Standing operation may suit some horse colic cases, review finds

Operating through a flank incision for colic surgery would avoid the need for general anaesthesia and should be less expensive.
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Standing flank laparotomy may be a suitable option for surgical treatment of some cases of equine colic, a recent study has concluded.

The standard surgical approach for colic is through an incision in the ventral midline, with the horse under general anaesthesia. General anaesthesia poses additional risks over and above those of the surgery itself, and the personnel and equipment required increase the cost.

Operating through a flank incision would avoid the need for general anaesthesia and should be less expensive.

Marco Lopes and co-workers conducted a retrospective analysis of clinical records of 37 equids (horses, ponies and a donkey) treated using a standing flank laparotomy at five hospitals, between 2003 and 2020. Their findings of the team, from various institutions in Australia, the US, Brazil and Israel, have been published in the Equine Veterinary Journal.

They did not include cases of small colon impaction in their analysis, as previous work had already shown that such cases could be dealt with using a flank incision.

Financial considerations were the main reason for the choice of technique. However, in 10 cases of nephrosplenic entrapment, the surgeon preferred a flank incision.

In seven animals the decision for euthanasia was taken immediately as they were found to have an untreatable condition, or the likelihood of survival was very poor.

Twenty of the 30 horses found to have a treatable condition survived. These conditions included small intestine inflammation or impaction, large colon displacement (especially nephrosplenic ligament entrapment) and sand impaction,

The authors identify limitations of the technique:

  • the horse must stand still during the operation, so standing flank laparotomy cannot be performed in horses with severe colic that cannot be adequately controlled medically
  • additional peritoneal analgesia may be needed
  • access to the peritoneal cavity and the abdominal organs is not as good as with a ventral midline incision.
  • a second incision on the opposite flank may be needed
  • surgeons are not as familiar with standing flank laparotomy
  • scars in the flank are more likely to be seen than those in the ventral midline.

They conclude that this series of cases indicates that standing flank laparotomy is a viable approach for abdominopelvic exploration in some horses with colic attributed to conditions of the small intestine, caecum, large colon and peritoneum.

Marco A. F. Lopes, Joanne Hardy, Kelly Farnsworth, Raphael Labens, W. Y. Eunice Lam, Erik Noschka, Tiago Afonso, Claudia Cruz Villagrán, Luiz C. P. Santos, Montague Saulez, Gal Kelmer. Standing flank laparotomy for colic: 37 cases. Equine Vet J (2021). 

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