OK, good evening everyone and welcome to tonight's equine webinar. My name is Sophie and I'm from the University of Edinburgh. So before I introduce the talk for tonight, if you've got any questions for the speaker throughout the talk, and then could you please pop it in the Q&A box that you've got on your screen, .
And then I'll ask this the speaker at the end. Likewise, if you're getting any technical difficulties, if you just pop a query in the neither the chat or the Q&A box, and then we've got Lewis who'll be able to help you if you are getting any technical difficulties. OK, so with the housekeeping done, I'm excited to present to Doctor Julia Zuk, who is going to talk to us about equine surgical colics and the recurrence and prevention.
So Julia graduated from the University of Montreal, in Canada, where she then did an internship, in equine surgery, . Mainly on standard bred and thoroughbred racehorses. In 2014, she then took a three year surgical residency where she focused solely on equine surgery, as well as undertaking a master's programme, and she did this at the University of Montreal.
Her main area of research is centred around the equine stifle, specifically mesal diseases and the contribution to joint disease, but currently, Julia's working as a clinical assistant professor in equine surgery at the University of Nottingham, where she's a diplomat of the American College of Veterinary Surgeons and for large animal surgery. And she's currently one of the two surgeons, at Oakham Equine Hospital in the Midlands, and there she sees elective and emergency cases. So, without any further ado, I'll hand you over to Julia.
Thank you very much, Sophia, for the introduction. Well done with the pronunciation of my last name as well. Right.
So, everyone tonight, well welcome and thank you for being with us. We obviously there is a lot of literature on the topic tonight and really the goal of tonight is to, make sure that everyone is up to date on more. Recent numbers and more recent developments in surgical colic, we are going to start with an anatomy review very brief in the beginning.
Then we're going to chat a little bit about colleagues and owners and what they know and maybe particularly what they don't know. Then updates on the risk factors from recent work of my colleagues from Nottingham. Update on colic costs as well, and then diving into the surgical colic topic, presenting some general numbers with a little bit all of the pathology, survival data, then a little bit of an overview of the colic prevention and how we can address that in a surgical manner.
There are techniques for small intestine and large intestine, and in the end, the small section to conclude on repeat laparotomies. So anatomy review, it will be brief. Apologies for a little bit of a blurry appearance here.
So now we're looking at the right side of the abdomen and the horse. It's just really a brief review. What have we got on the right side in the abdomen of the horse?
Obviously we have a large colon, the ascending colon, but most importantly, the Cum. There is the duodenum as well, the right kidney. And obviously when we admit horses and we're interested in colic workup, we try and pay attention to the right ventral cranial abdomen where sometimes if we think that there is, for example, some distended loops of small intestine visible on ultrasound, we would be suspicious of pathologies, for example, like epiploic entrapment.
On the left side of the abdomen, much different. This is where we find the spleen and also the stomach. You might remember that there is a ligament between the spleen and the stomach that is called the gastrosplenic ligament.
It is possible to have entrapment of the small bowel, in. To that ligament which is called a gastrosplenic ligament entrapment, and also we have on that side the large colon left sided, so left dorsal colon, left ventral colon, and obviously the left kidney and the very well known nephrosplenic space. So colleagues and owners, why have I put that there even if we're supposed to have a chat about colleague surgeries and all, I was just surprised there was a really interesting publication from the University of Nottingham in 2019 and EVG, and they just looked at really horse owners's knowledge and opinions on recognising colic and the horse, and I was quite shocked really from the results.
So I thought it was good for everyone really, . To have a quick reminder, so they asked 1,564 horse owners, 75 of which were UK based. They gave clinical scenarios.
One was for a surgical colleague, the other one was for an infection colic, for example. And what they realised is that for surgical colic clinical scenario, 49% of the owners thought that they were confident, deciding that the horse had colic. For an impaction colleague, for example, only 9% of the owners were confident that their horse had colics.
So really for a surgical colleague, it's 1 person out of 2 that will be confident that their horse is not feeling well, which really isn't very much. And only 20% also of the owners gave an accurate definition of the word colic. So I think this is to highlight that we do still.
