GASTROINTESTINAL

JOURNAL CLUB 12/09/21

Objective:

• To report a series of cases of peritoneal and intestinal diseases other

than SC diseases managed with standing flank laparotomy.

Study design:

• Retrospective case series.

Materials and Methods

• Records from equids with colic subjected to standing flank laparotomy

at five hospitals (2003-2020) were reviewed.

• Descriptive data analysis was performed.

Results

• Thirty horses (sixteen survived to discharge), six ponies (four survived) and one donkey
(euthanized) were subjected to standing flank laparotomy via the left flank (n = 31), right
flank (n = 2) or both flanks (n = 4).

• The primary disease affected the peritoneum (0/5 survived), SI (5/9 survived) and
caecum and/or LC (15/23 survived).

• Enterotomy was performed in four animals (all survived). Partial typhlectomy was
performed in one horse (euthanized). Resection-anastomosis of the SI or LC was
performed in three animals (one survived).
Results

• Three animals had intraoperative complications that negatively affected the outcome:

 Two ponies had intolerance to abdominopelvic exploration

 One mare had spontaneous exteriorization of a long segment of the SI leading to a

large tear in the mesentery.

 In seven cases, severe/extensive lesions found during standing flank laparotomy

warranted immediate euthanasia.

 The survival rate was 54%. All owners were satisfied with the decision to perform
standing flank laparotomy.
Conclusion

• Although ventral midline laparotomy is the standard of care for

horses with colic, standing flank laparotomy is a viable approach
for some types of colic.

• Systemic administration of analgesics may not produce sufficient

peritoneal analgesia, which can lead to intolerance to
abdominopelvic exploration during standing flank laparotomy in
horses with colic and may negatively affect the outcome.
Objective:

• To report the clinical features, outcomes, and prognostic factors

associated with the surgical treatment of epiploic foramen entrapment
(EFE).

Study design:

• Retrospective study at a single referral hospital.

Materials and Methods

• Preoperative, perioperative, and postoperative data of surgeries on

horses that underwent exploratory laparotomy for EFE were obtained.

• The postoperative outcome was assessed by follow-up telephone calls

with the owners/caregivers.

• Factors associated with postoperative reflux (POR), relaparotomy,

hospital discharge, colic after hospital discharge, and survival after
discharge were assessed.
Results

• In total, 145 surgeries were performed on 142 horses (recurrence rate, 3%).

• Warmblood horses represented 85% of the horses that underwent surgery.

• Windsucking/crib-biting was confirmed in 60% of these surgery cases.

Results

• Left-to-right entrapment was diagnosed in all horses.

• Ileal involvement was recorded in 74% of the cases.

• Uncontrollable intraoperative hemorrhage was encountered in 6% of the surgeries.

• One hundred seven (74%) horses recovered from surgery, and 65% of those survived to
discharge.

• The rate of survival to discharge of all surgeries was 48%. The median survival of
the cases that were discharged exceeded 3193 days.
Results

• Horses requiring intestinal resection were predisposed to POR, and those undergoing
jejunoileostomy were more prone to POR than those undergoing jejunojejunostomy.

• Horses with POR were less likely to be discharged than those without POR, and those
that underwent resection had shorter life expectancy after hospital discharge than those
that did not undergo resection.
Conclusion

• Surgical treatment of EFE was associated with high morbidity and

mortality, with recurrence in at least 3% of surviving horses.

• 26% of the horses underwent intraoperative euthanasia, and 35%

of the recovered horses died prior to hospital discharge.

• Owners of horses with EFE should be informed of the guarded

prognosis associated with current surgical treatment.
Discussion

• Discharge rates of 48% for all surgery cases and 65% for those that left the
recovery box alive in our population of mainly warmblood horses were
substantially lower compared with the 66%–69% (all horses that underwent
surgery) and 79%–85% (horses that were recovered) rates of hospital discharge
reported previously in other populations
Objective:

• To compare a 2-layer closure with suture line reversal for a pelvic

flexure enterotomy to 1-layer and traditional 2-layer hand sewn
closures.

Study design:

• Ex vivo, simple randomized study.

Materials and Methods

• Pelvic flexures were harvested from 18 horses and randomly assigned to 1 of 3

closure techniques (n56 per technique).

• A 10-cm enterotomy was made in each pelvic flexure and closed with the assigned
technique.

• Closure time, luminal diameter via contrast radiographs, and bursting pressure were
recorded for each specimen and compared between techniques using 1-way ANOVA
with Duncan post hoc test at P<.05.
The enterotomy site was closed with 2-0 Glycomer 631 (Biosyn Covidien LLC,
Mansfield, Massachusetts) on a 26- mm half-circle taper needle using 1 of 3
closures:

I. 1-layer closure with a simple continuous pattern incorporating the

serosubmucosal layer with bites placed 3-4 mm from the cut tissue edge

II. Traditional 2-layer closure with a simple continuous pattern as described and
oversewn with a separate Cushing pattern

III. 2-layer closure with suture line reversal with a simple continuous pattern
oversewn with a Cushing pattern beginning by reversing at the end knot of the
first layer, without cutting the needle end of the suture.
Results

• There was a significant difference in closure time (P5.034) with 1-

layer closure faster than both the traditional 2-layer closure (P5.024)
and the 2-layer closure with suture line reversal (P5.030).

• There was no significant difference in luminal diameter or

bursting pressure between the 3 closure techniques.
Conclusion

• Two-layer closure with suture line reversal may be an alternative to

traditional 2-layer closure for closure of the pelvic flexure based on
ex vivo bursting pressure testing and closure time.

• A 1-layer simple continuous closure resisted bursting pressure not

different to both 2-layer closure techniques. Further in vivo
evaluation may be indicated.