Long-term survival and complications following small intestinal resection and partially stapled, functional end-to-end anastomosis.
Authors: Kopec Elizabeth Katherine, Stevens Martha, Crowe Oliver, Wright Chris, Suthers Joanna
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Small intestinal resection is a common emergency procedure in equine colic surgery, but the optimal anastomotic technique remains debated amongst surgeons. Kopec and colleagues reviewed 25 horses that underwent small intestinal resection with a modified partially stapled, functional end-to-end anastomosis between 2010 and 2020, tracking short-term survival to discharge, medium-term outcomes at 6–12 months, and long-term survival through owner questionnaires (median follow-up 785 days). Survival rates were encouraging—84% reached discharge, 76% survived to one year, and 64% were alive at two years—with these figures comparable to published data on traditional handsewn techniques; however, 64% of horses developed at least one postoperative complication, and critically, severe anastomotic complications including small intestinal volvulus requiring re-laparotomy and kinking at the anastomotic site occurred in over 10% of cases. Although this partially stapled approach achieved similar long-term survival to conventional methods, the elevated incidence of anastomotic site complications—particularly those necessitating emergency re-intervention—warrants careful consideration when selecting technique, especially given the guarded prognosis associated with repeat colic surgery. These findings suggest that whilst the modified technique is viable, surgeons should maintain realistic expectations about complication rates and ensure robust owner communication regarding the risk of catastrophic anastomotic failure.
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Practical Takeaways
- •If faced with small intestinal resection, counsel owners on realistic survival expectations: ~84% to discharge, 64% at 2 years; this technique offers no survival advantage over standard handsewn methods
- •Anticipate that 2 in 3 horses will develop some postoperative complication; monitor closely for signs of recurrent obstruction or ileus in the first weeks post-operatively
- •While this stapling technique is feasible, severe complications at the anastomosis site (volvulus, kinking) occur in >1 in 10 cases—discuss with your surgeon whether handsewn anastomosis might carry a lower risk of these specific failures
Key Findings
- •84% of horses survived to discharge, with 76% alive at 6–12 months and 64% surviving to 2 years
- •64% of horses developed at least one postoperative complication
- •Small intestinal volvulus occurred in 2 horses (8%) requiring repeat laparotomy, and anastomotic kinking was diagnosed post-mortem in 1 horse (4%)
- •Partially stapled functional end-to-end anastomosis showed comparable long-term survival to handsewn techniques but with >10% severe anastomosis site complications