You know, all as horse veterinarians, we have a duty still to try and educate the owners a little bit more, always, and how to how to assess their horse a little bit and how to recognise that they are not right. And I was quite shocked, especially, you know, oftentimes surgical colleague, sometimes, sometimes it's not easy, but oftentimes it's quite. It's quite obvious, and I was very surprised to see that it was only 1 in 2 people who were confident saying that their horse wasn't right.
So diving quickly into updates on risk factors, again, recent work from the University of Nottingham looking at risk factors for acute abdominal pain, so colic and the adult horse. This was a review that was published in plus one, and it is a review of the risk factors and systematic review of the effect of management related changes. The risk factor identified was most frequently, no no surprise for anyone, change in management.
What do we speak about when we talk about change in management, we mean change in feed, change in career, change in exercise. Change in pasture, amount of pasture, or no pasture at all, or even duration and quality of the pasture, water availability of the water and then type of housing, changing yards and things like that. So in that same publication still talking about the curtis publication, when we look at each of these factors independently, for feed, for example, they showed that if for concentrate when the horse eats more than 2.5 kg of concentrate per day and more than 2.7 kg of oats per day, that was considered a risk factor for the development of colic.
Whole grain as well. Some risk factors were along the lines of eating more whole grain and other ones less whole grain, so this is a little bit less clear. Coastal grass hay was definitely a risk factor that was identified.
Horses that received hay from round bales were also considered at higher risk. And increased risk for crib biting and winds socking with hay versus hailage. We do know that crib biting and windsucking has been associated to the development of epiploic for entrapment.
It is not a correlation. But the work from Debbie Archer from Liverpool and all of that group, they definitely have found an association. So basically horses that were presented for colic and had a fore and entrapment, more of these horses were wind suckers than any of the other type of cos that presented.
Looking into the other factors briefly, so carer, we have a decrease risk if the carrier was the owner only. For exercise, there was increased risk if the horse was exercised more than once a week versus pasture only. For pasture, the risk factor was increased to more risk of colic if there is access to 4 pastures versus only 1.
More risk of colleagues with no access or recent decrease in access. More risk of colic if no or decrease water excess, and then more risk of colic if recent change in housing or in stabling, and more risks with wind sucking and biting. Also along the lines of risk factors I wanted to mention, this is a tad older 2015, and this is work that came out from the University of Ghent, a very good group that has been working a lot on, epiploic forum and entrapment of the small bowel, and they had a really finding in one of their anatomy study, they found that the size of the equine epiploic foramen is of the main circumference of about 11.6 centimetres plus or minus 2.6 and that population, of course, it's the majority.
Large size horses and therefore they have found also that actually the size of the foramen and the circumference to be more precise, of the foramen was positively correlated to the weight of the horse. So the heavier the horse is, the bigger the circumference is. Old horses, is that a risk factors.
There is little publication about that, but there is one that is quite robust and nice that was from 2015, a group from the University of Pennsylvania in the United States looking at short. Turn complications after colic surgery in geriatric versus mature non geriatric horses. So briefly they divided their horses in two groups, a mature horse group and a horse between 4 and 15 years old, and then a geriatric group where the horses were aged of at least 20 years old.
They found that all the horses had higher odds of strangulated intestinal lesion, which most of you will be aware of already. They have also found that in old horses or in older horses, they will usually have more postoperative reflux and more postoperative inhabitants. Now looking at some of the critical cases, this is again some work from the same group, the University of Nottingham, Sarah Freeman, and all of these colleagues.
They were looking at their big data about what happens to the horses in general, and this is not only referral centre data. This is more data about critical case. Which includes cases that general practitioners see as well, and they found no surprisingly that a lot, a lot of the critical cases will be euthanized.
So in that that study they identified up to really almost 80% of the critical cases were were euthanized and they . And the great part in their discussion saying that probably if we try and refer these horses and if these horses had a bit more intensive medical cases or intensive medical care, should I say, or maybe even surgery, then there would probably be more chances obviously to save these. A brief section about colic costs.
Obviously this changes and this here was published I believe in 2019 in vet records. I just had a look earlier today. Debbie Archer also did a piece, I believe it's in the vet record to about basically how much does it cost, and the conclusion is usually the cost of the first colic surgery, should I say, or if everything goes relatively well.
