Response to early repeat celiotomy in horses after a surgical treatment of jejunal strangulation.
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
Journal: Veterinary surgery : VS
Summary
# Response to Early Repeat Celiotomy in Horses After Jejunal Strangulation Surgery When horses develop persistent postoperative reflux (POR) and postoperative colic (POC) within 48 hours of jejunal strangulation surgery, decisions about re-exploration can be challenging; this retrospective review of 22 horses undergoing early repeat celiotomy examined outcomes and identified prognostic factors to guide clinical management. Repeat surgery was performed at a median of 57 hours after the initial operation, with horses showing POC re-explored significantly earlier than those with POR alone. Nine of 11 horses that initially underwent jejunojejunostomy required resection due to anastomotic complications at second surgery, whilst in horses managed without resection initially, four required delayed resection and four underwent decompression; crucially, repeat celiotomy successfully resolved POR in 13 of 16 cases and eliminated POC entirely in all nine affected horses, with 19 of 22 horses surviving to discharge and a median long-term survival of 90 months. A notable complication was incisional infection in 13 of 17 cases where both procedures used the same ventral midline approach, resulting in hernias in four of these infected incisions. These findings suggest that early re-exploration within the first 48 hours of persistent clinical signs is justified and does not worsen reflux, providing evidence-based criteria for surgical decision-making in post-jejunal strangulation complications, though surgeons should consider alternative incision sites for repeat procedures to reduce infection risk.
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Practical Takeaways
- •Early repeat surgery within 48 hours of unresolved postoperative colic or reflux significantly improves outcomes—do not delay if signs persist
- •Be prepared for anastomotic failure: most horses with initial jejunojejunostomy will need resection at second surgery, so expect this complication
- •Use a different surgical approach (paramedian or lateral) for repeat celiotomy to reduce incisional infection risk (76% infection rate with same ventral median approach) and subsequent hernia formation
Key Findings
- •Repeat celiotomy was successful in eliminating postoperative colic in all 9 horses (100%) and postoperative reflux in 13/16 horses (81%)
- •9 of 11 horses (82%) with initial jejunojejunostomy required resection due to anastomotic complications at second surgery
- •Incisional infections occurred in 13/17 horses (76%) when repeat surgery used the same ventral median incision, with hernias developing in 4/13 infected incisions
- •Median long-term survival was 90 months with 19/22 horses (86%) surviving to hospital discharge