The Horse

MAR 2018

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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YOUR GUIDE TO THE 2017 AAEP CONVENTION SPONSORED BY A30 TheHorse.com/AAEP2017 AAEP Wrap-Up THE HORSE March 2018 Mariana Diel de Amorim, DVM, DVSc, Dipl. ACT, who's on faculty at Cornell Uni- versity's College of Veterinary Medicine. In addition to unreliably mitigating estrus, marbles can be ejected from the uterus without the owner's knowledge. When they do remain in place, they can be forgotten about and/or difficult to find and remove, Diel de Amorim said. Intrauterine marbles are usually either 25 or 35 mm in size, the larger (heavier) of which are harder to remove, especially when mares have a pendulous uterus (one that hangs down loosely). Diel de Amorim said vets have associ- ated these marbles with: ■ Pyometra (uterine infection); ■ Adhesions (internal scarring); ■ Failure to cycle; ■ Chronic endometritis (inflammation of the uterine lining); ■ Infertility; and ■ Abortion. Vets usually find marbles via uterine palpation or transrectal ultrasound. If a mare has a pendulous uterus, however, "transrectal ultrasound examination is imperative," she said. If marble retrieval is expected to take longer than 20 minutes or if hysteroscopy (using endoscopy through the cervix to inspect the uterus) is necessary, Diel de Amorim recommends sedating the mare. The procedure is also easiest when a mare is in estrus because the cervix is softer and more easily dilated. The vet can induce estrus with a prostaglandin if necessary. Veterinarians can remove some easily accessible marbles with a sterile, gloved hand or a two-handed approach, one through the rectum to manipulate the marble from outside the uterus through the cervix, the other to retrieve the marble via the vagina. "This has an increased risk of rectal tear, so it might be easier to do hysteroscopy than having to do several rectal and vaginal manipulations," Diel de Amorim said. Other objects might be more challeng- ing to remove, either because of their position in the uterus or because they've grown into the endometrium. For more complex cases, vets can use videohysteroscopy and endoscopy. They can use one of several endoscopic tools, including snares, loops, and baskets for grabbing and manipulation. They fill the uterus with air and work as a team to re- move the marble using one of these tools. In summary, veterinarians retrieve most marbles from the mare uterus manually; however, more challenging cases might benefit from hysteroscopy tools. "Marbles are nonmedically approved devices, and several reports have war- ranted their retirement," said Diel de Amorim. h Horse owners might want to have their mares' ovaries surgi- cally removed for a variety of reasons: to prevent pregnancy, get rid of tumors, or, most com- monly, resolve behavioral issues. While surgeons still consider traditional ovariectomy methods effective, they've come to favor several newer procedures that are easier on the horse as well as the owner's pocketbook. Dean Hendrickson, DVM, Dipl. ACVS, a professor of equine surgery at Colorado State University's Veterinary Teaching Hospital, reviewed those options. Traditional methods can cost $2,500-3,000 and include standing colpotomy (done through the vagina), recum- bent (while lying down) flank ovariectomy, and dorsally (while on the back) recumbent midline ovariectomy (via the abdominal wall). "Although these techniques have been commonly used, they are rapidly being replaced by minimally invasive … laparo- scopic ovariectomies," he said. Laparoscopy involves insert- ing an endoscope and surgical instruments through one or more small incisions; vets can perform a standing ovariectomy without general anesthesia. The three techniques they use include: Standing-flank laparo- scopic ovariectomy Hendrick- son said this is his preferred technique, performed through one or both flanks in the stand- ing sedated mare. "In my opinion, standing lapa- roscopic ovariectomy is easier to perform than while under general anesthesia, given that the ovary hangs from the dorsal body wall," he said. The surgery costs about $1,500, and horses can go back to work after two weeks of stall rest and hand-walking. Laterally recumbent laparoscopic ovariectomy This procedure is only practical for removing one ovary and is performed under general anes- thesia. It costs about $2,000, and mares can start back in light work after four weeks of stall rest. Hendrickson said he and his colleagues rarely use this method anymore because in most cases the procedure can be performed in the standing mare. Dorsally recumbent lapa- roscopic ovariectomy This is also performed under general an- esthesia, with the horse hoisted upside down. It costs $2,000 and involves four weeks of stall rest. Hendrickson rarely uses this approach anymore, either. "Laparoscopy is a beautiful thing," he said, adding that while it requires very specialized equip- ment, the training to use it is reasonable.ÑAlexandra Beckstett COURTESY DR. DEAN HENDRICKSON A standing flank laparoscopic ovariectomy Minimally Invasive Ovary Removal Methods on the Rise e Visit TheHorse.com/AAEP2017 ■ Behavior Problems in Mares: Ovaries Aren't Always to Blame, TheHorse.com/40217

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