It should be covered in the 5000 pounds that the majority of the horses are insured for in the UK with vet fees. However, sometimes it goes over. Obviously depending on multiple things, if the horse requires surgery, of course, and if the horse is presented out of hours and hours and things like that.
So in that assessment of costs and insurance policies that that group did, they had 4 possibilities. So the outcome one was how much is it going to cost if the horse is presented for a colleague and We basically utilise it around 800 to 900 pounds. If the horse is presented to an equine hospital and has surgery to open the abdomen, see what we find and euthanasia.
Obviously the range of cost is quite wide. We see here from 1500 anywhere to 10,000 with a mean of 3500. It doesn't say obviously when the horse was euthanized and all, but as a mean to keep in mind around 3000 pounds.
An outcome 3, maybe the simplest of the outcome, the horse is referred to the hospital, and for that day, it's only a medical treatment of the colic, and it's a simple colic with not a lot of treatments required. We're looking more at 1500 pounds. And then for surgical treatment, well, again, the range is relatively wide with a mean of about 6500 pounds.
And if we look a little bit lower in the table here where I've actually I've not circled, but I've put some red around for the outcome one for the 800 to 900 pounds with the first option. Just euthanasia on hospital admission. These cases were euthanized within the 1st 24 hours, so that didn't include any surgical intervention.
So I just thought that was interesting sometimes. When you call for an estimate and things like that, obviously it's hard for us to give a precise estimate. You don't know what's going on.
We don't know what's going on. That's why the horse, you know, is being referred, but it's good to have at least these costs in mind and obviously these included multiple hospitals in the UK, not only O and that's it. OK, so diving into more the subject of tonight, surgical colleagues, general numbers.
So again, as I mentioned in the beginning, there are a lot, a lot, a lot of publications in that recently. And so I have done an overview and tried to present something that is quite concise but gives still quite, clear information that you can. Remember when you speak to the owners, regarding numbers and things.
So to make it, easier, I have divided it a little bit according to what, segment of bowel can be affected. So if we're looking, for example, at a surgical colic that is in the type of small bowel and a strangulated small bowel, like we can see on the right side. There could be a small intestinal strangulated lesion for many reasons.
Some of these that are maybe the ones we see. The most or quite frequently, certainly lipoma is on top of the list and should be on top of the list. There is not really any study talking about only lipomas and survival related to only strangulated pedantylate lipomas.
Small intestinal strangulated lesion caused by gastrosplenic ligament entrapment, short term survival rate, very reasonable from 70 to 88% more or less. If, and just for clarity, and usually in the studies and the publication when people discuss about short term survival. They do talk about having the horse alive up to discharge.
This is the definition, the majority of the time of short term survival, long term survival, obviously it depends, can be anywhere from a couple of months. Have to discharge to a year or 2 years, and this usually is mentioned. So for gastrosplenic ligament, short term survival from 70 to 90%, more or less on two different studies that are quite recent.
For epiloic foramin entrapment, which is personally at Oton Veterinary Hospital, we see a lot, a lot of these cases, and we're not quite sure why, but we do see a lot more in the literature it says that these cases are presented about 5% of the surgical colic caseload, and the practise where I work at the moment, it definitely is much higher than that somehow. In recent studies, the short term survival for epiploic forams is about 85%. However, what is quite disappointing with these ones, and these are a little bit older data, are that the long term survival actually goes down quite significantly, looking at 51% of the horses alive at one year.
And 34% of the horses alive at 2 years. As I said before, this is data from a little while ago, almost 10 years already, and since these well that publication particularly, there has been substantial development in the management of epiploic for women entrapment and prevention and things like that. So we will discuss that a little bit later on in the presentation here.
Another tricky small intestinal strangulated problem would be if there is a mesenteric grant, which also is very possible, and it's been published recently that the short term survival was more along the lines of 75% and the same for long term survival. They did say in that publication that obviously really important to try and close the rent in surgery if it is surgically accessible. If it is not closed, there are obviously more chances of recurrence, and this is something that they encountered in their case population, which was a study from Kentucky in the United States if I recall properly.
