FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / J Vet Emerg Crit Care (San Antonio) / Incisional infections associated with ventral midline celiot...
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)2020; 30(2); 136-148; doi: 10.1111/vec.12936

Incisional infections associated with ventral midline celiotomy in horses.

Abstract: To review the veterinary literature regarding healing and complications associated with equine celiotomy including anatomy and physiology, risk factors for incisional infection and hernia, and treatment. Background: Celiotomy is the most common approach to treat horses with surgical colic. Incision through the linea alba provides exposure to most of the abdomen for exploration, exteriorization, and correction of surgical lesions. Incisional apposition relies on suture strength during anesthetic recovery and for the first 30 days postoperatively. Factors associated with the patient, surgical lesion and procedures, anesthesia, and recovery put the horse at risk for surgical site infection. Infection is the most important risk factor for incisional hernia formation. Methods: A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage. Definitive diagnosis is based on positive bacteriologic culture of the incisional discharge. Incisional hernia is diagnosed by palpation of the incision, usually 30-60 days after surgery. Ultrasound of the incision may aide in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent. Methods: No objective data exist to assess the efficacy of specific therapies for surgical site infections following celiotomy. Principles of treatment include the establishment of drainage, bandaging, antimicrobial therapy based on culture and sensitivity, and extended rest in an attempt to avoid incisional hernia or dehiscence. Treatment for incisional hernia includes prolonged circumferential bandaging, open or minimally invasive hernia repair, or no treatment. Conclusions: Incisional complications are associated with prolonged convalescence and diminished prognosis for return to athleticism. Limiting risk factors for surgical site infections, prompt treatment, and incisional support may optimize celiotomy healing and timely return to function. Horses compete in many disciplines with incisional hernias.
© Veterinary Emergency and Critical Care Society 2020.
Get Full Text
Publication Date: 2020-02-25 PubMed ID: 32100465DOI: 10.1111/vec.12936Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article
  • Review

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article is a comprehensive review of the veterinary literature related to the healing and complications of ventral midline celiotomy in horses, a common surgical procedure particularly in colic cases.

Background

  • According to the research, celiotomy is a type of surgical incision often made in horses to treat surgical colic
  • The incisional site, also known as the linea alba, provides exposure to most of the abdomen, aiding in the exploration, exteriorization, and correction of surgical lesions.
  • The healing process of this incision majorly depends on the suture strength during anesthetic recovery and for the first 30 days after surgery.
  • The study also highlights various risk factors that can result in surgical site infections in horses that undergo a celiotomy. These risk factors can be associated with the patient, the surgical procedures used, the anesthesia applied, and the recovery process.
  • Notably, infection in the initial incision is a significant risk factor in the formation of incisional hernias.

Methods

  • In diagnosing surgical site infections, practitioners rely on visible symptomology, such as fever, swelling, pain, and discharge at the incisional site. Ultrasonography may also assist this process by identifying fluid accumulation before the onset of incisional drainage.
  • A definitive diagnosis is reached once a positive bacteriologic culture of the incisional discharge is recorded.
  • Incisional hernias are typically diagnosed by palpating the surgical incision, around 30-60 days after the surgery. Ultrasound techniques can also reveal early signs of incisional hernia by identifying gaps along the incision in the linea alba.
  • The research points out that there is no objective data to evaluate the efficacy of specific therapies following incisional infections after celiotomy.

Treatment and Conclusions

  • Treatment for surgical site infections involve draining the infected area, bandaging, and antimicrobial therapy as per the culture and sensitivity results. Extended rest periods are included to avoid incisional hernia or dehiscence.
  • Hernias are treated using a combination of prolonged bandaging, open or minimally invasive hernia repairs, or in some cases, no treatment is offered.
  • From the research, it is apparent that incisional complications can result in a longer recovery period and a lower chance of the horse returning to peak physical performance.
  • To maximize the healing process and speedy return to function, the research suggests minimizing the risk factors for surgical site infections, prompt treatment for any arising complications, and providing proper incisional support.
  • Even with incisional hernias, it is noted that horses can still compete in various disciplines.

Cite This Article

APA
Shearer TR, Holcombe SJ, Valberg SJ. (2020). Incisional infections associated with ventral midline celiotomy in horses. J Vet Emerg Crit Care (San Antonio), 30(2), 136-148. https://doi.org/10.1111/vec.12936

Publication

Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
ISSN: 1476-4431
NlmUniqueID: 101152804
Country: United States
Language: English
Volume: 30
Issue: 2
Pages: 136-148

Researcher Affiliations

Shearer, Tara R
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI.
Holcombe, Susan J
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI.
Valberg, Stephanie J
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI.

