Surgery for horses encompasses a range of procedures performed to diagnose, treat, or manage various medical conditions. These procedures may involve soft tissue or orthopedic interventions and require specialized techniques to accommodate the unique anatomical and physiological characteristics of equines. Common surgical procedures in horses include colic surgery, fracture repair, and arthroscopy. The success of equine surgery depends on numerous factors, including the type of procedure, the horse's overall health, and post-operative care. This page compiles peer-reviewed research studies and scholarly articles that explore surgical techniques, outcomes, and advancements in equine surgical practices.
Carmalt JL, Shoemaker RW, Wilson DG.The objective of this study was to determine if ligation of the common vaginal tunic could prevent or reduce the incidence of omental herniation and eventration in draught colts undergoing routine field castration. It was found that common vaginal tunic ligation, while not completely preventing omental herniation and evisceration, significantly reduced the incidence of these complications and should be considered in those males deemed at increased risk of significant post castration complications.
Fuerst AE, Oswald S, Jäggin S, Piskoty G, Michel S, Auer JA.The objective of this postmortem study was to determine the fracture configurations of the equine radius and tibia after a simulated kick. Fracture configurations of 35 radii and 36 tibiae from 19 adult horses were evaluated after a simulated kick in an experimental ex-vivo study. The bones were dissected, the proximal and distal ends were embedded in resin, fixed horizontally and preloaded in compression, and a steel impactor, designed to simulate a shod equine hoof, was dropped from a height of three to six metres onto the diaphysis. The experiments were filmed with a high-speed camera (30,0...
Edwards RB, Lu Y, Cole BJ, Muir P, Markel MD.To compare a radiofrequency energy (RFE) prototype probe to mechanical debridement (MD) and a commercially available RFE system used for chondroplasty in the treatment of an experimentally created partial thickness cartilage lesion in horses. The study design was experimental, randomized complete block, n=8, using fifteen mature ponies. Methods: Grade 2 to 3 cartilage lesions were prepared in both patellae. After 10 months duration, the injuries were used to study the effects of MD, a commercially available bipolar RFE device (CoVac 50; ArthroCare Corporation) and a prototype monopolar RFE dev...
Lores M, Ortenburger AI.3 horses were evaluated for signs of colic; cecocolic intussusception was detected. Results: Abnormalities detected included diminished intestinal sounds, inflammatory leukogram, dehydration, unremarkable fi ndings via rectal palpation, and ultrasonographic evidence of large intestine intussusception. Laparotomy revealed cecocolic intussusception. Results: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection was performed in each horse by use of an intraluminal anastomosis stapler device. Postoperative complications were minimal, and all horses recovered rapidly and we...
Martin-Flores M, Campoy L, Ludders JW, Erb HN, Gleed RD.To compare acceleromyography (AMG) with visual assessment of train-of-four (TOF) for monitoring neuromuscular blockade and detecting residual muscle paralysis in horses receiving atracurium. Methods: Prospective, controlled clinical study. Methods: Nine adult, client-owned horses weighing 577 (436, 727) kg (median, minimum, maximum) and ASA physical status I-II, admitted for surgery. Methods: An electrical nerve stimulator was used to stimulate the peroneal nerve with TOFs at 1 minute intervals. Before and after atracurium administration (0.15 mg kg(-1), IV), the number of twitches observed (T...
Blissitt KJ, Raisis AL, Adams VJ, Rogers KH, Henley WE, Young LE.To determine the haemodynamic effects of halothane and isoflurane with spontaneous and controlled ventilation in dorsally recumbent horses undergoing elective surgery. Methods: Prospective randomized clinical trial. Methods: Twenty-five adult horses, body mass 487 kg (range: 267-690). Methods: Horses undergoing elective surgery in dorsal recumbency were randomly assigned to one of four treatment groups, isoflurane (I) or halothane (H) anaesthesia, each with spontaneous (SB) or controlled ventilation (IPPV). Indices of cardiac function and femoral arterial blood flow (ABF) and resistance were m...