Now looking at the other big part of the gastrointestinal tract, so large colon ascending colon. There is a little bit of data on the displacements themselves. There are more data recently on nephrosplenic entrapment, so movement of the colon, that would go basically on top of the spleen and get stuck on the nephrosplenic ligament or the renal splenic ligament and doesn't come down.
Unless it is reduced by surgery, there is also a medical treatment and this is true for all types of displacement until proven otherwise, the Medicare treatment is always what we Aim for in the beginning and then obviously if the horse doesn't tolerate it and if the horse is not well, then we are going to elect to go for surgery. Now I said that for displacements obviously very different than the case of a large colon faullus. So if we stick for the moment with the ascending colon displacement.
Number one that we try usually will be always the medical treatment. If we're looking at medical treatment of right dorsal displacement, quite successful around 60, 65% of the cases for left dorsal displacement, which we also call nephrosplenic entrapment when they are displaced dorsally. Success rate anywhere with the medical treatment between 76 to 94% and even I think 98% more recently as well.
There are other types of displacement on which there is a little bit less evidence for success rates, for example, the pelvic flexure retroversion, and that's it. Looking at surgical treatment, that's not because I'm a surgeon, but obviously surgical treatment of displacement, if it's to the left or to the right, it's a 100% success, right? Because we put it back in place.
So we have the easy part and that's it. I just wanted to tell you on the right side here, this is a good picture. And, for people who have assisted in a colic surgery before, or even if you haven't, you've probably noticed that there is a big hole in the middle.
It actually this case, is a case that I had last summer. It had a tear of the. Mesocoon and basically the pelvic flexure had retraversed into that tear and obviously the horse did not respond to analgesia.
We opened it and we found the pelvic flexure retroversion. We had to take it out of the hole and then once I've exteriorized the colon, we realised. That there was a tear in the misocolon.
It is not something that is very published on, not at all, but in surgeons conferences and things. This is something that we see and horses in general will do quite well, obviously if the vascularization in the misocholo is intact and as well. Survival data for surgical colleagues.
Recently, there has been some studies again that are very interesting, and this is coming out from the University of Davis in California and was published in 2017 looking at the Investigation of periooperative and anaesthetic variables that are affecting the short term survival of horses with small intestinal strangulating lesions. This is a really interesting publication. There is a lot, a lot of information.
One of the information that is quite interesting is that the survival to anaesthetic recovery, and this includes all their small intestinal strangulating lesion, it was still 76%, which is very good. Obviously what comes into that is also the owner's opinion and do they want or know to carry on in surgery and sometimes. When we have bowel that looks like it looks on the right side of the picture here, some people won't go for resection ostomosis and that's OK.
But survival to anaesthetic recovery in that publication of up to 76%. 1 and 2 horses did some postoperative reflux. 79% of their horses survived to discharged, and more than one surgery during hospitalisation was necessary for 30% of the horses.
Now we will discuss a little bit more. About repeat laparotomies later, but this is one area when we talk about colic surgery that really in the last 5 years there has been a change in minds of a lot of surgeons where we do think that it's quite beneficial to go back in surgery within. It's a little bit personal, but in general, there is an agreement that within 72 hours, ideally within 48 hours to go back in the abdomen if the horse is not doing like it should be doing it, for example, it has signs of postoperative iles, it is refluxing or it is not just not looking like it should after colic surgery.
In that same publication from Espinoza, they identified as well that resection, anastomosis and jejunoyostomy were both associated with a repeat laparotomy and with not surviving to discharge. Now, what does that mean? It doesn't mean that we have to stop doing resection and ostomosis and it doesn't mean that we have to stop.
And doing Ginosostomies as well just means that we need obviously to keep an eye on these horses a little bit closer in the postoperative period. And yes, repeat laparotomy might be necessary, but sometimes it is not. So it really depends.
And sometimes the development of iles in the postoperative period is not always quite obvious from what we see in surgery. From that study, they've identified as well that if the last segment of the small intestine is involved in The problem, so if it's involved in the incarceration or in the entrapment or in the interception, for example. There will be more nasogastric intubation to do and more nasogastric reflux, usually postoperatively.
