33rd Annual Scientific Meeting proceedings

Introduction
Problem post-partum mares often fit into one of two broad categories: mares presenting as painful or systemically ill and mares presenting as systematically healthy but with post-partum problems that can affect their future wellbeing and/or fertility. As listed up here, the following post-partum deseases of the first category can be treated nowadays by a laparoscopic approache.

Uterine rupture
Full thickness uterine ruptures are the third most common cause of post-partum death in mares after urogenital haemorrhage and gastrointestinal ruptures. Causes of uterine rupture are well identified in literature and consist mainly of persistent straining of the mare against a fetal obstruction during a dystocia. These tears are usually located in the uterine body and occur when an extremity pushes through, or after blunt trauma to the uterine wall. Alternatively, tears can be induced iatrogenically. But lesions can also be sustained as part of a normal delivery. In these cases, tears are generally located towards the tip of the gravid horn.

Surgical repair of uterine ruptures have been performed under general anesthesia via caudal ventral midline celiotomy or flank approach. Alternatively the surgery can be carried out as a hand-assisted laparoscopic procedure or a solely laparoscopy. The advantages of this last mentioned technique are usually related to a decreased post-operative morbidity and mortality, as well as reduction of total costs for the owner. However, appropriate patient selection is essential to succeed.

Urinary bladder rupture
Urinary bladder rupture in mares occurs most commonly following parturition. Clinical signs of uroperitoneum in post-partum mares are nonspecific and may be delayed by 3-5 days after initial injury. Uroperitoneum can be diagnosed through a combination of serum haematology and biochemistry, peritoneal fluid analysis, cystoscopy and transcutaneous abdominal ultrasonography. Urinary bladder tears can either be treated conservatively or has to be managed surgically. Surgical repair of large or multiple tears is recommended to avoid the prolonged  hospitalisation and treatment associated with conservative management, and there are several methods described.

The traditional ventral celiotomy approach requires full traction on the bladder to expose the defects and closure of the defect can be technically very difficult depending on the location of the defect. So laparoscopic techniques have been developed for repair of bladder tears in standing or recumbent horses.

Duodenojejunal mesenteric rents
Duodenojejunal mesenteric rents occur in the duodenojejunal mesentery caudal to the root of the mesentery and often extend to the root of the mesentery`s attachment on the dorsal body wall. The high prevalence of foaling mares among mesenteric rent cases supports the observations, that duodenojejunal mesenteric renicuts are associated with the periparturient period, particularly for multiparous mares. Vigorous movements of the foal in the first stage of labor has been postulated to initiate mesenteric injury or tearing. Duodenojejunal mesenteric rents are notoriously difficult to close and depending on the extend, postpartum mesenteric rent could not be closed from a ventral median approach. It has been recommended that mesenteric rents should be closed during surgery to prevent recurrence of intestinal entrapment. So laparoscopic closure of a duodenojejunal mesenteric defect can be accomplished usually from the rigth side in the standing sedated mare.

Diaphragmatic hernia
The diaphragm can tear because of high intraabdominal pressure during normal foaling.  So any part of the intestine can become entrapped through the tear. The most common clinical sign associated with diaphragmatic hernia is colic, but respiratory embarrassment can also occur. Diaphragmatic hernias are most often discovered during colic surgery, but can be identified preoperatively by ultrasound and thoracic radiographs.

The prognosis for a successful surgical repair of diaphragmatic hernia in adult horses is guarded because of limited access to the defect and the significantly increased anesthetic risk due to respiratory compromise. Conventional surgical correction of diaphragmatic hernia is attempted either by ventral median celiotomy with no or limited visualization to the operative site or by a lateral approach after rib resection. 2001 Malone et al. published a thoracoscopic–assisted surgical procedure with rib resection in lateral recumbency. 

Central diaphragmatic hernias can be successfully treated by a minimal-invasive trans-thoracoscopic technique in the standing sedated horse. To avoid risks associated with general anesthesia, to reduce surgical trauma and postoperative recovery closure of a diaphragmatic hernia can be performed in the standing sedated horse using a thoracoscopic three portal technique.

References                                                                                    

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