Rubio-Martínez LM, Vázquez FJ, Romero A, Ormazábal JR.This paper reports on luxation of the elbow joint without concomitant fracture in a 1-month-old foal. Conservative treatment, with closed reduction and full-limb bandaging, including caudal and lateral splints, seemed successful initially, however, failed to provide enough stability and luxation recurred, and open reduction and surgical placement of prosthetic collateral ligaments was required. Luxation of the elbow joint should be considered when acute non-weight bearing forelimb lameness occurs associated with pain and swelling in the area of the elbow in young foals. Closed reduction failed...
Parente EJ, Tulleners EP, Southwood LL.The effectiveness and best method to perform a partial arytenoidectomy in racehorses is unclear. This study was performed to evaluate the success of and complications that can occur after a unilateral partial arytenoidectomy with primary mucosal closure in Thoroughbred racehorses. Objective: Partial arytenoidectomy is an effective surgical procedure to return Thoroughbred racehorses, afflicted by arytenoid chondropathy or a failed laryngoplasty, to preoperative levels of performance. Methods: Seventy-six Thoroughbred racehorses admitted to the New Bolton Centre between 1992 and 2006 were asses...
Caron JP, Brakenhoff J.To report a technique for repair or prevention of inguinal hernia in horses using intracorporeal suture closure of the internal inguinal and vaginal rings. Methods: Case series. Methods: Foals (n=6) and geldings (n=2). Methods: After selection of a peri-umbilical telescope portal, instrument portals were made unilaterally or bilaterally, as needed. Herniated viscera was reduced, castration (foals) or spermatic cord remnant transection at the internal inguinal ring (adults) performed, and then simple interrupted intracorporeal sutures of synthetic absorbable suture material were used to close t...
Schumacher J, Brink P, Easley J, Pollock P.To describe surgical techniques used for correction of congenital nasal deviation (wry nose) in horses (wry nose) and to report outcome. Methods: Retrospective study. Methods: Horses (n=4), 5-17 months old with wry nose. Methods: Nasal deviation was corrected by transecting the premaxillae/maxillae and nasal bones at their site of maximum curvature and realigning and stabilizing the bones in a more normal alignment using internal fixation. The nasal septum was removed during the same anesthetic period. Results: For each horse, physical appearance was improved and respiratory stridor eliminated...
Kuemmerle JM, Auer JA, Rademacher N, Lischer CJ, Bettschart-Wolfensberger R, Fürst AE.To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome. Methods: Retrospective study. Methods: Horses (n=10) with type Ia P1 fractures. Methods: Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement ...
Ishihara A, Shields KM, Litsky AS, Mattoon JS, Weisbrode SE, Bartlett JS, Bertone AL.This study evaluated healing of equine metatarsal osteotomies and ostectomies in response to percutaneous injection of adenoviral (Ad) bone morphogenetic protein (BMP)-2, Ad-BMP-6, or beta-galactosidase protein vector control (Ad-LacZ) administered 14 days after surgery. Radiographic and quantitative computed tomographic assessment of bone formation indicated greater and earlier mineralized callus in both the osteotomies and ostectomies of the metatarsi injected with Ad-BMP-2 or Ad-BMP-6. Peak torque to failure and torsional stiffness were greater in osteotomies treated with Ad-BMP-2 than Ad-B...
Furniss C, Carstens A, Cilliers I.A 12-year-old, grey, crossbred pony mare was presented with a swelling in the neck over the area of the 2nd cervical vertebra (C2), which was found to be painful on palpation. The neck was held stiffly. Radiography of the cervical region showed a focal area of increased radio-opacity over the dorsal, caudal and lateral aspect of the dorsal spinous process of C2. Ultrasound confirmed the presence of a hypoechoic area approximately 15 cm in diameter superimposed over the dorsal spinous process of C2. An aspirate was taken of the mass, which revealed purulent exudate confirming the diagnosis of a...
Vos NJ, Pollock PJ, Harty M, Brennan T, de Blaauw S, McAllister H.Four horses and one pony, ranging in age from one to 11 years, were diagnosed with two different types of odontoid peg fractures. Their clinical signs included reluctance to move the neck and head, dullness, and abnormalities of gait. Radiography was essential for the diagnosis, and the method of treatment varied depending on the severity of the neurological signs, the intended use of the horse, and financial constraints. Optimal treatment requires a technique that allows decompression, anatomical alignment, and stabilisation of the odontoid fracture. If the clinical (neurological) signs are n...
