End-to-Side Versus Side-to-Side Jejunocecostomy in Horses: A Retrospective Analysis of 150 Cases.
Authors: Brown Jennifer A, Holcombe Susan J, Southwood Louise L, Byron Christopher R, Embertson Rolf M, Hauptmann Joe G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Jejunocecostomy Technique Selection in Equine Colic Surgery When managing small intestinal impaction or obstruction in horses, jejunocecostomy creates a bypass between the jejunum and caecum, but the optimal surgical approach—end-to-side (E2S) versus side-to-side (S2S)—has remained unclear. This retrospective analysis of 150 horses across multiple centres (90 S2S, 60 E2S) examined postoperative reflux, colic recurrence, repeat celiotomy rates, and survival, with S2S procedures performed via either stapled or hand-sewn anastomoses. Discharge survival rates were comparable between groups (76% for S2S, 87% for E2S), and crucially, neither anastomotic technique nor surgical method significantly predicted postoperative reflux, colic, reoperation, or 12-month survival—suggesting that technical choice matters less than other factors. Surgeon experience (measured by American College of Veterinary Surgeons board certification duration) significantly influenced discharge survival (P=0.003), whilst older horses and those receiving prokinetic agents were more likely to develop postoperative reflux (P=0.006 and P=0.0006 respectively). For practitioners, this means that standardising your preferred technique and focusing on rigorous case selection, appropriate perioperative medications, and realistic expectations around age-related complications will likely yield better outcomes than switching between approaches.
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Practical Takeaways
- •Choice between end-to-side and side-to-side jejunocecostomy should not be based on technique alone—both approaches yield similar outcomes, so use whichever technique you perform most reliably
- •Surgeon experience matters more than surgical technique; outcomes improve with increasing surgeon board certification and experience
- •Older horses carry higher postoperative risk; discuss prognosis frankly with owners of geriatric colics and monitor closely for reflux complications
Key Findings
- •No significant difference in postoperative reflux, colic, repeat celiotomy, or survival between end-to-side and side-to-side jejunocecostomy techniques
- •Surgeon experience (years boarded by ACVS) significantly affected hospital discharge survival (P=0.003)
- •Increased age significantly associated with reduced 12-month survival (P=0.006) and increased postoperative reflux (P=0.013)
- •76% of side-to-side and 87% of end-to-side cases discharged alive from hospital