Use of perioperative variables to determine the requirement for repeat celiotomy in horses with postoperative reflux after small intestinal surgery.
Authors: Jacobs Carrie C, Stefanovski Darko, Southwood Louise L
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Postoperative reflux (POR) commonly follows small intestinal surgery in horses, but distinguishing between medical causes (functional ileus, medical mismanagement) and surgical complications (anastomosis failure, mechanical obstruction, devitalised intestine) remains clinically challenging. This retrospective analysis of 51 horses with POR following small intestinal surgery identified perioperative variables that could guide repeat celiotomy decision-making: notably, horses presenting with both postoperative fever and colic were significantly more likely to have a surgically remediable cause, whereas the absolute volume or duration of reflux were not discriminatory factors. Of the 51 cases reviewed, 14 horses required repeat surgery for definitive correction of anastomotic or mechanical complications, whilst 37 resolved with medical management alone or were found to have functional ileus on exploratory celiotomy. The timing and concurrent presentation of systemic signs appear more clinically valuable than reflux characteristics in identifying which horses will benefit from surgical re-exploration, potentially helping clinicians avoid unnecessary celiotomies in medically-managed cases whilst ensuring timely intervention when surgical pathology is present.
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Practical Takeaways
- •If a horse develops fever AND colic in the postoperative period after small intestinal surgery, suspect a surgical complication and consider repeat celiotomy rather than continuing medical management
- •The amount or duration of reflux alone should not drive the decision to reoperate—focus on fever and colic timing as better clinical indicators
- •Medical management may be appropriate for horses with postoperative reflux if fever is absent and colic timing does not suggest a new surgical problem
Key Findings
- •51 horses with postoperative reflux after SI surgery were reviewed; 14 had surgical reasons (anastomosis complications, mechanical obstruction, or nonviable intestine) while 37 had medical reasons
- •Postoperative fever and timing of colic in the postoperative period were associated with surgical reasons for reflux
- •Greater volume and duration of postoperative reflux were not associated with surgical reasons for reflux