FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / BMC Vet Res / Midline vs. flank laparotomy- criteria for choosing the opti...
BMC veterinary research2025; 21(1); 542; doi: 10.1186/s12917-025-04883-w

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

Abstract: 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).
© 2025. The Author(s).
Get Full Text
Publication Date: 2025-09-24 PubMed ID: 40993602PubMed Central: PMC12462257DOI: 10.1186/s12917-025-04883-wGoogle Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study compares two surgical techniques—standing flank laparotomy (SFL) and midline laparotomy (MI)—used to correct uterine torsion in pregnant mares, and proposes criteria for choosing the optimal approach based on mare and pregnancy characteristics.

Background

  • Uterine torsion is a significant pregnancy complication in mares, occurring in 5-10% of cases during the last trimester.
  • It involves twisting of the uterus, which can compromise blood flow and endanger the mare and fetus.
  • Two main surgical methods exist for correcting uterine torsion:
    • Standing flank laparotomy (SFL): Surgery through the flank on a standing mare under local anesthesia.
    • Midline laparotomy (MI): Surgery through a midline abdominal incision under general anesthesia with the mare lying down.

Study Aim

  • To present a clear protocol or set of criteria for deciding which surgical technique to use when correcting uterine torsion in mares.
  • This is based on clinical experience with 19 mares undergoing surgery for uterine torsion.

Methodology

  • Total of 19 mares were treated surgically for uterine torsion:
    • 13 mares underwent midline laparotomy under general anesthesia.
    • 7 mares had standing flank laparotomy under local anesthesia.
  • Preoperative diagnostics included rectal palpation and ultrasound to assess uterine wall condition, fetal viability, and presence of other disorders.

Outcomes and Observations

  • Standing flank laparotomy group (7 mares):
    • 6 mares successfully recovered and delivered healthy foals.
    • 1 mare required conversion to midline laparotomy as the torsion was not resolved by flank approach.
  • Midline laparotomy group (13 mares including conversion case):
    • 7 mares recovered and gave birth to normal foals.
    • One mare had a cesarean section due to inability to reposition the uterus; mare recovered well.
    • 2 mares with dead fetuses had cesarean sections; one died during surgery due to critical condition, the other recovered.
    • 3 mares aborted dead fetuses within one week post-operation:
      • One euthanized due to postoperative complications.
      • Two recovered without further complications.

Criteria for Surgical Technique Selection

  • Standing Flank Laparotomy (SFL) is preferred when:
    • The mare is calm, cooperative, and can tolerate sedation and local anesthesia.
    • Pregnancy duration is up to 320 days.
    • The fetus is alive.
    • No advanced circulatory damage is suspected in the uterine wall or broad ligament based on exams.
    • No comorbid conditions suspected.
  • Midline Laparotomy (MI) is chosen when:
    • The mare is nervous, unpredictable, or unsuitable for standing surgery.
    • Pregnancy exceeds 320 days.
    • The fetus is dead.
    • Severe compromise of uterine wall or suspicions of other abdominal issues exist.

Significance of the Study

  • Offers veterinary surgeons a practical, evidence-based guideline to optimize surgical approach decisions in mares with uterine torsion.
  • Helps improve surgical success rates, fetal survival, and mare recovery by aligning the surgical technique with individual mare and pregnancy characteristics.
  • Highlights that while flank laparotomy avoided general anesthesia complications in selected cases, midline laparotomy remains essential for complicated or advanced cases.

Cite This Article

APA
Samsel J, Gündemir O, Szara T, Witkowski M. (2025). Midline vs. flank laparotomy- criteria for choosing the optimal surgical technique for uterine torsion correction in the mare. BMC Vet Res, 21(1), 542. https://doi.org/10.1186/s12917-025-04883-w

Publication

BMC veterinary research
ISSN: 1746-6148
NlmUniqueID: 101249759
Country: England
Language: English
Volume: 21
Issue: 1
Pages: 542
PII: 542

Researcher Affiliations

Samsel, Jan
  • Equine Clinic in Warsaw Racetrack, Warsaw, 02-684, Poland.
Gündemir, Ozan
  • Department of Anatomy, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, 34500, Turkey.
Szara, Tomasz
  • Department of Morphological Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences- SGGW, Warsaw, 02-776, Poland. tomasz_szara@sggw.edu.pl.
Witkowski, Maciej
  • Faculty of Veterinary Medicine, Department of Diagnostics and Clinical Sciences, Krakow, 30-248, Poland.

MeSH Terms

  • Animals
  • Female
  • Horses
  • Pregnancy
  • Horse Diseases / surgery
  • Torsion Abnormality / veterinary
  • Torsion Abnormality / surgery
  • Laparotomy / veterinary
  • Laparotomy / methods
  • Uterine Diseases / veterinary
  • Uterine Diseases / surgery
  • Pregnancy Complications / veterinary
  • Pregnancy Complications / surgery

Conflict of Interest Statement

Declarations. Ethical approval: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

