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Gandini M, Giusto G. Combination of end-to-end jejuno-ileal anastomosis and side-to-side incomplete ileocecal bypass (hybrid jejuno-ileo-cecal anastomosis) following subtotal ileal resection in seven horses. J Am Vet Med Assoc 2021; 259:1337-1343. [PMID: 34727065 DOI: 10.2460/javma.20.10.0577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 7 horses (3 geldings, 2 mares, and 2 stallions) were examined because of acute colic caused by small intestinal obstruction involving the aborad portion of the jejunum and orad portion of the ileum. CLINICAL FINDINGS All horses underwent a routine colic examination on arrival and had a diagnosis of strangulating obstruction of the small intestine. TREATMENT AND OUTCOME All horses underwent emergency exploratory laparotomy, in which the affected aborad portion of the jejunum and orad portion of the ileum were resected; in 5 horses, a hand-sewn end-to-end jejuno-ileal anastomosis was combined with a hand-sewn incomplete ileocecal bypass to produce a hybrid jejuno-ileo-cecal anastomosis. In 2 horses, the hand-sewn end-to-end jejuno-ileal anastomosis was combined with a half-stapled, half-hand-sewn incomplete ileocecal bypass. The procedures restored continuity of the small intestine with partial bypass of the ileocecal valve. All horses survived to hospital discharge, and none developed colic or ileus during the postoperative period. Follow-up revealed that 6 horses were living and had no subsequent signs of colic (4 to 17 months after surgery), and 1 was euthanized because of colic 17 months after surgery. CLINICAL RELEVANCE Results for these horses suggested the hybrid jejuno-ileo-cecal anastomosis could be considered as an option for the resolution of small intestinal strangulating lesions involving the orad portion of the ileum. Studies are needed to assess short-term and long-term effects of the procedure in horses.
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Averay K, van Galen G, Ward M, Verwilghen D. Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments. BMC Vet Res 2021; 17:167. [PMID: 33858391 PMCID: PMC8048223 DOI: 10.1186/s12917-021-02871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated. Results Construction times were not statistically different between groups (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792). Conclusions The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-02871-4.
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Affiliation(s)
- Kate Averay
- Camden Equine Centre, Sydney School of Veterinary Science, University of Sydney, 410 Werombi Rd, Brownlow Hill, Sydney, New South Wales, 2570, Australia.
| | - Gaby van Galen
- Camden Equine Centre, Sydney School of Veterinary Science, University of Sydney, 410 Werombi Rd, Brownlow Hill, Sydney, New South Wales, 2570, Australia
| | - Michael Ward
- Sydney School of Veterinary Science, University of Sydney, 410 Werombi Rd, Brownlow Hill, 2570, New South Wales, Australia
| | - Denis Verwilghen
- Camden Equine Centre, Sydney School of Veterinary Science, University of Sydney, 410 Werombi Rd, Brownlow Hill, Sydney, New South Wales, 2570, Australia
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Gardner A, Dockery A, Quam V. Exploratory Celiotomy in the Horse Secondary to Acute Colic: A Review of Indications and Success Rates. Top Companion Anim Med 2019; 34:1-9. [PMID: 30808489 DOI: 10.1053/j.tcam.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/11/2022]
Abstract
To review indications and risk factors for exploratory celiotomy secondary to acute colic in the horse; decision making for and during surgery; and prognosis for return to function after exploratory celiotomy for the practicing veterinarian. Data sources included scientific reviews and original research publications from veterinary sources, as well as clinical data specifically in regard to underlying disease and survival rates from a tertiary referral hospital where exploratory celiotomy is commonly performed. There is a high positive predictive value of specific clinical preoperative parameters of the equine acute abdomen, many of which rely on techniques available to field practitioners, relative to the need for surgical intervention. Decision making regarding surgical procedure or even intraoperative euthanasia depends on owner expectations. Survival rates following exploratory celiotomy range from fair to excellent (60%-100%) depending on underlying lesion and return to athleticism following celiotomy is good to excellent (76%-90%). A knowledge base of indications for and rates of survival from colic requiring exploratory celiotomy in the horse is of paramount importance to the equine practitioner. Preconceived notions of poor survival rates are rampant among horse owners, and owners rely on their primary veterinarian's advice for continuation to referral center and in further treatment including exploratory celiotomy.