MeSH Terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Horse Diseases / etiology
  • Horse Diseases / pathology
  • Horses
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / therapy
  • Surgical Wound Infection / veterinary
  • Wound Healing

References

This article includes 85 references
  1. Freeman DE, Hammock P, Baker GJ. Short- and long-term survival and prevalence of postoperative ileus after small intestinal surgery in the horse.. Equine Vet J Suppl 2000;32:42-51.
  2. Kobluk CN, Ducharme NG, Lumsden JH. Factors affecting incisional complication rates associated with colic surgery in horses: 78 cases (1983-1985).. J Am Vet Med Assoc 1989;195(5):639-642.
  3. Phillips TJ, Walmsley JP. Retrospective analysis of the results of 151 exploratory laparotomies in horses with gastrointestinal disease.. Equine Vet J 1993;25(5):427-431.
  4. Wilson DA, Baker GJ, Boero MJ. Complications of celiotomy incisions in horses.. Vet Surg 1995;24:506-514.
  5. Honnas CM, Cohen ND. Risk factors for wound infection following celiotomy in horses.. J Am Vet Med Assoc 1997;210(1):78-81.
  6. Ingle-Fehr JE, Baxter GM, Howard RD, Trotter GW, Stashak TS. Bacterial culturing of ventral median celiotomies for prediction of postoperative incisional complications in horses.. Vet Surg 1997;26(1):7-13.
  7. Mair TS, Smith LJ. Survival and complications rates in 300 horses undergoing surgical treatment of colic. Part 2: short-term complications.. Equine Vet J 2005;37(4):303-309.
  8. Proudman CJ, Smith JE, Edwards GB, French NP. Long-term survival of equine surgical colic cases. Part 1: patterns of mortality and morbidity.. Equine Vet J 2002;34(5):432-437.
  9. Torfs S, Levet T, Delesalle C. Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk?. Vet Surg 2010;39(5):616-620.
  10. Davis W, Fogle C, Gerard MP, Levine JF, Blikslager AT. Return to use and performance following exploratory celiotomy for colic in horses: 1956 cases (2003-2010).. Equine Vet J 2013;45(20):224-228.
  11. Christophersen MT, Tnibar A, Pihl TH, Anderson PH, Ekstrom CT. Sporting activity following colic surgery in horses: a retrospective study.. Equine Vet J Suppl 2011;40:3-6.
  12. Sisson S. Equine myology.. Sisson and Grossman's the Anatomy of the Domestic Animals 1975:407-411.
  13. Dyce KM, Sack WO, Wensing CJG. The abdomen of the horse.. Textbook of Veterinary Anatomy 2002:526-527.
  14. Theoret CL. Physiology of wound healing.. Equine Wound Management 2008:5-25.
  15. Simoes D, Miguel SP, Ribeiro MP, Coutinho P, Mendonca AG, Correia IJ. Recent advances on antimicrobial wound dressing: a review.. European J Pharm Biopharm 2018;127:130-141.
  16. Bellon JM, Perez-Lopez P, Simon-Allue R. New suture materials for midline laparotomy closure: an experimental study.. BMC Surg 2014;14:1-11.
  17. Lien SC, Hu Y, Wollstein A. Contraction of abdominal wall muscles influences size and occurrence of incisional hernia.. Surgery 2015;158(1):278-288.
  18. Culbertson EJ, Xing L, Wen Y, Franz MG. Loss of mechanical strain impairs abdominal wall fibroblast proliferation, orientation, and collagen contraction function.. Surgery 2011;150(3):410-417.
  19. Tero AH, Teppo LN, Minna K, Hannu K, Markku J. Muscle injuries.. Am J Sports Med 2005;33:745-764.
  20. Huard J, Li Y, Fu FH. Muscle injuries and repair: current trends in research.. J Bone Joint Surg Am 2002;84(5):822-832.
  21. Chism PN, Latimer FG, Patton CS, Rohrbach BW, Blackford JT. Tissue strength and wound morphology of the equine linea alba after ventral median celiotomy.. Vet Surg 2000;29(2):145-151.
  22. Kirker-Head CA, Kerwin PJ, Steckel RR, Rubin CT. The in vivo biodynamic properties of the intact equine linea alba.. Equine Vet J Suppl 1989;7(1):98-107.
  23. Zsoldos RR, Kotschwar A, Kotschwar AB, Rodriguez CP, Peham C, Licka T. Activity of the equine rectus abdominis and oblique external abdominal muscles measured by surface EMG during walk and trot on the treadmill.. Equine Vet J Suppl 2010;38:523-529.
  24. Smith LJ, Mellor DJ, Marr CM, Reid SW, Mair TS. Incisional complications following exploratory celiotomy: does an abdominal bandage reduce the risk?. Equine Vet J 2007;39:277-283.
  25. Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: long-term complications and survival.. Equine Vet J 2005;37:310-314.
  26. Stone WC, Lindsay WA, Mason DE. Factors associated with acute wound dehiscence following equine abdominal surgery.. Proceedings of the Fourth Equine Colic Research Symposium, Athens, GA 1990.
  27. Gardener AK, Mudge MC. Catastrophic dehiscence of ventral abdominal incisions: descriptions of risk factors and factors for survival.. Equine Vet Ed 2017;29(S8):38.
  28. Pessaux P, Msika S, Atalla D, Hay JM, Flamant Y. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery.. Arch Surg 2003;138:314-324.
  29. Mayhew PD, Freeman L, Kwan T, Brown DC. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008).. J Am Vet Med Assoc 2012;240(2):193-198.
