Standing flank laparotomy for colic: 37 cases.
Authors: Lopes Marco A F, Hardy Joanne, Farnsworth Kelly, Labens Raphael, Lam W Y Eunice, Noschka Erik, Afonso Tiago, Cruz Villagrán Claudia, Santos Luiz C P, Saulez Montague, Kelmer Gal
Journal: Equine veterinary journal
Summary
# Standing Flank Laparotomy for Colic: Clinical Outcomes and Practical Considerations Between 2003 and 2020, researchers across five hospitals reviewed 37 cases (30 horses, 6 ponies, 1 donkey) managed via standing flank laparotomy for colic conditions affecting the peritoneum, small intestine, caecum and large colon—conditions where this technique offered an alternative to standard ventral midline surgery under general anaesthesia. The approach proved technically feasible across left flank (n=31), right flank (n=2), or bilateral access (n=4), with procedures ranging from diagnostic exploration to enterotomy, typhlectomy and resection-anastomosis; overall survival to discharge was 54% (20/37 animals). Disease location influenced prognosis substantially: peritoneal disease carried zero survival, whilst small intestinal cases achieved 56% survival (5/9) and caecal/large colon disease 65% survival (15/23), with enterotomy patients performing best at 100% survival (4/4). Critical limitations emerged around peritoneal analgesia—systemic analgesics proved inadequate in some cases, resulting in patient intolerance to abdominal exploration and intraoperative complications including mesenteric tears from uncontrolled visceral exteriorisation. For practitioners considering standing flank laparotomy, the technique remains viable for selected cases, particularly those requiring small intestinal or caecal intervention where owner acceptance is high; however, robust local analgesia protocols and careful patient selection—avoiding cases with suspected peritonitis—are essential to optimising outcomes and preventing catastrophic intraoperative complications.
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Practical Takeaways
- •Standing flank laparotomy is a viable alternative to general anaesthesia for selected colic cases, avoiding risks of recovery and reducing costs, though it requires careful case selection and patient tolerance
- •This approach works well for simple enterotomies and selected large colon cases, but peritoneal diseases and extensive lesions should be referred for ventral midline laparotomy
- •Ensure adequate regional analgesia and peritoneal infiltration during standing flank procedures to prevent intolerance and exploration complications, particularly in ponies
Key Findings
- •Standing flank laparotomy achieved 54% survival rate (20/37 animals) across peritoneal and intestinal diseases in equids
- •Left flank approach was used in 31 cases; right flank in 2 cases; bilateral approach in 4 cases
- •Small intestinal enterotomy had 100% survival (4/4), while peritoneal disease had 0% survival (0/5)
- •Intolerance to abdominal exploration occurred in 2 ponies during standing flank laparotomy, suggesting insufficient peritoneal analgesia may be a limiting factor