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Bergen T, Haspeslagh M, Wiemer P, Swagemakers M, van Loon G, Martens A. Surgical treatment of epiploic foramen entrapment in 142 horses (2008–2016). Vet Surg 2019; 48:291-298. [DOI: 10.1111/vsu.13161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Bergen
- Department of Surgery and Anesthesiology of Domestic Animals, Faculty of Veterinary MedicineGhent University Merelbeke Belgium
- Clinique Equine d'Acy‐Romance Acy‐Romance France
| | - Maarten Haspeslagh
- Department of Surgery and Anesthesiology of Domestic Animals, Faculty of Veterinary MedicineGhent University Merelbeke Belgium
| | - Peter Wiemer
- Department of Surgery and Anesthesiology of Domestic Animals, Faculty of Veterinary MedicineGhent University Merelbeke Belgium
- De Lingehoeve Diergeneeskunde Lienden The Netherlands
| | - Michaël Swagemakers
- Department of Surgery and Anesthesiology of Domestic Animals, Faculty of Veterinary MedicineGhent University Merelbeke Belgium
| | - Gunther van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary MedicineGhent University Merelbeke Belgium
| | - Ann Martens
- Department of Surgery and Anesthesiology of Domestic Animals, Faculty of Veterinary MedicineGhent University Merelbeke Belgium
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Freeman DE. Fifty years of colic surgery. Equine Vet J 2018; 50:423-435. [DOI: 10.1111/evj.12817] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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Affiliation(s)
- D. Freeman
- College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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Salem SE, Proudman CJ, Archer DC. Prevention of post operative complications following surgical treatment of equine colic: Current evidence. Equine Vet J 2015; 48:143-51. [PMID: 26440916 DOI: 10.1111/evj.12517] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
Abstract
Changes in management of the surgical colic patient over the last 30 years have resulted in considerable improvement in post operative survival rates. However, post operative complications remain common and these impact negatively on horse welfare, probability of survival, return to previous use and the costs of treatment. Multiple studies have investigated risk factors for post operative complications following surgical management of colic and interventions that might be effective in reducing the likelihood of these occurring. The findings from these studies are frequently contradictory and the evidence for many interventions is lacking or inconclusive. This review discusses the current available evidence and identifies areas where further studies are necessary and factors that should be taken into consideration in study design.
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Affiliation(s)
- S E Salem
- Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - C J Proudman
- Faculty of Health and Medical Sciences, School of Veterinary Medicine, Guildford, Surrey, UK
| | - D C Archer
- Institute of Infection and Global Health and School of Veterinary Sciences, University of Liverpool, Leahurst, Neston, UK
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Brown JA, Holcombe SJ, Southwood LL, Byron CR, Embertson RM, Hauptmann JG. End-to-Side Versus Side-to-Side Jejunocecostomy in Horses: A Retrospective Analysis of 150 Cases. Vet Surg 2014; 44:527-33. [DOI: 10.1111/j.1532-950x.2014.12256.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer A. Brown
- Marion DuPont Scott Equine Medical Center; Virginia-Maryland Regional College of Veterinary Medicine; Virginia Polytechnic and State University; Leesburg Virginia
| | - Susan J. Holcombe
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; East Lansing Michigan
| | - Louise L. Southwood
- Department of Clinical Studies New Bolton Center; University of Pennsylvania; Kennett Square Pennsylvania
| | - Christopher R. Byron
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine, University of Illinois; Urbana Illinois
| | | | - Joe G. Hauptmann
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; East Lansing Michigan
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Bracamonte JL, Anderson SL, Hendrick S, Barber SM, Deutscher D, Sumner D. Ex vivo comparison of the biomechanical properties of hand-sewn and stapled jejunoileal anastomoses in horses. Vet Surg 2014; 43:451-8. [PMID: 24724591 DOI: 10.1111/j.1532-950x.2014.12188.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 02/01/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare bursting strength, construction time, and anastomotic dimensions of 4 jejunoileal anastomotic techniques. STUDY DESIGN Experimental ex vivo study. ANIMALS Adult horses (n = 12). METHODS Jejunoileal anastomoses were constructed from harvested ileal and distal jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique (SS), or stapled functional end-to-end technique (FEE). Anastomotic construction time was recorded. Bursting pressures (BP), bursting wall tension (BWT), percentage of mean anastomotic luminal diameter reduction, percentage of luminal diameter reduction relative to adjacent ileal and jejunal diameters and stomal length, were calculated. RESULTS FEE had the shortest construction time. BP of 1HS and 2HS was significantly higher than FEE and SS (P < .001), which were not different from each other (P = .67). There were no significant differences in BP (P = .25) and BWT (P = .21) between 1HS and 2HS. Mean luminal diameter reduction was less for 1HS (25.1%) than for 2HS (34.8%), however, not statistically different (P = .12). Luminal diameter reduction relative to ileal diameter was significantly less for 1HS (15.2%) than for 2HS (28.47%; P = .012). Luminal diameter reduction relative to jejunal diameter was less for 1HS (32.4%) than 2HS (44.6%) but not statistically different; P = .07). Stomal length was significantly larger for SS (9.93 cm) than FEE (7.32 cm; P = .0002). CONCLUSION 1HS and 2HS jejunoileal anastomosis are equal in strength; however, 1HS results in less relative luminal diameter reduction. SS and FEE have comparable strength but fail at significantly lower BPs than hand-sewn jejunoileal anastomoses.