David F, Savard C, Drolet R, Alexander K, Pang DS, Laverty S.To report the diagnosis and treatment of a branchial apparatus anomaly (BAA) associated with a mandibular malformation in a foal. Methods: Clinical report. Methods: Haflinger foal. Methods: A 6-day-old foal had a fluctuating cystic mass in the pharyngeal (throatlatch) region, which changed in appearance after ingestion of milk. Upper airway endoscopy and diagnostic imaging (ultrasonography, radiography, computed tomography) permitted identification of the anatomic location of a communicating tract between the lumen of the cystic mass and the pharynx. The mass was surgically removed and communi...
Rossol M, Gygax D, Andritzky-Waas J, Zheng G, Lischer CJ, Zhang X, Auer JA.To (1) evaluate and compare computer-assisted surgery (CAS) with conventional screw insertion (conventional osteosynthesis [COS]) for treatment of equine abaxial distal phalanx fractures; (2) compare planned screw position with actual postoperative position; and (3) determine preferred screw insertion direction. Methods: Experimental study. Methods: Cadaveric equine limbs (n=32). Methods: In 8 specimens each, a 4.5 mm cortex bone screw was inserted in lag fashion in dorsopalmar (plantar) direction using CAS or COS. In 2 other groups of 8, the screws were inserted in opposite direction. Precisi...
Maher O, Davis DM, Drake C, Myhre GD, Labbe KM, Han JH, Lejeune SS.To report outcome of horses treated for navicular syndrome using a pull-through (PT) technique for palmar digital neurectomy (PDN). Methods: Retrospective study. Methods: Horses (n=41) with navicular syndrome (NS). Methods: Medical records (1998-2002) for horses that had NS and failed to respond to conservative management that had unilateral or bilateral forelimb, biaxial PDN were reviewed. Outcome for up to 6 years was obtained by telephone questionnaire or lameness examination. Survival analysis was used to assess time to recurrence of lameness. Results: One year after PDN, 36 horses (88%) w...
Vos NJ.Osteomyelitis of the mandible with Actinomyces species was diagnosed in a 4-year-old sports horse with radiographic changes suggestive of neoplasia. Surgical debridement, intravenous and local iodine solution treatment were administered. Mandibular Actinomyces infections are reported in humans and ruminants; they have not been previously reported in the horse. Actinomycose de la mandibule simulant une malignité chez un cheval. Une ostéomyélite de la mandibule à Actinomyces sp. a été diagnostiquée chez un cheval de sport âgé de 4 ans montrant des changements radiographiques ressemblant...
Sturgeon BP, Milne EM, Smith KC.A 20 x 10 cm, lobulated mass was present in the perianal region of a 4-year-old Dales pony. Histopathology revealed an unencapsulated, loose arrangement of sheets and whorls of narrow mesenchymal cells, situated in the deep dermis. Intervening areas had a myxomatous appearance. The whorls were often arranged around a central structure resembling an axon or a vascular structure. Immunohistochemistry revealed that the elongated mesenchymal cells and central axon-like structures expressed vimentin, S-100, and neuron-specific enolase, but not pancytokeratin, glial fibrillary acid protein, and the ...
Moran JA, Lemberger K, Cadoré JL, Lepage OM.An 11-year-old Andalusian stallion developed marked signs of colic associated with an acute small intestine obstruction. Exploratory laparotomy revealed a distal jejunum full-thickness wall induration and multiple small adherent intraluminal masses. Fifteen centimeters of jejunum, including the induration, and several intraluminal masses were resected. Histologic examination revealed an adenocarcinoma and multiple polypoid adenomas. The horse was discharged, and no complications were reported 12 months postoperatively. Colic was considered secondary to partial jejunal lumen obstruction by the ...
Puff C, Herder V, Philipp A, Baumgärtner W.A 15-year-old Haflinger gelding presented with a mass in the left nictitating membrane. Two biopsies and the excised nictitating membrane were taken at different time points as a result of reoccurrence of the mass and submitted for histopathologic evaluation. The horse was euthanized as a result of poor prognosis following the reoccurrence of the mass after surgical removal. Histologically, the mass consisted of dilated, thin-walled vascular clefts and channels, lined by flattened to cuboidal endothelial cells with moderate cellular pleomorphism. There was up to 1 mitotic figure per high power...