  30. Buczinski S, Bourel C, Belanger AM. Ultrasonographic assessment of standing laparotomy wound healing in dairy cows.. Res Vet Sci 2012;93(1):478-483.
  31. Gibson KT, Curtis CR, Turner AS, Mcllwraith CW, Aaines WA, Stashak TS. Incisional hernias in the horse: incidence and predisposing factors.. Vet Surg 1989;18(5):360-366.
  32. Darnaud SM, Southwood LL, Aceto HW, Stefanovski D, Tomassone L, Zarucco L. Are horse age and incision length associated with surgical site infection following equine colic surgery?. Vet J 2016;217:3-7.
  33. Packer MJ, German AJ, Hunter L, Trayhurn P, Proudman CJ. Adipose tissue-derived adiponectin expression is significantly associated with increased postoperative mortality in horses undergoing emergency abdominal surgery.. Equine Vet J Suppl 2011;39:26-33.
  34. Grossi JV, Nicola FF, Zepeda IA. Linea alba collagen and assessment in morbidly obese patients.. Arq Bras Cir Dig 2016;29(1):8-11.
  35. French NP, Smith J, Edwards GB, Proudman CJ. Equine surgical colic: risk factors for postoperative complications.. Equine Vet J 2002;34(5):444-449.
  36. Isgren CM, Salem SE, Archer DC, Worsman FCF, Townsend NB. Risk factors for surgical site infection following laparotomy: effect of season and perioperative variables and reporting of bacterial isolates in 287 horses.. Equine Vet J 2017;49(1):39-44.
  37. Galuppo LD, Pascoe JR, Jang SS, Willits NH, Greenman SL. Evaluation of iodophor skin preparation techniques and factors influencing drainage from ventral midline incisions in horses.. J Am Vet Med Assoc 1999;215(7):963-969.
  38. Freeman DE, Rotting AK, Inoue OJ. Abdominal closure and complications.. Clin Tech Equine Pract 2002;1(3):174-187.
  39. Darouiche RO, Wall MJ Jr, Itani KM. Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis.. N Engl J Med 2010;362(1):18-26.
  40. Osuna DJ, DeYoung DJ, Walker RL. Comparison of three skin preparation techniques in the dog, Part 1: experimental trial.. Vet Surg 1990;19(1):14-19.
  41. Amber EI, Henderson RA, Swaim SF. A comparison of antimicrobial efficacy and tissue reaction of four antiseptics on canine wounds.. Vet Surg 1983;12(2):63-68.
  42. Davids BI, Davidson MJ, TenBroek SH, Colahan PT, Oli MW. Efficacy of mechanical versus non-mechanical sterile preoperative skin preparation with cholorhexidine gluconate 4% solution.. Vet Surg 2015;44(5):648-652.
  43. Isgren CM, Salem SE, Townsend NB, Timofte D, Maddox TW, Archer DC. A sequential bacterial sampling study in horses undergoing exploratory laparotomy.. Equine Vet Educ 2017;29(S8):26.
  44. Celeste C, Stashak TS. Selection of suture materials, suture patterns and drains for wound closure.. Equine Wound Management 2008:193-224.
  45. Kummerle JM. Suture materials and patterns.. Equine Surgery 2012:181-202.
  46. Anderson SL, Bracamonte JL, Hendrick S. Ex vivo evaluation of 7 polydioxanone for closure of equine ventral midline celiotomies.. Can Vet J Res 2014;78(2):156-160.
  47. Trostle SS, Wilson DG, Stone WC, Markel MD. A study of the biomechanical properties of the adult equine linea alba: relationship of tissue bite size and suture material to breaking strength.. Vet Surg 1994;23(6):435-441.
  48. Campbell EJ, Bailey JV. Mechanical properties of suture materials in vitro and after in vivo implantation in horses.. Vet Surg 1992;21(5):355-361.
  49. Trostle SS, Hendrickson DA. Suture sinus formation following closure of ventral midline incisions with polypropylene in three horses.. J Am Vet Med Assoc 1995;207(6):242-245.
  50. Fierheller EE, Wilson DG. An in vitro biomechanical comparison of the breaking strength and stiffness of polydioxanone (sizes 2, 7) and polyglactin 910 (sizes 3, 6) in the equine linea alba.. Vet Surg 2005;34(1):18-23.
  51. Anderson SL, Bracamonte JL, Hendrick S, Carmalt JL, Wilson DG. Ex vivo comparison of USP 7 polydioxanone and USP 2 polyglactin 910 for closure of ventral midline celiotomies in horses.. Vet Surg 2013;42(4):463-467.
  52. Magee AA, Galuppo LD. Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba.. Vet Surg 1999;28(6):442-447.
  53. Turner AS, Yovich JV. Continuous absorbable suture pattern in the closure of ventral midline abdominal incision in horses.. Equine Vet J 1988;20(6):401-405.
  54. Rinnovati R, Romagnoli N, Stancampiano L, Spadari A. Occurrence of incisional complications after closure of equine ventral midline celiotomies with 2 polyglycolic acid in simple interrupted suture pattern.. J Equine Vet Sci 2016;47:80-83.
  55. Swanwick RA, Milne FJ. The non-suturing of parietal peritoneum in abdominal surgery of the horse.. Vet Record 1973;93(12):328-335.
  56. Scharner D, Winter K, Brehm W, Gittel C. Incisional complications following ventral medial coeliotomy in horses: does suturing of the peritoneum reduce the risk?. Tierärztliche Praxis Großtiere 2016;45(1):24-32.
  57. Coomer RPC, Mair TS, Edwards GB, Proudman CJ. Do subcutaneous sutures increase risk of laparotomy wound suppuration?. Equine Vet J 2007;39(5):396-399.
