Surgical technique to repair grade IV rectal tears in post-parturient mares.
Authors: Kay Alastair T, Spirito Michael A, Rodgerson Dwayne H, Brown Stuart E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Grade IV rectal tears in mares following parturition have historically carried a guarded prognosis, but this 2008 case series demonstrates that standing surgical repair with careful technique can achieve favourable outcomes. Kay and colleagues treated six mares using a novel approach: after caudal anesthesia and sphincterotomy at the 12 o'clock position, they exteriorised the tear margins, apposed them with steel staples, then reinforced the repair with a continuous 2-0 poliglecaprone 25 suture in a single mucosal layer. Four of six mares (67%) survived long-term and subsequently became pregnant, with two mares lost to peritonitis and pelvic fracture complications rather than repair failure. The technique's key innovation—performing this complex reconstruction in standing stocks rather than under general anaesthesia—potentially reduces the perioperative risks associated with dorsal recumbency in heavily pregnant or recently parturient mares, making it particularly relevant for practitioners managing emergency obstetric complications. For veterinarians encountering grade IV tears in the post-parturient period, this oversewn stapled closure offers a realistic surgical option with acceptable survival rates, though careful patient selection, robust perioperative antibiotics and anti-inflammatory support, and readiness for standing abdominal lavage remain critical to success.
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Practical Takeaways
- •Grade IV rectal tears in post-parturient mares can be surgically repaired in standing animals using a two-layer closure technique (stapled and oversewn), with reasonable expectations of survival and return to breeding
- •The standing approach with perineal access and temporary sphincterotomy avoids general anesthesia risks and allows better visualization of the tear margins
- •Close post-operative monitoring is essential as peritonitis can develop even with an intact repair; consider prophylactic standing abdominal lavage and broad-spectrum antibiotics
Key Findings
- •Four of six mares (67%) survived long-term after grade IV rectal tear repair using a two-layer stapled and oversewn closure technique
- •Successful repairs allowed two mares to become pregnant after surgery
- •Standing surgical repair with sphincterotomy allowed adequate exposure and apposition of rectal tear margins
- •One mare developed severe diffuse peritonitis despite intact repair, and another fractured her pelvis during anesthesia recovery