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Affiliation(s)
- José L Bracamonte
- Department of Large Animal Clinical Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Close K, Epstein KL, Sherlock CE. A Retrospective Study Comparing the Outcome of Horses Undergoing Small Intestinal Resection and Anastomosis With A Single Layer (Lembert) or Double Layer (Simple Continuous and Cushing) Technique. Vet Surg 2014; 43:471-8. [DOI: 10.1111/j.1532-950x.2014.12143.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 06/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Kristyn Close
- College of Veterinary Medicine; Department of Large Animal Medicine; University of Georgia; Athens Georgia
| | - Kira L. Epstein
- College of Veterinary Medicine; Department of Large Animal Medicine; University of Georgia; Athens Georgia
| | - Ceri E. Sherlock
- College of Veterinary Medicine; Department of Large Animal Medicine; University of Georgia; Athens Georgia
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Stewart S, Southwood LL, Aceto HW. Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010. Equine Vet J 2013; 46:333-8. [DOI: 10.1111/evj.12143] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S. Stewart
- Department of Clinical Studies; New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; USA
| | - L. L. Southwood
- Department of Clinical Studies; New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; USA
| | - H. W. Aceto
- Department of Clinical Studies; New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; USA
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Lee WL, Epstein KL, Sherlock CE, Mueller POE, Eggleston RB. In vitro comparison of a single-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end jejunoileal anastomosis in normal equine small intestine. Vet Surg 2012; 41:589-93. [PMID: 22731983 DOI: 10.1111/j.1532-950x.2012.00997.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare in vitro physical and mechanical characteristics of 1-layer and 2-layer end-to-end jejunoileostomy. STUDY DESIGN In vitro experimental study. ANIMALS Adult horses (n = 6). METHODS Harvested equine jejunum and ileum was used to create 1- and 2-layer end-to-end jejunoileostomy specimens. Construction time, bursting pressure, and relative lumen diameter (anastomosis diameter expressed as a percentage of the lumen diameter of adjacent jejunum and ileum) were compared. Construction time and relative lumen diameters were compared using a paired t-test. Bursting pressure for anastomoses and control jejunal segments were compared using a repeated-measure ANOVA. Statistical significance was set at P < .05. RESULTS Mean (± SEM) construct completion times were shorter for 1 layer (21 ± 0.91 minutes) than 2 layers (26.71 ± 1.16 minutes; P = .005). Relative lumen diameters (percentage of jejunal diameter) were larger for 1 layer (77.67 ± 4.46%) than for 2 layers (69.37 ± 2.8%; P = .035). There were no significant differences in bursting pressures between the 2 groups and the control jejunum (P =.155) or relative lumen diameters (percentage of ileal diameter; P =.118). CONCLUSIONS One-layer jejunoileostomy can be created in a shorter time and maintain a larger anastomosis luminal diameter without compromising maximum bursting pressure when compared to 2-layer jejunoileostomy.
