Recto-vaginal laceration in mare during foaling/disruption the connection between the and vagina

Surgical Management of Recto-Vaginal Laceration in Mares


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Timing:

Delay repair for 4–6 weeks after injury to allow swelling, infection, and inflammation to subside.

Immediate repair is only attempted if it's a Grade I (small mucosal tear).



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Surgical Planning:

Standing position preferred (safer for mare; under heavy sedation + epidural anesthesia).

Prepare the perineal area aseptically, evacuate feces from rectum.

Place a soft rectal tampon (like moistened gauze) to prevent fecal contamination during surgery.



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Surgical Techniques:

There are two main approaches depending on the type of tear:

1. One-Stage Repair (common today — especially Modified Goetz Technique)

Single surgery, closing all layers together carefully.

Best for Grade IIIb (complete tear with communication).


Steps:

Make an incision to freshen the torn edges between rectum and vagina.

Dissect to create a rectal flap and vaginal flap — making two separate layers.

Suture the rectal mucosa first with absorbable suture (e.g., 3-0 PDS) in a continuous or interrupted pattern.

Then close the perineal body (fibrous tissue) with a stronger absorbable suture (e.g., 2-0 Vicryl).

Finally, close the vaginal mucosa with a fine absorbable suture.

Close any skin defects externally if necessary.



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2. Two-Stage Repair (older method; used if tissue is very fibrotic or infection is bad)

First surgery creates a barrier between rectum and vagina.

Second surgery reconstructs the perineal body 4–6 weeks later.



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Important Surgical Points:

Tension-free suturing is critical to avoid breakdown.

Maintain strict rectal hygiene during surgery.

Place interrupted or mattress sutures if tension is high.



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Post-Operative Care:

Broad-spectrum antibiotics for 5–7 days.

NSAIDs (like flunixin meglumine) for pain and to reduce inflammation.

Laxatives (mineral oil, bran mash) to soften stool for 10-14 days.

Manual removal of feces if necessary to avoid straining.

No breeding for at least 2–3 months post-surgery.

Monitor for rectovaginal fistula or breakdown signs.
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