Response to early repeat celiotomy in horses after a surgical treatment of jejunal strangulation. Issue 6 (29th May 2017)

• Record Type: Journal Article
• Authors: Bauck, Anje G.; Easley, Jeremiah T.; Cleary, Orlaith B.; Graham, Sarah; Morton, Alison J.; Rötting, Anna K.; Schaeffer, David J.; Smith, Andrew D.; Freeman, David E.
• Is Part Of: Veterinary surgery. Volume 46:Issue 6(2017)
• Page Start: 843
• Page End: 850
• Publication Date: 2017-05-29
• Subjects: Veterinary surgery -- Periodicals; Veterinary Medicine -- Periodicals; Surgery -- Periodicals; Societies, Medical -- Periodicals; 636.0897
• DOI: 10.1111/vsu.12670
• Languages: English
• ISSNs: 0161-3499

Abstract

Abstract: Objective: To determine the outcome after early repeat celiotomy in horses operated for jejunal strangulation. Study design: Retrospective case series. Animals: Horses (n = 22) that underwent repeat celiotomy for postoperative reflux (POR) and/or postoperative colic (POC) that did not improve within 48 hours from onset after initial surgical treatment of strangulating jejunal lesions by jejunojejunostomy (n = 14) or no resection (n = 8). Methods: Medical records were reviewed for clinical signs, duration of signs before repeat surgery, surgical findings and treatment, and outcome. Survival was documented by phone call at long‐term follow‐up. The influence of POC and POR on timing of surgery were analyzed. Long‐term survival was examined by Kaplan‐Meier analyses. Results: Repeat celiotomy was performed at a median of 57 hours after initial surgery and 16.5 hours from onset of signs, and earlier in horses with POC compared with POR ( P < .05). A total of 3/22 horses were euthanatized under anesthesia. A total of 9 of 11 horses with initial jejunojejunostomy required resection of the original anastomosis due to anastomotic complications. In 8 horses without resection, second surgery included resection (4) or decompression (4). Repeat celiotomy was successful in 13/16 horses with POR. Repeat celiotomy eliminated POC in all horses (n = 9). A total of 19 horses were recovered from anesthesia and all survived to discharge. Incisional infections were diagnosed in 13/17 horses where both surgeries were performed through the same ventral median approach, and hernias developed in 4/13 infected incisions. Median survival time was 90 months. Conclusion: Repeat celiotomy can eliminate signs of POR and/or POC, and the additional surgery does not appear to aggravate POR. Criteria for repeat celiotomy in this study could provide guidelines for managing POC and POR after surgery for jejunal strangulation.