Dr. Lane Schmitt, a large animal veterinarian in Montana, was a young associate when he encountered the uterine prolapse that changed the way he approached severe cases.
The cow was an Angus-Hereford cross, located about a mile from the barn. She was part of the practice’s number one client herd; the pressure was on.
Then the cow jumped up and took off toward the barn.
As she ran, the prolapsed uterus dropped lower and lower with each bounce.
Schmitt and the herdsman eventually got her into the chute, where he blocked her and attempted to replace the uterus. She sat down. He tried again. She sat down again. On the third attempt, Schmitt pushed his hand through the uterus.
At that point, he knew he was dealing with a severely compromised prolapse and began considering another option.
He had heard about using a banding technique to amputate a severely damaged prolapsed uterus and happened to have purchased the equipment previously. So he drove back to the clinic to grab his Callicrate bander.
While he was at the clinic, Schmitt decided to grab some calcium for the cow, wondering whether hypocalcemia might have contributed to the prolapse. When he returned, the cow somehow twisted the calcium tube off the gun while he was administering it. When he opened her mouth, all he could see was the back of the tube in her esophagus.
“Wow, that was quite a night,” Schmitt recalls.
He planned to return the next day and amputate the uterus, assuming the cow survived the night. She did. When he returned, he found the calcium tube had passed, and proceeded with the procedure. That case became Schmitt’s first experience using a Callicrate prolapse band for a severely damaged uterine prolapse.
Since then, he has incorporated the technique into his approach to difficult prolapse cases.
Using a Bander for Uterine Prolapse
This technique is not the first choice for every uterine prolapse. When a prolapse is fresh and the tissue is viable, a conventional replacement should still be attempted.
For severely damaged cases, however, Schmitt uses a band to ligate the prolapsed uterus before amputation.
This is Schmitt’s approach:
- Block the cow. Use an epidural and local anesthesia as appropriate for the procedure.
- Place the band around the prolapsed uterus. Use a Callicrate Smart Bander and the larger prolapse band, placing it just caudal to the prolapsed cervix.
- Apply moderate tension. Do not immediately clamp the band completely.
- Check what is inside the prolapse. Before fully tightening the band, make an incision into the uterus to ensure there is no intestine or other tissue incorporated into the prolapse.
- Finish tightening the band. Once confirmed the prolapse contains only the tissue you intend to remove, complete the banding.
- Treat the cow and amputate the uterus. Administer appropriate treatments, perform the amputation and replace the remaining cervical tissue.
- Close the vulva as needed. Schmitt generally places a couple of sutures in the vulva after the procedure.
The critical step for Schmitt is checking the contents of the prolapse before completing the ligation. Other tissues, including intestine or bladder, can potentially become incorporated into a prolapsed uterus, making identification important before amputation.
When Uterine Amputation Makes Sense
Schmitt considers the technique particularly useful when the uterus is too damaged for a reasonable attempt at replacement.
“Anything that I look at and think ‘this is a poor prognosis,’ I reach straight for the band,” he says.
Such cases include:
- Severely lacerated uterine prolapses
- Prolapses accompanied by substantial blood loss
- Cases in which ranch personnel have already attempted replacement and caused additional trauma
- Prolapses that have been outside the cow for an extended period
- Cases where the uterus is too traumatized or the overall prognosis is too poor for successful replacement
- Severe uterine damage discovered during a C-section
In one case, Schmitt used the technique in a heifer that had been prolapsed for more than a day. In another case, he performed a C-section and discovered a severe dorsal tear in the uterus. He manually prolapsed the uterus, applied the band, amputated the damaged tissue and replaced the remaining reproductive tract.
The technique is not appropriate for every case. If the prolapse is fresh, the tissue is viable and the uterus can reasonably be replaced, Schmitt still prefers to replace it.
He is also cautious when a cow is down on her back. Increased abdominal pressure can increase the risk that other tissues will become incorporated into the prolapse, making those cases less favorable candidates for the technique.
Keep the Bander in the Toolbox
Schmitt does not present banding as a replacement for conventional prolapse management. Instead, he sees it as another option when faced with a uterus that is too traumatized to put back in.
He now carries the bander with him on prolapse calls.
“If you haven’t seen it or thought about it or somebody told you about it one time, you can use any specific selection,” Schmitt says. “It’s a tool. A tool in the toolbox.”
The value of the technique comes down to having another option when a conventional approach is unlikely to succeed.
