Meta-Analysis of the Effects of Adhesion Barriers on Adhesion Formation in the Horse

Use of polyamide cable ties during experimental omentectomy in adult horses with histopathological assessment

OBJECTIVE

To report the use of nylon cable ties (NCT) for omentectomy in the horse.

STUDY DESIGN

Experimental study.

ANIMALS

Eight healthy adult horses.

METHODS

Horses underwent nylon cable tie (NCT) ligation of the greater omentum after ventral midline celiotomy. The time required to complete the omentectomy was recorded. Horses were recovered for 14 days before repeat celiotomy, adhesions assessment, and histological examination of the omentectomy site using a proposed histologic grading scheme. The total time for omentectomy procedure and histologic score was assessed for normality. Data are expressed as mean ± standard deviation.

RESULTS

NCT ligation provided sufficient hemostasis to complete the omentectomy (28 ± 15 s), without rescue ligation. No gross evidence of intra-abdominal adhesion or morbidity was associated with the omentectomy site 14 days after surgery. NCT were intact at the site of application, covered with smooth fibrous connective tissue. Adiponecrosis with minimal inflammation and fibrovascular occlusion of omental vessels was present at the surgical site. Mild inflammation was present at the NCT-tissue interface.

CONCLUSION

The use of NCT resulted in fast and effective omentectomy in healthy horses without short-term evidence of inflammatory reaction or intra-abdominal adhesion.

CLINICAL SIGNIFICANCE

The described technique provides an alternative for omentectomy in healthy adult horses.

Meta-analysis of the Effect of Treatment Strategies for Nephrosplenic Entrapment of the Large Colon

A variety of treatment strategies for nephrosplenic entrapment of the large colon are reported, with conflicting evidence in the published literature as to the preferred treatment option. The aim of this study is to provide a systematic meta-analytical assessment of the efficacy of different treatment strategies in horses with confirmed or suspected nephrosplenic entrapment. This study involves meta-analysis including nonrandomized studies. A comprehensive literature search was performed from January 1970 to January 2017. Inclusion criteria were retrospective studies involving horses with confirmed and suspected nephrosplenic entrapment. A meta-analysis was performed using a random effects model, with the effect size calculated as an odds ratio (OR) with 95% confidence intervals. Statistical significance was P < .05. Out of 84 peer reviewed publications that met the search criteria, 19 relevant studies were identified. Using an OR as the effect size, the meta-analysis noted that the choice of medical or surgical therapy had no statistically significant effect on survival (P = .134). Patients treated via the rolling technique were no more likely to resolve with medical management than those treated via jogging (P = .187). Patients treated with phenylephrine were no more likely to exhibit medical resolution than patients that did not receive phenylephrine, either when all medical treatment methods were considered (P = .290), or when rolling under general anesthesia was used (P = .331). Treatment strategy, including medical versus surgical therapy, does not affect the likelihood of resolution of nephrosplenic entrapment. However, the lack of randomized trials means the results should be treated with caution and case selection remains important..

Effects of hyaluronate-carboxymethylcellulose membranes on the clinical outcome of horses undergoing emergency exploratory celiotomy

OBJECTIVE

To determine the influence of hyaluronate-carboxymethylcellulose (HA-CMC) membranes applied to intestinal anastomoses or enterotomies on postoperative complications after emergency exploratory celiotomy.

STUDY DESIGN

Multicenter retrospective case-controlled series.

ANIMALS

Adult horses (59 in the HA-CMC group and 91 controls).

METHODS

Medical records from 4 referral hospitals were searched for horses ≥1 year of age, treated between 2008 and 2014 with emergency exploratory celiotomy, and surviving at least 24 hours postoperatively. Horses receiving repeat celiotomy during the same hospitalization were excluded. Horses who received HA-CMC were matched with controls who did not receive HA-CMC but had similar intestinal lesions and procedures at the same referral hospital. Postoperative complications (colic, nasogastric reflux, fever, incisional infection, and septic peritonitis), duration of hospitalization, and survival were compared between groups. Data were compared between horses by t test, Wilcoxon signed rank test, and χ² test.

RESULTS

The volume of nasogastric reflux at admission (P = .02) and the duration of administration of lidocaine after surgery (P = .02) were greater in horses with HA-CMC membranes than in controls. No difference in postoperative complications or survival was detected between groups: 48 of 59 (81%) horses treated with HA-CMC survived until discharge from the hospital compared with 80 of 91 (88%) horses in the control group (P = .27). Fifteen of 21 horses treated with HA-CMC and 30 of 43 horses in the control group survived >12 months after hospital discharge.

CONCLUSION

Application of HA-CMC membranes to anastomoses or intestinal incisions did not influence postoperative complications or survival after emergency celiotomy compared with controls.

CLINICAL SIGNIFICANCE

The safety and efficacy of HA-CMC membrane application to intestinal sites during colic surgery in horses is equivocal.