-operative pain in a subset of horses undergoing laparoscopy is unclear. The objective of this study was to evaluate if residual pneumoperitoneum is associated with transient post-operative pain in mares undergoing ovariectomy. Thirty-eight mares undergoing routine standing laparoscopic ovariectomy were randomly allocated into 2 groups. At the completion of laparoscopy, either the abdominal cavity was actively desufflated or the cannulas were opened to achieve ambient pressure before incisional closure. Assessments were performed for 18 hours after surgery using a validated visceral/somatic pain scale for horses. Overall, pain was minimal in both groups (median score 2/39) post-surgery. Active desufflation of the pneumoperitoneum at the completion of laparoscopy approached statistical significance (P = 0.07) in decreasing pain at 12 hours after laparoscopy. However, effects of active desuffation were not significant throughout the monitored 18-hour post-surgery period. We conclude that the decision to actively desufflate at the completion of laparoscopy should be based on surgeon's preference.

Évaluation de la douleur postopératoire après un désoufflement actif à l'achèvement d'une laparoscopie chez les juments subissant une ovariectomie. La cause d'une douleur postopératoire transitoire dans un sous-groupe de chevaux subissant une laparoscopie est indéterminée. Cette étude avait pour objectif d'évaluer si le pneumopéritoine résiduel est associé à de la douleur postopératoire chez les juments subissant une ovariectomie. Trente-huit juments subissant une ovariectomie laparascopique debout de routine ont été réparties au hasard dans deux groupes. À l'achèvement de la laparoscopie, soit la cavité abdominale a été activement désoufflée ou les canules ont été ouvertes pour obtenir une pression ambiante avant la fermeture de l'incision. Des évaluations ont été réalisées pendant 18 heures après la chirurgie en utilisant une échelle de douleur viscérale/somatique validée pour les chevaux. Dans l'ensemble, la douleur a été minimale dans les deux groupes (note médiane de 2/39) après la chirurgie. La désoufflement actif du pneumopéritoine à l'achèvement de la laparoscopie s'approchait de l'importance statistique (valeur de P = 0,07) en réduisant la douleur à 12 heures après la laparoscopie. Cependant, les effets du désoufflement actif n'étaient pas significatifs pendant la période de surveillance 18 heures après la chirurgie. La décision de désouffler activement à l'achèvement de la laparoscopie est toujours sujette à la préférence du chirurgien.(Traduit par Isabelle Vallières).

Comparison of hand-sewn and oversewn stapled jejunojejunal anastomoses in horses.

The objective of this study was to compare the biomechanical properties of hand-sewn jejunojejunal anastomoses to those of oversewn stapled jejunojejunal anastomoses. Jejunojejunal anastomoses were constructed from harvested jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique oversewn with Cushing pattern (SS), and closed 1-stage stapled functional end-to-end technique oversewn with Cushing pattern (FEE). Anastomosed segments were distended with fluid until the point of biomechanical failure. The 2HS had the longest construction time of all anastomoses. Bursting pressures were significantly higher for hand-sewn jejunojejunostomies than those for oversewn stapled jejunojejunostomies. No significant differences were found in bursting pressures between 1HS and 2HS or between SS and FEE. Hand-sewn jejunojejunostomies proved to be biomechanically stronger than oversewn stapled jejunojejunostomies when initially constructed. However, all anastomotic types would be secure techniques to be used clinically based on the supraphysiological pressures they are capable of withstanding.

Comparaison des anastomoses jéjuno-jéjunales cousues à la main et agrafées et cousues chez les chevaux. Cette étude avait pour objectif de comparer les propriétés biomécaniques des anastomoses jéjuno-jéjunales cousues à la main et celles des anastomoses jéjuno-jéjunales agrafées et cousues. Des anastomoses jéjuno-jéjunales ont été construites à partir de segments jéjunaux prélevés en utilisant la technique Lembert à couche unique (1HS), la technique Cushing à double couche simple continue (2HS), la technique agrafée côte à côte selon la méthode Cushing (SS) et la technique fonctionnelle de bout en bout fermée en 1 étape avec couture selon la méthode Cushing (FEE). Des segments anastomosés ont été dilatés avec du liquide jusqu'au point de défaillance biomécanique. La technique 2HS présentait le temps de construction le plus long de toutes les anastomoses. Les pressions de rupture étaient significativement supérieures pour les jéjuno-jéjunostomies cousues par rapport aux jéjuno-jéjunostomies agrafées et cousues. Aucune différence significative n'a été constatée au niveau des pressions de rupture entre 1HS et 2HS ou entre SS et FEE. Les jéjuno-jéjunostomies cousues à la main se sont avérées plus fortes sur le plan mécanique que les jéjuno-jéjunostomies agrafées et cousues lors de la construction initiale. Cependant, tous les types anastomotiques seraient des techniques sûres pour utilisation clinique en se basant sur les pressions supra-physiologiques qu'elles sont capables de supporter.(Traduit par Isabelle Vallières).

Occurrence of Incisional Complications After Closure of Equine Celiotomies With USP 7 Polydioxanone.

OBJECTIVES: To report the occurrence of, and risk factors associated with, incisional complications of equine ventral median celiotomies closed with USP 7 polydioxanone (7PD). STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Horses (n = 73; 75 celiotomies). METHODS: Medical records (2000-2010) were retrieved and reviewed for horses that had a ventral celiotomy closed with 7PD and survived ≥14 days. Follow-up (>1 year) was obtained from the medical record, owner, or referring veterinarian. Independent variables were selected based on risk factors identified in previous studies, perceived clinical relevance, and if there were adequate data recorded in the medical record. Statistical analysis, including multivariable logistic regression with a forward-building model process, was performed to evaluate variables associated with incisional complications. RESULTS: One or more incisional complication(s) occurred in 19 celiotomies (25.3%) during hospitalization or after discharge including: drainage (25.3%), infection (12.0%), and partial dehiscence (5.3%). Two of 63 horses (3.2%) available for follow-up developed an incisional hernia. Variables associated with incisional complications after multivariate analysis included: number of days hospitalized, surgery time, postoperative colic, and postoperative fever. CONCLUSION: Overall occurrence of incisional herniation after closure of ventral celiotomies with 7PD was low.