Holder TE, Schumacher J, Donnell RL, Rohrbach BW, Adair HS.To determine the effects of hyperbaric oxygen therapy (HBOT) on full-thickness skin grafts applied to fresh and granulating wounds of horses. Methods: 6 horses. Methods: On day 0, two 4-cm-diameter circular sections of full-thickness skin were removed from each of 2 randomly selected limbs of each horse, and two 4-cm-diameter circular skin grafts were harvested from the pectoral region. A skin graft was applied to 1 randomly selected wound on each limb, leaving the 2 nongrafted wounds to heal by second intention. On day 7, 2 grafts were harvested from the pectoral region and applied to the gra...
Trumble TN, Brown MP, Merritt KA, Billinghurst RC.Validate use of a commercially available immunoassay for measurement of bone alkaline phosphatase (BAP) in equine serum and synovial fluid (SF), and investigate the effects of osteochondral (OC) injury in horses on BAP concentrations in serum and SF. Methods: SF was collected from 37 joints of 34 Thoroughbred (TB) racehorses undergoing arthroscopic surgery for the removal of OC fragments from either the carpal joints (n=18) or the metacarpo-/metatarsophalangeal (MP) joints (n=19). SF was also obtained from 52 joints of 16 normal TB horses, collected bilaterally from carpal joints of 10 horses ...
Cousty M, Rossier Y, David F.The traditional techniques for injection of the sacroiliac (SI) region are based on external landmarks. Because of the depth of the SI joint and pathological modifications, SI injections are sometimes challenging in horses. Objective: An ultrasound-guided techniques would allow placement of the needle without depending on external landmarks. Methods: Fourteen pelvic specimens were isolated from mature horses. A 20 cm bent spinal needle was positioned with ultrasonographic guidance under both iliac wings aiming for SI joints using 5 approaches: cranial, craniomedial, medial and 2 caudal approac...
Wallis TW, Goodrich LR, McIlwraith CW, Frisbie DD, Hendrickson DA, Trotter GW, Baxter GM, Kawcak CE.There are no published results of subchondral cystic lesions (SCLs) in the medial femoral condyle (MFC) treated with arthroscopic injection of corticosteroids into the lining of the cyst. Objective: 1) To determine the success rate for treatment of SCLs in the MFC with arthroscopic injection of the fibrous tissue of the cyst with corticosteroids. 2) To identify any factors that may predict outcome. Objective: Injection of the fibrous tissue of SCLs of the MFC with corticosteroids utilising arthroscopic guidance yields a similar or higher chance for intended performance than does arthroscopic d...
Cheetham J, Radcliffe CR, Ducharme NG, Sanders I, Mu L, Hermanson JW.Studies are required to define more accurately and completely the neuroanatomy of the equine dorsal cricoarytenoid muscle as a prerequisite for developing a neuroprosthesis for recurrent laryngeal neuropathy. Objective: To describe the anatomy, innervation, fibre types and function of the equine dorsal cricoarytenoid muscle. Methods: Thirty-one larynges were collected at necropsy from horses with no history of upper airway disease and 25 subjected to gross dissection. Thereafter, the following preparations were made on a subset of larynges: histochemical staining (n = 5), Sihler's and acetylch...
Henderson CE, Sullins KE, Brown JA.To determine long-term effects of transendoscopic, laser-assisted ventriculocordectomy (LAVC) on airway noise and performance in horses with naturally occurring left laryngeal hemiplegia. Methods: Retrospective case series. Methods: 22 horses with left laryngeal hemiplegia treated by means of LAVC. Methods: Medical records were reviewed and initial complaint, intended use of the horse, duration of abnormal airway noise, preoperative performance level, endoscopic findings, surgical procedure, postoperative treatment, and complications were recorded. Follow-up telephone interviews with owners an...
Perkins JD, Hughes TK, Brain B.To describe and evaluate the use of a transoral, endoscope-guided technique for transection of an entrapping epiglottic fold in sedated standing horses. Methods: Retrospective study. Methods: Horses (n=16) with epiglottic fold entrapment (EFE). Methods: Medical records (2005-2006) of 16 horses with EFE were reviewed to determine history, physical and endoscopic examination findings, postoperative complications, and outcome after axial division of EFE using a hooked bistoury, under an endoscopic-guided, transoral approach. Results: EFE was confirmed by endoscopy. Axial division was successfully...