  58. Colbath AC, Patipa L, Berghaus RD, Parks AH. The influence of suture pattern on the incidence of incisional drainage following exploratory laparotomy.. Equine Vet J 2014;46(2):156-160.
  59. Biedrzycki AH, Brounts SH. Case series evaluating the use of absorbable staples compared with metallic staples in equine ventral midline incisions.. Equine Vet Ed 2016;28(2):83-88.
  60. Bischofberger AS, Brauer T, Gugelchuk G, Klohen A. Difference in incisional complications following exploratory celiotomies using antibacterial-coated suture material for subcutaneous closure: prospective randomized study in 100 horses.. Equine Vet J 2010;42(4):304-309.
  61. Costa-Farre C, Prades M, Ribera T, Valero O, Taura P. Does intraoperative low arterial partial pressure of oxygen increase the risk of surgical site infection following emergency exploratory laparotomy in horses?. Vet J 2014;200(1):175-180.
  62. Robson K, Cripps P, Bardel D. Lack of association between arterial oxygen tensions in horses during exploratory coeliotomy and post-operative incisional complications: a retrospective study.. Vet J 2016;210:24-29.
  63. Freeman KD, Southwood LL, Lane J, Lindborf S, Aceto HW. Post-operative infection, pyrexia and perioperative antimicrobial drug use in surgical colic patients.. Equine Vet J 2012;44(4):476-481.
  64. Klohen A. New perspective in postoperative complications after abdominal surgery.. Vet Clin Equine 2009;25(2):341-350.
  65. Tnibar A, Grubbe LK, Thuroe NK. Effect of a stent bandage on the likelihood of incisional infection following exploratory coeliotomy for colic in horses: a comparative retrospective study.. Equine Vet J 2013;45(5):564-569.
  66. Kilcoyne I, Nieto JE, Dechant JE. A comparative study of the effect of different stent bandages on the likelihood of incisional complications following exploratory laparotomy in horses with colic.. Equine Vet Ed 2017;29(S8):38.
  67. Oikawa M, Takagi S, Anzai R, Yoshikawa H, Yoshikawa T. Pathology of equine respiratory disease occurring in association with transport.. J Comp Path 1995;113(1):29-43.
  68. Racklyeft DJ, Raidal S, Love DN. Towards an understanding of equine pleuropneumonia: factors relevant for control.. Aust Vet J 2000;78(5):334-338.
  69. Dallap-Schaer BL, Linton JK, Aceto H. Antimicrobial use in horses undergoing colic surgery.. J Vet Intern Med 2012;26(6):1449-1456.
  70. Eposito S. Is single-dose antibiotic prophylaxis sufficient for any surgical procedure?. J Chemother 1999;11(6):556-564.
  71. Haven ML, Wichtel JJ, Bristol DG, Fetrow JF, Spears JW. Effects of antibiotic prophylaxis on postoperative complications after rumenotomy in cattle.. J Am Vet Med Assoc 1992;200(9):1332-1335.
  72. Traub-Dargatz J, George JL, Dargatz DA, Morley PS, Southwood LL, Tillotson K. Survey of complications and antimicrobial use in equine patients at veterinary teaching hospitals that underwent surgery because of colic.. J Am Vet Med Assoc 2002;220(9):1359-1365.
  73. Durward-Akhurst SA, Mair TS, Boston R, Dunkel B. A comparison of two antimicrobial regimens on the prevalence of incisional infections after colic surgery.. Vet Rec 2013;172(11):287-290.
  74. Hardy J, Rakestraw PC. Postoperative care, complications, and reoperation.. Equine Surgery 2012:522-526.
  75. Ahern BJ, Richardson DW. Surgical site infection and the use of antimicrobials.. Equine Surgery 2012:68-84.
  76. Protopapas A, Marr CM, Archer FJ, May SA. Ultrasonographic assessment and factors associated with incisional infection and dehiscence following celiotomy in horses.. Vet Surg 2000;29:289.
  77. Wilson DA, Badertscher RR, Boero MJ, Baker GJ, Foreman JH. Ultrasonographic evaluation of the healing of ventral midline abdominal incisions in the horse.. Equine Vet J 1989;21(S7):107-110.
  78. Dunkel B, Mair T, Marr C, Carnwath J, Bolt DM. Indications, complications, and outcomes of horses undergoing repeated celiotomy within 14 days after the first colic surgery: 95 cases (2005-2013).. J Am Vet Med Assoc 2015;246(5):540-546.
  79. Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 4: early (acute) relaparotomy.. Equine Vet J 2005;37(4):315-318.
  80. Bauck AG, Easley JT, Cleary OB. Response to early repeat celiotomy in horses after a surgical treatment of jejunal strangulation.. Vet Surg 2017;46(6):843-850.
  81. Toth F, Schumacher J. Prosthetic mesh repair of abdominal wall hernias in horses.. Vet Surg 2018;47(4):536-542.
  82. Caron JP, Mehler SJ. Laparoscopic mesh incisional hernioplasty in five horses.. Vet Surg 2009;38(3):318-325.
  83. Kelmer G, Schumacher J. Repair of abdominal wall hernias in horses using primary closure and subcutaneous implantation of mesh.. Vet Rec 2008;163(23):677-679.
  84. Whitfield-Cargile CM, Rakestraw PC, Hardy J, Cohen ND, Davis BE. Comparison of primary closure of incisional hernias in horses with and without the use of prosthetic mesh support.. Equine Vet J Suppl 2011;39:69-75.
  85. Southwood LL, Lindborg S, Myers M, Aceto HW. Influence of Salmonella status on the long-term outcome of horses after colic surgery.. Vet Surg 2017;46(6):780-788.

