Midline vs. flank laparotomy- criteria for choosing the optimal surgical technique for uterine torsion correction in the mare.
Authors: Samsel Jan, Gündemir Ozan, Szara Tomasz, Witkowski Maciej
Journal: BMC veterinary research
Summary
# Editorial Summary Uterine torsion complicates 5–10% of equine pregnancies in the final trimester, and two surgical approaches exist: standing flank laparotomy under local anaesthesia (SFL) and midline laparotomy under general anaesthesia (MI). Samsel and colleagues retrospectively evaluated 19 mares treated surgically to develop evidence-based selection criteria for technique choice, with 13 undergoing MI and 7 undergoing SFL. Success rates favoured the standing approach—six of seven mares (86%) recovered and delivered healthy foals—whilst MI produced live foals in seven of 13 cases (54%), with complications including intraoperative failures, fetal loss, and one perioperative death. The authors propose a practical decision-making framework: mares with balanced temperament, pregnancy ≤320 days, viable foetus, and no advanced uterine vascular compromise are candidates for SFL; nervous or unpredictable mares, those >320 days pregnant, or those with dead foetuses, severely compromised uterine tissue, or suspected comorbidities warrant MI instead. For practitioners managing dystocia emergencies, this protocol offers pragmatic guidance on patient selection that may improve outcomes by reserving general anaesthesia for cases where standing surgery is anatomically or clinically unfeasible.
Read the full abstract on PubMed
Practical Takeaways
- •For cooperative mares with live foals and uncomplicated uterine torsion at <320 days gestation, standing flank laparotomy offers good outcomes with lower anesthetic risk and faster recovery—avoid general anesthesia in these cases
- •Reserve midline laparotomy under general anesthesia for advanced pregnancies (>320 days), dead or compromised fetuses, severe uterine damage, or mares with temperament/behavioral issues that preclude standing surgery
- •Use rectal palpation and ultrasound to assess uterine wall viability and fetal status preoperatively—this assessment directly determines which surgical approach to select and predicts success rates
Key Findings
- •6 of 7 mares (86%) undergoing standing flank laparotomy under local anesthesia recovered and produced healthy foals
- •7 of 13 mares (54%) undergoing midline laparotomy under general anesthesia recovered and produced normal foals
- •Standing flank laparotomy was successful in mares with pregnancies ≤320 days, live fetuses, and no advanced uterine wall compromise
- •Midline laparotomy was required for mares with pregnancies >320 days, dead fetuses, severely compromised uterine tissue, or behavioral contraindications to standing surgery