Figure legends:
Figure 1: Anatomy of the perineal area of the mare
Figure 2: Hernia presentation: during the first evaluation, the swelling was detectable mainly on the right side. The cutaneous abrasion supports the chronicity of the herniation. The left side appeared normal.
Figure 3: Poor vulvar conformation of the mare (according to Caslick Index) which could have led to the perineal muscle weakness and could have predisposed to herniation.
Figure 4: Standing appositional herniorrhaphy procedure on the right side a) Preparation of the operative field, b) Blunt dissection of the skin and underlying fascia, c) Dorso-ventral 12 cm linear skin incision, d) Hemostasis performed using Enseal® - Ethicon forceps (arrowed), e) Thin and hypotrophic remnants of the levator ani, f) Hernia breach, g, h, i) which involved the coccygeus, remnants of the levator ani, and the external anal sphincter muscles which were then anchored to the sacrotuberosus ligament and the periosteum of the ischium, j) Final result with skin suture on both sides of the perineal area
Figure 5: Re-herniation of the hernia content ventrally to the herniorraphy on the left side
Figure 6: Transposition of the semimembranosus muscle a) Preparation of the operation site, b) Dorso-ventral 20 cm linear skin incision, c) Identification of the semimembranosus muscle, d, e) Muscle transection using an emasculator and ligation with a transecting suture of the remnant muscle, f) Open superficial muscular fascia, g, h) 45° degree proximo-medial transposition of the semimembranosus muscle and defect closure, i) Muscular fascia closing using a simple interrupted suture j) Skin suture with horizontal mattress sutures.