Standing Colic Surgery? In Some Cases It's Possible

Standing Colic Surgery? In Some Cases It's Possible

While traditional surgeries are still suitable for the vast majority of colic cases, recent research showed that standing operations for colic can be beneficial when other options have failed.

Photo: Anne M. Eberhardt/The Horse

What do you do when two colic surgeries have failed, and the equine patient is still in a great deal of pain? One team of veterinarians facing this scenario tried something a little different on one 7-year-old Swiss Warmblood gelding and, as it turned out, the third surgery—a standing, hand-assisted procedure—was the charm.

“We couldn’t see the lesion that was causing the colic—in this case, a mesenteric defect—when we used traditional laparoscopic (camera-assisted) techniques,” said Thomas Witte, BVetMed, PhD, FHEA, MRCVS, Dipl. ACVS, ECVS, RCVS-Recognized Specialist in Equine Surgery. “But when we adopted a hand-assisted technique, which allows manipulation of the intestine directly with one hand, we were able to identify and correct the lesion. Being able to see and visually inspect the defect was critical to the success of the repair, especially because we were able to locate and avoid all the regional blood vessels.”

Witte, a senior lecturer in equine surgery at the Royal Veterinary College in Hatfield, England, said veterinarians discovered the gelding had a tear in his mesojejunum, a layered tissue in the abdomen that helps hold the jejunum (the middle part of the small intestine) in place. Part of the horse’s small intestine had slipped through the tear (also called a rent) and become stuck, causing it to swell and tighten. In their first surgery, they could only see the swelling and displacement of the intestines, and so they corrected that. But eight hours later, the horse experienced severe colic again. The team operated again and saw the tear, but couldn’t reach it to fix it correctly, Witte said.

“We tried to fix the rent at the second surgery under general anesthesia and couldn't get to the most proximal (closest to the horse's back) part of it,” he said. “The risk of only partially closing the rent is that it is then smaller, and so there is an even greater chance of the bowel becoming strangulated than there is with a big rent. So we left it in the hope that it would perhaps remain clinically insignificant.”

However, two days later, the horse colicked badly again. This time, the surgeons chose to operate with the gelding in a standing position using a “keyhole” (laparoscopic) surgery.

“The major benefit of standing surgery is being able to explore the top of the abdomen (as the intestines fall away towards the bottom), (which was) particularly helpful in this case where the tear was long and extended a long way dorsally (towards the horse’s back),” Witte said. “Gravity can be helpful in that intestines fall into the bottom of the abdomen, giving space, but can also work against the surgeon in limiting the amount of manipulation they can do.”

However, standing colic surgery is not without its risks, he added. A conscious horse is able to move or even fall over, even though the local anesthesia has blocked pain at the surgery site, Witte said.

Having a surgeon’s hand in the abdomen also brings some risks. The procedure requires a larger incision than what is often used in traditional keyhole surgery with small instruments, he said. It’s an issue of having to weigh the pros and cons, especially in horses that are particularly sensitive to long periods of sedation and anesthesia, he relayed.

“The size of the incision is a trade-off between the increased risks of pain, infection and dehiscence (reopening), and longer recovery times, versus the ability to complete the surgery quickly and efficiently for the patient,” said Witte. “Longer surgery times are often an issue for us with our equine patents where sedative agents can have a major impact on gastrointestinal function and can result in impactions and other complications themselves.”

While Witte’s hand-and-camera-assisted standing surgery on the Swiss Warmblood was a success, and the horse has been colic-free since, he said he can’t recommend it for most colic cases because routine surgical techniques are more suitable in most instances. Even so, his work provides evidence that such surgeries can be beneficial when other options have failed.

“Careful case selection is key,” he said. “The technique worked well for this specific case. We're putting it out there as an option for more involved cases. It would not necessarily become a part of the management of more commonplace causes of colic, but potentially adds an additional option for more difficult cases.”

The study, "Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse," was published in the Journal of the American Veterinary Medical Association

About the Author

Christa Lesté-Lasserre, MA

Christa Lesté-Lasserre is a freelance writer based in France. A native of Dallas, Texas, Lesté-Lasserre grew up riding Quarter Horses, Appaloosas, and Shetland Ponies. She holds a master’s degree in English, specializing in creative writing, from the University of Mississippi in Oxford and earned a bachelor's in journalism and creative writing with a minor in sciences from Baylor University in Waco, Texas. She currently keeps her two Trakehners at home near Paris. Follow Lesté-Lasserre on Twitter @christalestelas.

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