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Affiliation(s)
- Wesley L Lee
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia Athens, GA 30602, USA
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Mendez-Angulo JL, Ernst NS, Mudge MC. Clinical assessment and outcome of a single-layer technique for anastomosis of the small intestine in horses. Vet Rec 2010; 167:652-5. [DOI: 10.1136/vr.c5251] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J. L. Mendez-Angulo
- Galbreath Equine Trauma; Intensive Care and Research Center; Veterinary Teaching Hospital; Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Ohio State University; 601 Vernon L. Tharp Street Columbus OH 43210 USA
| | - N. S. Ernst
- Galbreath Equine Trauma; Intensive Care and Research Center; Veterinary Teaching Hospital; Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Ohio State University; 601 Vernon L. Tharp Street Columbus OH 43210 USA
| | - M. C. Mudge
- Galbreath Equine Trauma; Intensive Care and Research Center; Veterinary Teaching Hospital; Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Ohio State University; 601 Vernon L. Tharp Street Columbus OH 43210 USA
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Proudman CJ, Edwards GB, Barnes J. Differential survival in horses requiring end-to-end jejunojejunal anastomosis compared to those requiring side-to-side jejunocaecal anastomosis. Equine Vet J 2010; 39:181-5. [PMID: 17378448 DOI: 10.2746/042516407x171354] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Horses requiring different methods of intestinal anastomosis during equine colic surgery may have differences in mortality and morbidity. HYPOTHESES Horses requiring side-to-side jejunocaecal anastomosis have a higher mortality and morbidity rate than those requiring end-to-end jejunojejunal anastomosis. Morbidity and mortality of handsewn vs. stapled side-to-side jejunocaecal anastomoses are not significantly different. METHODS A prospective, nonrandomised, observational study was conducted. Clinical and surgical details were recorded during hospitalisation and survival data acquired by periodic telephone questionnaire. Differences in mortality and morbidity rate were evaluated by survival analysis. RESULTS A total of 184 horses underwent end-to-end jejunojejunal anastomosis and 178 underwent side-to-side jejunocaecal anastomosis. Horses with a jejunocaecal anastomosis had a significantly higher mortality rate. The incidence of post operative colic in horses requiring side-to-side jejunocaecal anastomoses was greater than those requiring end-to-end jejunojejunal anastomoses. Within the group undergoing side-to-side jejunocaecal anastomosis there was no evidence of differential survival between horses with handsewn vs. stapled anastomoses. CONCLUSIONS Mortality rate is higher in horses that have required side-to-side jejunocaecal anastomosis than in those that needed end-to-end jejunojejunal anastomosis; and post operative colic is more common after side-to-side jejunocaecal anastomosis. No difference in mortality was found between horses with handsewn and stapled side-to-side jejunocaecal anastomoses. POTENTIAL RELEVANCE Surgeons should be aware of the increased mortality and morbidity in horses requiring side-to-side jejunocaecal anastomosis. Our finding of no difference in mortality between handsewn and stapled side-to-side jejunocaecal anastomoses justifies surgeons exercising personal preference in their selection of anastomosis method.
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Affiliation(s)
- C J Proudman
- Equine Division, Faculty of Veterinary Science, University of Liverpool, 'Leahurst', Neston, Cheshire CH64 7TE, UK
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Intrinsic innervation of the ileocaecal junction in the horse: Preliminary study. Equine Vet J 2010; 41:759-64. [DOI: 10.2746/042516409x407594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
In recent years important advancements in colic surgery have led to improved prediction of survival rates, better survival rates, and decreased complication rates. This article describes several modalities to combat and prevent incisional hernia and intestinal adhesion formation in horses undergoing colic surgery. These modalities have had a positive impact on reducing complications in horses after surgery.
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Affiliation(s)
- Gal Kelmer
- Large Animal Department, Koret Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel.
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Abstract
Prognosticating survival in horses with colic is challenging because of the number of diseases and pathophysiologic processes that can cause the behavior. Although the treatment of horses with colic has improved dramatically over the years, case fatality can still be high because of the delay in recognizing the problem, the time delay inherent in receiving veterinary care, and the lack of effective treatment for the more severe diseases. Intensive case management and surgery for these horses may be expensive and emotionally draining for owners; therefore, providing an accurate prognosis is key to decisions needed for case management. This article is dedicated to recent advances in applying a prognosis for survival in horses at higher risk for a fatal outcome.
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Affiliation(s)
- Sarah Dukti
- Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Leesburg, VA 20177, USA.
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Mair TS, Smith LJ, Sherlock CE. Evidence-Based Gastrointestinal Surgery in Horses. Vet Clin North Am Equine Pract 2007; 23:267-92. [DOI: 10.1016/j.cveq.2007.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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