Becker R, Haenssgen K, Precht C, Khoma OZ, Hlushchuk R, Koch C, Kaessmeyer S, de Preux M.Equine trigeminal-mediated headshaking is a painful neuropathic disorder comparable to trigeminal neuralgia in humans. The selective destruction of pain fibers within the trigeminal ganglion, called rhizotomy, is the surgical treatment of choice for idiopathic trigeminal neuralgia refractory to medical treatment in humans. The human trigeminal ganglion is enclosed by a dural recess called the Meckel's or trigeminal cave, in which the ganglion is surrounded by a cerebrospinal fluid (CSF)-filled subarachnoid space. During glycerol rhizotomy, glycerol is percutaneously injected in this CSF-filled...
Farkas A, Thieme K, Soimala T, Jensen CK, Eule JC.This retrospective study evaluates the efficacy of povidone-iodine (PI) and polyhexamethylene biguanide (PHMB) as preoperative antiseptics in equine ophthalmic procedures. Methods: Horses that underwent routine ophthalmic surgery and procedures. Methods: Data were collected retrospectively from the medical records of equine patients undergoing ophthalmic procedures. Inclusion criteria were sampling for aerobic microbial culture at three different time points (T0: pre-irrigation, T1: post-irrigation, and T2: postoperatively) and T0 showing bacterial growth. Microbiological outcomes were assesse...
Martin E, Sarkan K, Viall A, Hostetter S, Epstein K.Neutrophil characteristics in peritoneal fluid (PF) may aid in diagnosing and treating specific colic lesions and complications. The objective of this retrospective study was to evaluate quantitative PF leukocyte values, as well as PF total protein (TP) and lactate, for associations with diagnosis, morbidity, and mortality in horses with acute colic. Three hundred and forty-two horses that presented to one institution between January 2010-2020 for the evaluation of acute colic were included. The PF total nucleated cell count (TNCC), % and total neutrophil counts, total protein (TP), and lactat...
Christie KD, Epstein KL, Tyma JF, Afonso T, Fultz LE, Giguère S.Surgical site infection (SSI) is an important complication following emergency celiotomy in the horse. Judicious antimicrobial use is important for the prevention of antimicrobial resistance and the limitation of antimicrobial-associated complications. Previous studies in horses have found no association between SSI and perioperative antimicrobial duration, but the ideal duration of antimicrobial administration in horses undergoing exploratory celiotomy remains unclear. Objective: To compare SSI and describe post-operative complications, survival, duration and cost of hospitalisation in horses...
Verhaar N, Geburek F.Clinical intestinal viability assessment is associated with significant limitations, and there is an undisputable need for ancillary diagnostics during colic surgery. Human and companion animal surgeons struggle with similar intraoperative issues, yet there is little exchange between specialists. Therefore, this narrative review aimed to create an overview of real-time ancillary diagnostics with the potential for intraoperative intestinal viability assessment in horses. Most real-time ancillary diagnostics can be classified as either tissue perfusion or oxygenation assessments. Intestinal perf...
Tharwat M, Al-Sobayil F.Colic or acute abdominal pain is the most prevalent cause of emergency intervention in veterinary medicine, and it has been considered the principal reason for collapse and/or euthanasia in a wide range of studies. The condition may be initiated by a number of different disorders affecting the abdominal viscera, but acute gut disease is the most common etiology in equines showing colic symptoms. of the main goals of colic management is to distinguish between surgical and medical causes, as prompt surgical intervention can significantly improve outcomes for those requiring surgery. Despite the ...
Cervantes-Sevilla JR, Ramírez-Cervera M, Guzman-Ruvalcaba MJ.Traumatic hemothorax is a serious condition requiring immediate intervention. We present a case of a 48-year-old male professional jockey who suffered traumatic hemothorax, bilateral pulmonary contusions, and multiple rib fractures after being stomped by a horse. Management included intercostal drainage placement, costal fixation from the 5th to the 10th rib, and intensive care unit admission. Postoperative complications included, acute kidney injury, rhabdomyolysis, and severe acute respiratory distress syndrome. This case highlights the importance of a multidisciplinary approach in managing ...
