Effects of hyaluronate-carboxymethylcellulose membranes on the clinical outcome of horses undergoing emergency exploratory celiotomy.
Authors: Troy Jarrod R, Holcombe Susan J, Fogle Callie A, Epstein Kira L, Woodie J Brett
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Hyaluronate-Carboxymethylcellulose Membranes in Equine Colic Surgery Emergency abdominal surgery in horses carries significant postoperative morbidity, and surgeons have explored various adjunctive strategies to reduce complications following intestinal repair. This multicentre retrospective case-controlled study examined whether application of hyaluronate-carboxymethylcellulose (HA-CMC) anti-adhesion membranes to intestinal anastomoses or enterotomies improved outcomes in 150 adult horses undergoing emergency celiotomy between 2008 and 2014, with 59 receiving HA-CMC and 91 matched controls. Whilst the HA-CMC group presented with greater nasogastric reflux volumes at admission and required longer perioperative lidocaine administration, there were no significant differences in postoperative complications (colic, reflux, fever, incisional infection, or septic peritonitis), in-hospital survival (81% versus 88%, P = 0.27), or long-term survival beyond 12 months between groups. These findings suggest that despite theoretical benefits in reducing adhesion formation, HA-CMC membranes do not confer measurable clinical advantage during equine colic surgery, raising questions about their cost-effectiveness as an adjunctive intervention in this context. Further prospective studies with standardised outcome measures and larger cohorts may be warranted before wider adoption of this technique can be justified in practice.
Read the full abstract on PubMed
Practical Takeaways
- •Application of HA-CMC membranes to intestinal anastomoses or enterotomies during colic surgery does not improve survival or reduce postoperative complications compared to standard surgical management alone
- •These membranes cannot be reliably recommended as a protective measure to enhance outcomes in emergency colic surgery based on current evidence
- •Surgical decision-making for colic cases should focus on other established factors rather than expecting benefit from routine HA-CMC membrane use
Key Findings
- •81% of horses receiving HA-CMC membranes survived to hospital discharge compared with 88% in control group (P=0.27), showing no significant difference
- •No difference detected in postoperative complications including colic, nasogastric reflux, fever, incisional infection, or septic peritonitis between HA-CMC and control groups
- •HA-CMC group had greater nasogastric reflux volume at admission and longer lidocaine administration duration postoperatively, suggesting greater initial severity
- •Long-term survival beyond 12 months was 71% (15/21) in HA-CMC group versus 70% (30/43) in control group