Evaluation of a modified one-stage technique for repair of third-degree perineal laceration and rectovestibular fistula with rectal pull-back technique in 12 mares: a retrospective case series.
Authors: Sharshar Ahmed, Hammad Amal, Salem Mohamed, El-Sunsafty Mohamed
Journal: BMC veterinary research
Summary
Third-degree perineal lacerations and rectovestibular fistulae represent serious complications in mares requiring surgical reconstruction, yet optimal techniques remain inconsistent across practitioners. Ahmed and colleagues retrospectively evaluated a modified one-stage approach—specifically a rectal pull-back modification of the Goetz technique—in 12 mares (10 with third-degree perineal laceration, 2 with rectovestibular fistula), comparing outcomes of their approach with the standard method. The key modification involved dissecting and pulling the rectal flap caudally before suturing it to the reconstructed anal sphincter, whilst the vestibular shelf and vaginal tissues were repaired using size 2 polyglactin 910 sutures in a six-bite pattern. Notable results included complete absence of rectal shelf necrosis and fistula recurrence, though two mares experienced minor partial dehiscence of the perineal body and one showed partial anal sphincter dehiscence—all of which resolved successfully with conservative management. For equine practitioners managing these challenging injuries, this modified technique offers potential advantages in reducing serious postoperative complications whilst maintaining functional outcomes, though broader prospective studies would strengthen evidence for wider adoption.
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Practical Takeaways
- •The rectal pull-back modification of the Goetz technique offers a viable one-stage surgical option for treating third-degree perineal lacerations and rectovestibular fistulas in mares
- •This technique appears to reduce the risk of rectal tissue complications compared to standard approaches, with excellent healing outcomes even when minor dehiscence occurred
- •Consider this method as an alternative when managing complex perineal injuries, though outcomes should be validated in larger prospective studies
Key Findings
- •Modified rectal pull-back one-stage technique successfully treated 10 mares with third-degree perineal laceration and 2 mares with rectovestibular fistula
- •No cases of rectal tissue necrosis or rectovestibular fistula formation were recorded post-operatively
- •Minor complications occurred in 3/12 mares (2 partial perineal body dehiscence, 1 partial anal sphincter dehiscence), all healed successfully