Citations

This article has been cited 4 times.
  1. Gozalo-Marcilla M, Ringer SK. Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021 Jun 14;11(6).
    doi: 10.3390/ani11061777pubmed: 34198637google scholar: lookup
  2. Crabtree NE, Capper AM, McKinnon LH, Epstein KL. Perioperative factors and outcomes associated with antimicrobial therapy duration in horses undergoing exploratory celiotomy. Can Vet J 2025 Jun;66(6):653-662.
    pubmed: 40510283
  3. Griessel TS, Muñoz Morán JA, Byaruhanga C, Smit Y. A single-centre retrospective study of surgical site infection following equine colic surgery (2013‒2021). Vet Rec 2025 May 17;196(10):e5227.
    doi: 10.1002/vetr.5227pubmed: 40123113google scholar: lookup
  4. Isgren CM, Pinchbeck GL, Salem SE, Hann MJ, Townsend NB, Cullen MD, Archer DC. Evaluation of a stent dressing and abdominal bandage on surgical site infection following emergency equine laparotomy: A randomised controlled trial. Equine Vet J 2025 Nov;57(6):1466-1477.
    doi: 10.1111/evj.14482pubmed: 39967458google scholar: lookup
Subscribe to our newsletter
Join 99,357 horse owners like you who receive our email updates on horse health and nutrition.