Horner S, Agne GF, Byrne DP, Bain ME, Lynch BM, Gow WR, Verdegaal EL.Equine Coronavirus (ECoV) can cause gastrointestinal disease and was first described in 2000 in the USA followed by several international outbreak case reports. Disease manifestation is characterised by vague clinical signs, including mild pyrexia, lethargy and anorexia. Morbidity ranges greatly from 10% to 83%. Although uncommon, ECoV may result in death secondary to disruption to the gastrointestinal barrier causing endotoxaemia and hyperammonaemic encephalopathy. Unfortunately to date, there is no vaccine available to prevent ECoV. Methods: Three faecal quantitative polymerase chain reactio...
Pereira DIB, Botton SA, Ianiski LB, Braga CQ, Maciel AF, Melo LG, Zambrano CG, Bruhn FRP, Santurio JM.This systematic review compiles reports of clinical pythiosis in horses, mules and donkeys from 1960 to 2023 worldwide, focusing on Brazil. We searched databases and included 71 articles detailing clinical characteristics, geographic distribution, epidemiology, diagnostic methods, therapies, and outcomes. The results showed that publications on equine pythiosis have significantly increased since 2010. Brazil reported the highest incidence, comprising 55% of cases, predominantly in the southern, northeastern, and central-western regions during summer and autumn. Cutaneous pythiosis was the most...
World neurosurgeryMay 18, 2024
Volume 188 e207-e212 doi: 10.1016/j.wneu.2024.05.083
De Jesus O, Vigo-Prieto J.Horseback riding can cause severe brain and spinal injuries. This study aimed to identify the spectrum of neurosurgical injuries related to recreational horseback riding. A retrospective study was performed utilizing the University of Puerto Rico neurosurgery database to identify patients who were consulted to the neurosurgery service between 2018 and 2023 after a horse fall during recreational activities. The outcome upon discharge using the modified Rankin scale (mRS) was documented. Descriptive statistics were used to report frequency and median values. The neurosurgery service evaluated an...
McIlwraith CW, Owen RA, Basrur PK.Cytogenetic and histological studies were carried out on an intersex horse which was diagnosed clinically as a cryptorchid. Surgery confirmed the horse to be a bilateral abdominal cryptorchid and histological examination revealed ovarian tissue associated with the left epididymis. Chromosome analysis of cultured cells from testicular tissue, ovarian tissue and skin revealed 64-XX and 64-XY make-up, the left gonad containing a greater preponderance of XX cells over XY cells. The external characteristics and behaviour of the horse were indistinguishable from that of a "routine" cryptorchid. Othe...
Smyth GB.An abnormal cryptorchid testicle removed from the abdominal cavity of a 4 year old Thoroughbred stallion is described. The abnormal organ conforms to the requirements of Willis (1960) for a teratoma. The difference between these tumours in man and horses is discussed.
Labens R, Khairuddin NH, Murray M, Jermyn K, Ahmad RS.To assess fracture gap reduction and stability of linear vs triangular 4.5-mm lag screw repair of experimental, uniarticular, and complete forelimb proximal phalanx (P1) fractures. Methods: Experimental. Methods: Fourteen equine cadaver limbs/horses. Methods: Simulated fractures were repaired with 2 lag screws under 4-Nm insertion torque (linear repair). Computed tomography (CT) imaging was performed with the leg unloaded and loaded to forces generated while walking. The fracture repair was revised to include 3 lag screws placed with the same insertion torque (triangular repair) prior to CT. T...
Klein CE, Engiles JB, Roessner HA, Hopster K, Hurcombe SD.To compare the application and healing of the zip skin closure system (ZSCS) with sutured closure by use of a split-scar model of ventral midline incisions in horses in a prospective, randomized experimental study. Methods: 8 adult horses. Methods: All horses underwent an exploratory ventral midline celiotomy with a standardized 30-cm skin incision. Each horse was randomized to have either the cranial 15 cm closed with suture and caudal 15 cm with the ZSCS or vice versa (split-scar model). Skin closure time was recorded and compared. Photography and skin biopsies were taken preoperatively and ...