Reproductive Surgery of the Adult Ruminant

What are the main indications for a cescarean?

Caesarean section Indications

• Calf too big

• Cow too small

• Deformed calf

• Twisted uterus unable to correct

• Dead/emphysematous calf but…….

• High value/embryo calf

• Muddled up twins

• Cervical stenosis

• Salvage calf in sick/down cow

Decision made in conjunction with the farmer

• Head and shoulder through the pelvis  = too late as past the point of no return

NO 2 VETS WILL DO THE SAME THING

How should you prepare the cow for cesarean section?

Preparation:

• Find a suitable place and restrain cow

• LIGHT

• Assess temperament – sedation?

• Link to Noah compendium ‘Rompun’ data sheet ‘0.5ml xylazine IM, then walk away’, can give more (but….calf)

• Detomidine also an option Instruct farmer to get warm/clean water, electricity, string for tail, table for kit, extra help – keep them busy while you prep

• Clip and prepare surgical site, LEFT side Admin local and other drugs

• Open and organise kit

What restraint should be provided for a cow undergoing a c-section?

Restraint

• Crush? (bars often in way, can do halfway out crush with head tied by halter)

• Halter in corner? (safety)

What drugs are generally used in a bovine c-section?

Drugs Epidural

• if cow straining (see previous lecture) – beware as could go down

• Broad spectrum abs - Penicillin and Streptomycin ‘Pen and strep’ or Amoxicillin Clavulonic Acid ‘Synulox’ or ………..

• NSAID (Meloxicam ‘Metacam’, Ketoprofen ’Ketofen’)

• Clenbuterol ‘Planipart’ – to relax uterus

• Local anaesthetic for flank – various options

How is the line block for bovine c-section performed?

Line block 100- 150ml - injecting in a line down (10-15 ml) in each spot, putting needle in, deep then redirect

Landmarks: caudal edge of last rib, handbreath from rib, hand breadth down from lumbar vertebrae, start of incision is corner between hand on lumbar and last rib

• Go cranial in case animal needs to have future surgeries

• Have to incise over area you injected (can be issues with wound healing)

How is the inverted L nerve block performed?

Inverted L (upside down)

• 150ml (quite a lot) - more than a line block

• Local slightly away from where you incise (better for wound healing)

• Probably most popular with practitioners

How is the paravertebral nerve block performed?

Paravertebral - 2 options, anaesthetises nerve T13, L1, L2 Proximal

• – 5cm from midline

• Cranial edge of L1 , L2, L3 and (L4)

• Distal - L1, L2 and L4 (slightly easier)

• 90ml (30ml per site)

Local very far away from incision site BUT hard to palpate landmarks in fat beef cow, technically more difficult to do and takes more time

**Using hanging drop technique to ensure not intraabdominal

• Can cause scoliosis of spine, making it more difficult to stitch

How should you scrub when preparing to enter the abdomen?

Before you enter the abdomen

• Final scrub of cow

• Final scrub of you – hands, arms, shoulders,

• body Scrub of farmer (they might need to re-scrub or wear gloves)

• Get suture material ready in case you perforate rumen

Describe the layers to cut through when performing your incision or the caesarean. (IMAGE)

Laparotomy layers Layer Incision method Skin – approx. 45cm long Scalpel (be bold) External abdominal oblique Scalpel Internal abdominal oblique Scalpel or Blunt dissection + scissors Transversus Blunt dissection, then extend with scissors (make ‘v’) Peritoneum (looks very like rumen) Pick up with forceps, small sharp incision with scalpel then extend with scissors (make ‘v’)

Once the incision is made, how do you perform the c-section? (Location of calf)

Caesarean – how?

• Locate uterus * - hand in, to the right (tail) and down

• Right horn = more difficult (next slide)

• Grasp metatarsal or hock with one hand and hoof with other and pull foot towards wound

• Hook hock on end of wound Incise with scissors right over hoof and up to hock

• Incise placenta (improves grip)

• Give farmer foot to hold above metatarsal (like calving)

• Find other leg Gently pull calf (+/- ropes/chains) caudal and dorsal

• WATCH UMBILICUS

Once the calf is pulled, what are the next steps?

• Closing uterus*

Caesarean – how?

Leave farmer to assist calf

Breathe………

• Trim placenta

• Inverted closure of uterus (2 layers), clamps (pic)

• Lembert, cushing

• Vicryl (cat gut) 6-8 metric, USP 2 to 4

• Not into lumen and don’t trap placenta

• If friable – better to have one good layer

• Scoop fluid from abdomen

How do you close the abdominal wall following the c-section?

