Figure 5
Patient preparation and the anaesthesiological protocol were the same as
those used in the previous surgery. The surgical procedure was performed
with he mare in a standing position. A dorso-ventral left 20 cm linear
skin incision, lateral to the previous one, was made over the hernia
content (Figure 6.b.). The surgeon proceeded by means of a blunt
dissection of the skin and the underlying fascia until the
semimembranosus muscle which was exposed and isolated from the
surrounding structure was identified (Figure 6c). The muscle was
transected using an emasculator, and the distal part was ligated with a
transecting suture using a 2 USP multifilament adsorbable suture (Figure
6d,e). The muscular fascia was completely opened with the aim of
exposing the semimembranosus muscular belly (Figure 6f). At this point,
the semimembranosus muscle was reversed proximo-medially, and a 45°
degree transposition was obtained, and was sutured using simple
interrupted sutures to the vaginal wall, external anal sphincter,
sacrotuberosus ligament, and periosteum of the ischium using a 2 USP
multifilament adsorbable suture (Figure 6,g,h.). The muscular fascia was
closed using a simple interrupted suture (Figure 6i). The subcutaneous
tissue was sutured by applying the same suture material in a simple
continuous suture pattern. The skin was closed using a 1 USP
monofilament nylon suture with a series of horizontal mattress suture
(Figure 6j).