And in other studies, they have identified that for strangulated small intestinal lesions, really, it's almost 1 in 2 cases where the ileum will be involved and it is a little bit. It is a little bit difficult when the ileum is involved as well. The number one reason is that not all of the ileum can be exteriorized from the abdomen.
The very distal part of the ileum, the one that basically opens into the yum is not something that we can see. It is only something that we can palpate. So if it is in fact involved all the way to the base of the yum, it complicates, well, the surgeon's life and also the decisions, and sometimes it will be more difficult for the horse in postoperative period.
This is a good study that I use all the time, and still, if it's only 2014 because the study was extremely well done, it's a different one. It's out of Pennsylvania, and they compared basically, the usual techniques that we will do for resection and anastomosis for small intestinal strangulated lesions. And so they Compare the short and the long term complications, and tonight I'm presenting the survival rates following three different procedures.
So either Jinoinostomy, Jinal ileostomy, and the Jino psychostomy and 112 horses. So why would we go, for example, for Jino psychostomy? We would go for a Jiyostomy if we don't have any healthy tissue in the ileum to do the anastomosis between the Jinum and the ileum.
Or we would do a gegenous ecostomy if, for example, the lesion is affecting the ileum all the way into the sy almost, or we actually cannot see any healthy part of the ileum, in which case we would need to cut it and instead of doing the anastomosis in a tissue that is non-healthy, we will choose to do the anastomosis between the jejunum. And the stadium and then we basically bypassed the helium. So survival to discharge, looking at Gino Jainostomies, 79% of the horses and survived to discharge, and for these same horses.
9, so for the ones that went out of the hospital, 93% of these horses survived or were alive at one year. For anginal ileostomy, very similar numbers for survival to discharge, around 78%. And of these horses that had a ginal ileostomy, 100% were alive at one year.
When looking at the geostomies, usually this is something that like one surgeons don't like doing very much, looking at the survival to discharge in 83% of the cases and survival at one year still 80%. It's a very, very good number, but Usually why I said that people don't like to do it very much is it will be more complicated in the postoperative period when usually there is a Ginoyostomy that is performed. It is changing the normal anatomy of the horse, and it is recognised like in This publication here that the horses that had sorry, Juno psychosomies performed had more colic and more rapid cellotomies in the long term than both the Ginoinostomies and the ginal ileostomies.
To be noted that the ginal ileostomies had more repeat cellulotomies in the short term. So for example, while they were still in the hospital for their first colic surgery, Gino psychostomy from this publication, the takeaway message is they might have more problem and colic in the long term. OK, now looking at survival, not into small bowel pathologies, but more into colics related to large colon, really, really interesting publication here from 2015 in equine Veterinary Journal, .
From Colorado and Kentucky from the United States. So looking at the duration of disease and when horses are presented for large colon volvulus, and as you will read in the title, the duration of the disease influences survival to discharge, and their population was thoroughbred mares. So this is really important and not Actually everyone knew it, but this is a publication that comes to really reinforce what everyone thought, and it's really to stress about the fact that basically time is of the essence for any colleague and any referral always.
So in that study, the factors that were associated with non-survival, so courses that did not survive, were colic duration prior to admission. PCV ad admission, surgery duration, heart rate 48 hours post-op, the presence or the consistency of the droppings post-op, and the length of hospitalisation. This is something all of these factors are very, very common in a lot of the studies that are related to colics, really, the colic duration prior to admission really definitely is very important.
So, and the things that we should remember probably, mayors with colleagues for more than 2 to 4 hours before presentation were 3 times more likely not to survive. If we compared to mares that had been colicing for more than 4 hours, these were nearly 12 times more likely not to survive. So it is really important if there is a doubt that the horse might be a surgical candidate.
I'm using this obviously large colon. At least you couldn't really get worse, but this way to think is good for any types of collie. If the horse is insured, always try and do the best for the horse and send the horse away as soon as there is a doubt that this might be a surgical candidate.
Another very interesting study from Davis and the United States from 2016, looking at clinical findings when I was discussing a little bit earlier, the gastrosplenic ligament entrapment, there is also the epiploic form entrapment that we've discussed. The study is great because it compared the both actually in the same publication. So compared the clinical findings and the short term survival between horses with intestinal entrapments and gastrosplenic ligaments and ones that had the form entrapment.