Laparotomy - closure Identify each layer in turn

* Make sure you get right to the top and bottom

1. Peritoneum and transverse (3rd) simple continuous, absorbable

2. External and internal abdominal oblique (2nd and 1st) simple continuous, absorbable

   1. Vicryl – 6-8 metric or USP 2 to 4 (cat gut)

3. Skin, surgeons preference (ford interlocking with 2 x cruciate at bottom), non-absorbable e.g. supramid 6-8 metric or USP 2

Variations:

• Occasionally taking a bite of first layer when suturing the second muscle layer

• Sub-cut layer for dead space, interrupted stitches at distal end of skin wound to allow drainage

What drugs are typically given post-cescarean?

Drugs post op

• Oxytocin (to reverse clenbuterol)

• Oxytetracycline ‘blue spray’

• +/- calcium

• Antibiotics (5 days) and NSAID as req

Remember the calf

What are important instructions to leave with the farmer?

• Admin meds as instructed/required

• Watch for retained foetal membranes (RFM) Watch for wound swelling (can remove distal stitches to release serous fluid or pus)

• Stitches out 14-21 days

• Phone you if worried

Normal pst op - wound swelling + emphysema

What are the main indications for a caesarean on the RIGHT hand side?

Caesarean on the right-hand side Indications

• Previous abdominal surgery on left (Can probably do 3 but depends on complications)

• Issues with gastrointestinal track getting into the incision

• Often requires two vets/surgeons

What are some tips for caesarean sections?

Caesarean – My Tips

What can go wrong with a caesarean section? IMAGE

Caesarean - What can go wrong? Short Term (during the op) Cow goes down Enter rumen Friable uterus and stiches tear through Stressed/acidotic calf

Medium Term (1 – 3 weeks) RFM and/or uterine infection (metritis) Wound infection Peritonitis Poor foetal-maternal bond

Long Term (3 weeks +) Subsequent milk production Subsequent fertility Ethics surrounding breeding animals that can’t reproduce and deliver offspring naturally

How are c-sections performed in sheep?

C section in sheep

• Principles very similar

• Restraint – lying down v standing

• Less local 40-60ml, generally inverted L block

  • Watch don’t use too much – can be toxic in high doses

• Key differences:

  • Often multiple fetuses

  • Thinner muscle layers (Can stitch al together if very thin)

  • IF ONE hole in uterus and two lambs, need to go back into cervix to enter opposite horn

  • Cost: 110

What are indications and methods used to perform an epiosotomy?

• IMAGE

Episiotomy Specific indications

• Tight vulva - prevents tear

• Standard epidural

• 5 – 10cm skin incision (+/- mucosa)

• 10 and/or 2 o’clock 2-layer suture with Vicryl or cat gut (6-8 metric USP 2 to 4)

  • Continuous mucosa

  • Simple interrupted skin

Don’t always look great immediately after surgery but tend to heal well

Why are vasectomies performed and what are the man features?

Vasectomy ‘Teaser’ – Why? synchro and advancement of breeding season

• Mainly tups (bulls)

• Healthy entire male, younger = easier as less fat

• Restraint – as if foot trimming, bum in old tyre, farmer on chair, wheelbarrow, calving ropes round legs and kneel on them

• Pre-op – 8 - 10ml local around each chord (draw back!), epidral, ± seation

• Broad spec. Abs, NSAID

How is the vasectomy performed?

Vasectomy – How?

1. Vertical skin incision about 4cm

2. Digital dissection to isolate spermatic cord

3. Hook cord under finger or with pair of forceps

4. Locate deferent duct (should be medial, feels firm, white and artery/vein close by)

5. Secure between thumb and forefinger

6. Make a nick in vaginal tunic to expose deferent duct

7. Exteriorise at least 3cm of duct, clamp at either end and ligate at either end

8. Cut between forceps - KEEP THE BIT

9. No need to suture vaginal tunic

10. Skin Sutures

11. Repeat other side

What are the main complications of vasectomies?

Vasectomy – What can go wrong?

Usual infection, haemorrhage

Remove wrong tissue

Deferent duct re-anastomosis

SO…

Always offer histo (Store if not running, make sure to label pot properly

Always offer Electroejaculation

1 – 6 weeks reported before infertile (2 weeks generally accepted)

What is the alternative to a vasectomy?

Epididymectomy

What are some other male surgeries?

Other male surgeries – not Day 1