Ovario-hysterectomies: Techniques and Outcomes

Complete ovariohysterectomy (OVH) is not a commonly performed procedure in the horse. Indications include the following: chronic pyometra that is non-responsive to treatment, uterine neoplasia, extensive uterine damage, and segmental aplasia. Challenges for this surgery include exposure of the cervix, hemostasis, and preventing/ minimizing abdominal contamination when transecting the uterine body.

The patient should be held “off feed” for 36 hours to decrease colonic fill. Low bulk feeds can be utilized prior to surgery as well. In cases with pyometra, the uterus should be lavaged and emptied as much as possible prior to surgery. Pre-operative antimicrobial and NSAID use is at the discretion of the surgeon. Ultimately a ventral midline celiotomy with the mare in dorsal recumbency will be required. Hand-assisted laparoscopy can be utilized to transect the ovarian pedicle and broad ligament on each side of the uterus prior to making an open laparotomy approach to remove the uterus. A caudal ventral midline incision is made and the mammary gland is divided on midline. The body wall is opened to the level of the prepubic tendon. Bilateral ovariectomy is performed as the initial step in OVH. Each ovary is exteriorized and the branches of the ovarian artery are ligated or sealed using a vessel sealing device. Each ovary is then removed. Following removal of each ovary the broad ligament is dissected caudally. Hemostasisisachievedusingligatures or by using a vessel sealing device depending of the size of the vasculature. The uterus is exteriorized and pulled cranially. Exteriorizing the large colon may aid in exposure of the uterus. Using a combination of self-retaining and handheld retractors additional exposure may be gained. Stay sutures and/or a TA-90 stapling device can be placed as far caudal on the uterus as possible and used to retract the cervix cranially. There are numerous large arteries from the caudal uterine branch of the urogenital artery that require ligation before transecting the uterus. The abdomen should be packed off with wet laparotomy sponges prior to transection of the uterus. The closure is started using #2 absorbable suture material then the uterus is incised for a short distance and that portion is closed. This is performed in a stepwise fashion of incising and closing the uterus until transection is complete. The remaining stump of tissue is over sewn in one or two layers using an inverting pattern of #2 absorbable suture material. The laparotomy sponges are removed and the abdomen is lavaged and suctioned. An abdominal drain can be placed if there is concern about contamination of the peritoneal cavity. Closure of the ventral midline incision is routine.  [...]