So briefly, and their population and probably this applies less to us over here. But gastro ligament entrapment, it was 0.44% of their colic surgical case load, and the deployed for entrapment was 0.75.
As I said, in other studies, usually the prevalence for epiploic for women is around 5%, and personally in Rutland and Leicestershire area, it seems to be a little bit higher. There was no difference in the short term survival for any of these two pathologies, both with a very good survival rate, at least survival to discharge for the gastrosplenic ligaments up to 88%, and with the apyloid form entrapment up to 85%. Now call it prevention.
We're gonna start just talk a little bit about the small intestine and then we're gonna speak a little bit about the colic prevention for large intestines. So for small intestine, epiloic foramin entrapment, this is at the moment the colic from small intestine that we can prevent, as I said, just a little bit before epiploic form entrapment affects about 5% of the horses that are under that are undergoing colic surgery. Reported recurrence rate anywhere between 2% and 14% depending on the studies.
There is a method that has been developed by the group of Gent Van Bergen and I've spoken about earlier as well tonight. They have developed a mesh closure that we can do under laparoscopy. It is a procedure that we do standing under sedation, like a standard laparoscopy, a little bit like an ovarectomy, except that obviously it's in a different area and it is only on the right side of the abdomen.
On the right side here you can see pictures on the top you can see in the top picture in the. The middle the mesh and what the mesh looks like, it's a ziabolo shaped mesh. It's a non-reservable mesh made of polypropylene that will be pushed into the epiploic foramen with the laparoscopic guidance.
This is a procedure that we will do in days 2 weeks after the initial colic surgery, obviously depending on how the horse recovers after the first colic surgery. So this was published first in 2016, and among these studies they have found that 43% of the horses which were operated for an for an entrapment had the spontaneous closure after the entrapment. When it was reduced under general anaesthesia, so almost one horse and 2, that we operate for like for trapin because probably of the manipulation that we have to do to get the bowel out and that's a really hard surgery to perform and it takes time and probably because of the manipulation, there is in some horses a natural closure of the foramen after a little bit like you can see on the bottom right pictures over here.
And since then that same group has actually developed a mesh closure technique. This time it is done under general anaesthesia, and it is very similar to the mesh that you've just seen before, the double shape diabollo mesh, but it is placed, or it is to be placed in the eloic foramen. During the initial exploratory cellulotomy, and it will cause adhesions, basically fibrous closure of the epiploic.
For men, they have described that in one horse in their study, they found a lesion between the coded process and the right side of the liver, but that was the only complication that they could identify. So that's quite interesting and actually very new. Right, now looking into how can we prevent colics caused by the large intestines.
So we're talking about displacement or valvullus, for example, now the classic nephrosplenic entrapment, it is diagnosed in So this is again synonymous with displacement to the left, diagnosed in up to 9% of the horses that were referred, and the recurrence rate up to 23% in some recent publications. What can we do? Usually, the standard for that will be a closure of the nephrosplenic space, and it will be done in standing laparoscopy.
Now opposite to the closure of the hyoid foramen, this one is done on the left side where the nephrosplenic space is accessible. There are multiple different techniques that have been used and tried, for example, with a large cannula, extracorporeal knots, or with a mesh closure, or even recently with barbed kno suture, which is what you have imaged on the right side here, the publication of Valeria Albane which basically consists of suturing the splenic capsule to the peri renal fat a little bit, and then we close the space and the colon cannot go and stay trapped in the nephro splenic space anymore. And the other large colon disorders that we can help surgically, obviously large colon volvulus is quite an important pathology, and it usually has a lot of complications if the horses actually get through it in the postoperative period.
So colon displacements, including vovulli, will account for 33 to 49% of surgical colleagues. One of the recent publication that was well received in the American College of Veterinary Surgeons and a lot of people had a lot of questions about that. The famous coopexy, and everyone wonders.
So this study looked at the clinical outcomes after coopexy through left ventri paramis an incision. Again, their population is thoroughbred boomers, but I was, they were all presented with a large colon disorder. So why I say that all of the horses were.
