An Alternative Approach to Colic Operations

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By Mark Andrews 

A recent study has concluded that standing flank laparotomy may be a suitable option for surgical treatment of some cases of equine colic. 

The standard surgical approach for colic is through an incision in the ventral midline, with the horse under general anesthesia. General anesthesia poses additional risks over and above those of the surgery itself, and the personnel and equipment required increases the cost.  

Operating through a flank incision would avoid the need for general anesthesia and should be less expensive. 

Marco Lopes and coworkers conducted a retrospective analysis of clinical records of 37 equids (horses, ponies, and a donkey) treated using a standing flank laparotomy at five hospitals between 2003 and 2020. Their findings are published in the Equine Veterinary Journal

They did not include cases of small colon impaction in their analysis, as previous work had already shown that such cases could be dealt with using a flank incision. 

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Source: The University of Adelaide

Financial considerations were the main reason for the choice of technique. However, in ten cases of nephrosplenic entrapment (when the large colon migrates between the spleen and the abdominal wall and becomes trapped over the nephrosplenic ligament) the surgeon preferred a flank incision. 

In seven animals, the decision for euthanasia was taken immediately as they were found to have an untreatable condition, or the likelihood of survival was very poor. 

Twenty of the 30 horses found to have a treatable condition survived. These conditions included small intestine inflammation or impaction, large colon displacement (especially nephrosplenic ligament entrapment), and sand impaction. 

The authors identify limitations of the technique: 

  • The horse must stand still during the operation, so standing flank laparotomy cannot be performed on horses with severe colic that cannot be adequately controlled medically; 
  • Additional peritoneal analgesia may be needed; 
  • Access to the peritoneal cavity and the abdominal organs is not as good as with a ventral midline incision; 
  • A second incision on the opposite flank may be needed; 
  • Surgeons are not as familiar with standing flank laparotomy; and, 
  • Scars in the flank are more likely to be seen than those in the ventral midline. 

They conclude that this series of cases indicates that standing flank laparotomy is a viable approach for abdominopelvic exploration in some horses with colic attributed to conditions of the small intestine, caecum, large colon, and peritoneum. 

For more details, see Standing flank laparotomy for colic: 37 cases

Related: Rehabilitation for Horses and Return to Performance after Colic Surgery

Published with the kind permission of Mark Andrews, Equine Science Update.