RESUMO
The aim of the present study is to describe the surgical technique and complications of uterine elevation by laparoscopic surgery, using the broad uterine ligament plication with toogles. Five mares of different breeds, weight and age were selected, presenting poor perineal conformation and pendulous uterus. The surgical technique was performed with a toogle applicator, 0.6mm sterile nylon thread and toogles, using three portals on each side of the flank. After one month, a new laparoscopy was performed, with only one portal on each side, to observe uterine positioning and healing. The average surgical time reached in this study was 82 minutes per procedure, and the uterus of all mares was successfully raised, remaining in a more horizontal orientation and presenting satisfactory healing. There are only two articles published with uteropexy in mares, where the proposed techniques take longer, which consequently increases the surgical risk.
O objetivo do presente estudo é descrever a técnica cirúrgica e as complicações da elevação uterina por cirurgia laparoscópica, utilizando-se a plicatura do ligamento uterino com aplicação de toogles. Foram selecionadas cinco éguas de diferentes raças, peso e idade, as quais apresentavam baixa conformação perineal e útero pendular. A técnica cirúrgica foi realizada com aplicador de toogles, fio de nylon estéril de 0,6mm e toogles, sendo utilizados três portais de cada lado do flanco. Após um mês, uma nova laparoscopia foi realizada, com apenas um portal de cada lado, para observar o posicionamento uterino e a cicatrização. O tempo cirúrgico médio alcançado neste estudo foi de 82 minutos por procedimento, e o útero de todas as éguas foi elevado com sucesso, permanecendo em uma orientação mais horizontal e apresentando cicatrização satisfatória. Existem apenas dois artigos publicados com a utilização da uteropexia em éguas, porém nestes as técnicas propostas demoram mais, o que, consequentemente, aumenta o risco cirúrgico.
Assuntos
Animais , Feminino , Útero/cirurgia , Laparoscopia/métodos , Cavalos , Laparoscopia/veterináriaRESUMO
Background: Brazil is an important horse breeder that creates about three million jobs and movements about R$16,15 billions per year. Although, it is important to the horse breeding industry success that the animals reproductive performance be kept. The mare pregnancy loss causes abundant forfeitures to horse breeders, furthermore, the chronic pyometra is one of that causes. The chronic pyometra is an uncommon mare condition, clinical treatments are often ineffective, under those circumstances the hysterectomy, ovariohysterectomy and uteropexy are recommended. This report proposes to describe the chronic pyometra surgical treatments with the uteropexy technique in mini horses that do not respond to the clinical treatment. Case: A 14-year-old mini breed horse mare weighing 117 kg was sent to Veterinarian Hospital (HV) of the Paraná Federal University (UFPR), presenting dystocia background and intrauterine purulent secretion. The clinical treatment had been conducted, but not well succeeded. An hysteroscopy was conducted with a cervix rupture monitoring, uterine mucosa edematiated and crispy, presenting liquid and a high amount of purulent secretion in the uterus horn and body. The biopsy identified uteropexy. The post-surgical complications were minimums and 30 days after the procedure the laparoscopy was repeated with uterine healing monitoring, without adherences and the uterus were at horizontal position. The hysteroscopy was conducted where a small amount of purulent secretion was perceived. Ten days after the second laparoscopy the patient was discharged. Two years after the procedure, the animal responsible informed that there was not a relapse. Discussion: the mare pyometra occurrence is uncommon and emerges by nature protection false mechanisms. Any change or flaw in one of these protection mechanics barriers, may result in a reproductive change due to uterine infection, resulting in reduction of mare reproductive capacity. Probably this reports patients developed pyometra due to the cervix lesion it's presented made easier the uterus external microorganisms entrance, that predisposes an chronic uterine infection. As many authors report, the chronic pyometra clinical treatment is not always successful, also observed in the case reported, indicating then surgical treatment. There are many pyometra surgical treatments indications as: Wedge resection technique in case of cervix adherence, uteropexy technique, ovary-hysterectomy technique or hysterectomy. The ovary-hysterectomy and the hysterectomy was not conducted for being considered highly invasive. This case choice procedure was the uteropexy, which corresponds to fixing the broad ligament of the uterus to the abdominal wall, repositioning it horizontally, to obtain a better drainage and motility, since this is your anatomic position. In the report, the surgical technique was conducted satisfactorily, certifying the uterine elevation by laparoscopy in the postoperative and also by the responsible report, that the animal does not relapse in two years. The postoperative complications were not alarming, considering that it ceased 24h after the procedure. The conclusions present in this treatment show that the hysteropexy conducted by videosurgery with toggles application developed the necessary uterine elevation to the liquid drainage, that allows the mare to execute the uterine cleaning by the physiological form.(AU)