Broad mars obviously because some of some of the surgeons will notexi a colon in a spoiled horse, and actually the majority will notexi the colon in sport horses. So it is very good information still in that publication it was done on brood mares. So what happened with with that, the colon torsions are frequent, and they're more, they're more frequent, than colon displacements and brood marrows.
We talk 88% of large colon volvulus versus 12% of displacements in that study. So Definitely a large colon ovule is more important for brood males. The coloexis they were performed at 2nd displacement or 2nd voulus or after, so not after first offence.
7% of their cases needed relaparotomy. So this is one of the the result box that I have just copied over here to show that during the hospitalisation. Some interesting complications.
For example, peritonitis and hemorrhagy from the choleplexicide one, stricture of the right dorsal colon, one, colonic necrosis one. These are what they have found obviously during hospitalisation following the lexi. After discharge, there could be other problems, and what they have encountered was large colon volvulus caudal to the coopexxicide, severe gas disnsion of the of the large colon, small intestinal adhesion, or mental adhesion, peritonitis, hyoform entrapment, chemo abdomen, and small intestinal fulfillus.
3% of the horses in that study unfortunately had the colon rupture, and this is probably what most people are scared of when they are considering colopexy, and this is probably the reason why the majority of the people will notexi colons on spoiled horses still. The mean of 19, almost 20 days after surgery, this is when the majority of the colon ruptures happened in that study. The site of the rupture was not consistent between cases.
So overall, in that study from Burrows of 2018, the brood mares with the large colon ovulles that were peed, 93% survived to discharge, and 81% survived to one year. For large colon disorders, again, another thing that we can do is large colon resection. So the large colon resection work, a lot of work, a lot of it is done from the University of Colorado, and the reasons for colectomy and colon resection, why would we do it?
We could do it for salvage or we could do it for prophylaxis in the study from Pittsan it from Colorado in 2017, it was more or less half and half. Half of the horses had colectomy for salvage, half for prophylaxis. 50% of the horses colic during hospitalisation.
One had a repeat cellotomy. 81% of the horses survived the discharge, and 67% of the horses. And that were discharged, never collected after.
There are different techniques, and in that study, they've evaluated both techniques. There was no significant difference between the current rejection techniques. The survival discharge did not differ between if you did it for salvage or if you did it for prophylaxis.
So this is another possibility for repeat offender after colon displacement or after large colon voulus. So colectomy, colon resection. And then briefly, a couple of minutes on repeat laparotomies because as I said in the beginning, this is an area that is really changing in the minds of many surgeons and active discussions about that in the European college conferences and also in the American College.
The latest publication on that is out of Pennsylvania looking at perioperative variables that influence repeat cellulotomy and horses with postoperative reflux. That was only after a small intestinal surgery, so they found that. 27% of their horses had a surgical reason for a repeat cellotomy.
5 had adhesions, 3 had bowel ischemia, 2 had the small intestinal valvulus. 2 had obstruction of . The psychostomy and one horse had a leakage of the anastomosis.
The medium time to relaparotomy and that study was 5 days. And as I said before, the tendency more recently is maybe to go more within the 1st 48 to 72 hours. And the same study from Pennsylvania from Kerrie Jacobs, 73% had medical reasons for reco as opposed to surgical reasons.
What would be a medical reason for reco? For example, any signs of iles, and persistent reflux, greater volume of or duration of postoperative reflux was not associated with surgical or medical reasons. So basically, if the horse is reflexing a lot, it doesn't mean That it's more of a surgical reason or that it's more of a medical reason, but it is definitely not normal and the amount of reflux needs to decrease quite quickly in the postoperative period.
Otherwise, it will be suggested to the owner to repeat the cellulotomy. To ensure that there is nothing wrong in the abdomen, and oftentimes all we will find is distension of the small bowel because it's been stopped a little bit because of the pain and the previous distention and then we decompress all of the content from the small intestine into the skin, and then they do very well. Postoperative fever and timing for a colic, they found that for every one increased Fahrenheit and temperature, rectal temperature in the post-operative period, the odds for a surgical reason for the reflux were increased by 4.8 folds.