References

This article includes 26 references
  1. Vandeplassche M, Spincemaille J, Bouters R, Bonte P. Some aspects of equine obstetrics. Equine Vet J 1972;4:105–9.
    doi: 10.1111/j.2042-3306.1972.tb03890.xpubmed: 4569567google scholar: lookup
  2. Witkowski M, Zajac S, Luczak R. Przyczyny Oraz metody Rozwiazywania Skomplikowanych Porodow u Klaczy. Medycyna Weterynaryjna 2002;58(02):124–6.
    doi: 10.21521/mw.5633google scholar: lookup
  3. Ruffin DC, Schumacher J, Comer JS. Uterine torsion associated with small intestinal incarceration in a mare at 126 days of gestation. J Am Vet Med Assoc 1995;207:329–30.
    doi: 10.2460/javma.1995.207.03.329pubmed: 7628935google scholar: lookup
  4. Tibary A, Pearson LK. Mare Problems in the Last Month of Pregnancy. AAEP Proc 2012, 58, 350–358.
  5. Frazer G, Perkins N, Blanchard T, Orsini J, Threlfall W. Prevalence of fetal maldispositions in equine referral hospital dystocias. Equine Vet J 1997;29:111–6.
    doi: 10.1111/j.2042-3306.1997.tb01651.xpubmed: 9104559google scholar: lookup
  6. Yorke EH, Caldwell FJ, Johnson AK. Uterine torsion in mares. Compend Contin Educ Vet 2012;34:E2.
    pubmed: 23532880
  7. Martens KA, Govaere JLJ, Hoogewijs MK, Lefevre L, Nollet H, Vlaminck L, Chiers K, de Kruif A. Uterine torsion in the mare: a review and three case reports. Vlaams Diergeneeskundig Tijdschrift 2008;77:397–405.
    doi: 10.21825/vdt.87232google scholar: lookup
  8. Pascoe J, Meagber D, Wheat J. Surgical management of uterine torsion in the mare: A review of 26 cases. J Am Vet Med Ass 1981;179:351–4.
    doi: 10.2460/javma.1981.179.04.351pubmed: 7287555google scholar: lookup
  9. van der Weijden GC. Dystocia in the mare. Proc. 35th Congress British Equestrian Trade Association, Warwick, UK 1996, s. 134.
  10. Frazer GS, Embertson RM, Perkins NR. Complications of late gestation in the mare. Equine Vet Educ Man 2002;5:16–21.
    doi: 10.1111/j.2042-3292.2002.tb01789.xgoogle scholar: lookup
  11. Chaney KP, Holcombe SJ, LeBlanc MM, Hauptman JG, Embertson RM, Mueller PO, Beard WL. The effect of uterine torsion on mare and foal survival: a retrospective study, 1985–2005. Equine Vet J 2007;39:33–6.
    doi: 10.2746/042516407X159862pubmed: 17228592google scholar: lookup
  12. Sertich PL. Periparturient emergencies. Vet. Clin. North Am Equine Pract 1994;10:19–36.
    doi: 10.1016/S0749-0739(17)30367-Xpubmed: 8039032google scholar: lookup
  13. Jung C, Hospes R, Bostedt H, Litzke LF. Surgical treatment of uterine torsion using a ventral midline laparotomy in 19 mares. Aust Vet J 2008;86:272–6.
    doi: 10.1111/j.1751-0813.2008.00315.xpubmed: 18616479google scholar: lookup
  14. Frazer G, Perkins N, Constable P. Bovine uterine torsions – 164 referral hospital cases. Theriogenology 1996;46:739–58.
    doi: 10.1016/S0093-691X(96)00233-6pubmed: 16727939google scholar: lookup
  15. Perkins N, Hardy J, Frazer G, Threlfall W. Theriogenology question of the month – uterine torsion. J Am Vet Med Ass 1996;209:1395–6.
    doi: 10.2460/javma.1996.209.08.1395pubmed: 8870733google scholar: lookup
  16. Vandeplassche M. Prepartum complications and dystocia, [w:] current therapy in equine medicine. Ed: Robinson N., Saunders W. B. Co.; Philadelphia 1987. pp. 537–40.
  17. LeBlanc MM. Common peripartum problems in the mare.. J Equine Vet Sci 2008;28:709–15.
    doi: 10.1016/j.jevs.2008.10.007google scholar: lookup
  18. Steel CM, Gibson KT. Colic in the pregnant and periparturient mare.. Equine Vet Educ Man 2002, 5–15.
  19. Wichtel J, Reinertson E, Clark T. Nonsurgical correction of uterine torsion in seven mares.. J Am Vet Med Ass 1988;193:337–8.
    pubmed: 3182384
  20. Rainer P, Heinze G, Nold M, Lusa L, Geroldinger A. Firth’s logistic regression with rare events: accurate effect estimates and predictions?. Stat Med 2017;14:2302–17.
    pubmed: 28295456
  21. Spoormakers TJP, Graat EAM, Braake F, Stout TAE, Bergman HJ. Mare and foal survival and subsequent fertility of mares treated for uterine torsion.. Equine Vet J 2015;48:172–5.
    doi: 10.1111/evj.12418pubmed: 25640418google scholar: lookup
  22. Khosa JS, Anand A, Sangwan V, Mahajan SK, Mohindroo J, Singh SS. Surgical management of uterine torsion through ventral celiotomy in eleven mares.. Indian J Anim Res 2020;54(2):244–8.
  23. Derbala MK, Hassan EA, Abu-Seida AM. Outcome following standing flank laparotomy for treatment of uterine torsion in 87 Arabian mares.. Equine Vet Educ 2024;00:1–7.
  24. Witkowski M, Turek B, Tischner M. Uterine torsion in the mare: diagnosis, operation methods and prognosis.. Med Wet 2017;73:124–8.
  25. Samsel J. Chirurgiczna Korekcja Skrętu Macicy Poprzez laparotomię Na Koniu stojącym. Pięć Przypadków klinicznych.. Życie Weterynaryjne 2020;95:489–93.
  26. Platt H. Growth of the equine foetus.. Equine Vet J 1984;16:247–52.
    doi: 10.1111/j.2042-3306.1984.tb01920.xpubmed: 6383808google scholar: lookup

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 99,000 horse owners like you who receive our email updates on horse health and nutrition.