Midline vs. flank laparotomy- criteria for choosing the optimal surgical technique for uterine torsion correction in the mare

Uterine torsion in mares belongs to maternal pregnancy disorders, accounting for 5-10% of complications in the last trimester of pregnancy. Two surgical techniques for repositioning uterine torsion are used: flank laparotomy in local anesthesia on a standing mare (SFL) and midline laparotomy carried out under general anesthesia (MI). The study aims to present the exact protocol used by the authors to qualify a mare with uterine torsion for surgery using one of the above-mentioned methods.A total of 19 mares were operated on, of which 13 underwent midline laparotomy under general anesthesia, and the flank approach in a standing position operated on 7. Of the seven mares operated on in standing position under local anesthesia, six recovered and gave birth to healthy foals. In one of the operated mares by this approach, repositioning of the uterus was unsuccessful, and torsion was finally resolved after performing a laparotomy in the midline. Out of 13 operated mares in the midline (including the last-mentioned case), seven mares recovered and gave birth to normal foals. Another mare underwent c.s. because of the impossibility of twisted uterus reposition, but its outcome was good. 2 other mares with dead fetuses at admission underwent c.s. as well. One of them was in a critical general condition and died during surgery; the outcome of the other one was good. 3 following mares from this group aborted dead fetuses during the first week after the operation. One of them was euthanized after abortion, because of post-operative complications, the other two recovered without complications.Based on their own experience and available literature, the authors currently use the following key when selecting an appropriate surgical technique for uterine torsion repositioning in the mare:A mare of a balanced character promising approval of the procedure in sedation and local anesthesia with pregnancy up to 320 days with a living fetus and no apparent advanced circulatory changes within the uterine wall and/or broad ligament (diagnosed by rectal palpation and/or ultrasound examination) and no suspicion of comorbidities - flank approach in standing position (standing flank laparotomy SFL).Nervous, unpredictable mare, pregnancy over 320 days, dead fetus and/or severely compromised uterine wall, suspicion of concomitant abdominal problems - midline incision in general anesthesia (MI).