And the colic later in the postoperative period were more likely to have a surgical reason than a medical reason. And a little bit of an older study about repeat laparotomies just to finish, which I think it's still a very pertinent. This is a study that was performed in the UK from cases of different hospitals.
The medium duration prior to repeat la laparotomy, and that study was more around 3 days. The most common finding was paralytics, like I just discussed and decompressing the content of the small intestine into the sum. And anastomosis problems were identified in up to 30%, incisional infections in up to 70%.
This is something that we always tell the owners before we go to surgery again. But it it is a little bit little fish compared to is the horse going to live or not, but generally speaking, incision infection after first cellulotomy can go up to 25% of the cases. After second cellulotomy, more around 50% of the cases will have an incisional infection.
Right. I hope that there's a good overview. Thank you very much for your attention.
If you have any questions, please let me know. Thank you very much, Julia. That was, yeah, a really interesting and yeah, I covered a lot of it was a quick overview.
That was a quick overview. It was a very quick overview. Yes.
So there was, it was quite interesting, well, a few statistics, so 78% of horses, that we euthanize that were considered critical cases, horses people didn't want to take to surgery or What was the definition of the critical cases? No, the critical cases, these include cases I think that the majority did not want to go for surgery. Right, OK.
So that leads into one of the, the questions is, I mean, so colic rates, surgery rates, technically we've we've improved surgically, but do you still think there's a bit of a stigma with clients about colic surgeries? Do they, do people, they don't want, even though, kind of rates of recovery are better than they used to be. Do people just not want to do it for whatever reason?
I mean, it could be financial, it could be personal, or does it still have this historical stigma, that people think colic surgery is, is not a good idea for their horse? Yes, I mean, obviously plenty of colleagues will be resolved medically, plenty of Colleagues will be resolved on the yard, but we definitely do hear still that some people say, oh, you know, this horse is going to be for sale. I don't want to have colic surgery on my horse because then I can never sell it.
And this is something that we still hear quite frequently, unfortunately. Yeah. Yeah, so, do you, and insurance companies, I mean, this comes up quite a lot, you know, the, the average cost of a colic was 6500 pounds.
Insurance companies are only insuring 3.5 to 5000 pounds. I mean, is, is, is, well, that could potentially be a problem or Well, yes, and this, you know, sometimes we always do our best to try and keep the, you know, the clients updated with the bill, but the difficulty comes from the fact that we don't know from the start what we're gonna get.
That's why we're opening the abdomen and this, you know, we don't know if we're gonna need to do resection and osmosis. So all we can do really is do a good communication with the clients and, and we go from there because we can get a little bit of anything, really. Yeah.
Yeah, exactly, yeah, because without opening up the abdomen, you don't really know, so. Yes, and obviously that's with the 6500. I mean this includes, you know, multiple different hospitals and multiple different places in the country and you probably know like me that the costs are not the same everywhere.
So obviously it's to be taken a little bit with a grain of salt, but it is to be expected that the the insurance limit will most likely be reached. Yes. Yeah, yeah.
And then, regarding the meshes for the epiloic frame and entrapments, is there a reason why you would, you would not want to place a mesh at the time of surgery? Well, there is. Not really.
I mean, in that study, that's only one study, and they have not reported really any significant complications, shall I say. And this is not something that when the standing, the standing version came out, it came out before and everyone was excited, but actually, it's much less invasive, you know, for the horse if we, if we obliterate the space, . The foramen in surgery, and, and it works quite well.
So there is no reason why we wouldn't, we wouldn't really do it. Yeah, and is that something that you routinely do then, or? We have measures here that are ready to roll, but we've not done it very much so far, but we're ready.
We're ready. Well it's, it's a good job you have a high proportion. Yeah, we're having a moment with at the minute.
I'm hoping it'll stop soon because yeah they're never as good as. OK, yeah, so that's all our questions. So that all that remains is to say thank you very much for a really interesting talk.
I'd also like to thank Bailey's for sponsoring tonight's webinar. And I hope everyone at home enjoyed it as much as I did. So thank you again, Julia, for really thank you thank you very much.
Have a good day. Bye bye, bye.
