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Veterinary surgery : VS2026; doi: 10.1111/vsu.70129

Jejunocecostomy in horses-a review of its unique complexities.

Abstract: Jejunocecostomy (JC), or jejunocecal anastomosis, is arguably the most controversial surgical procedure in equine small intestinal surgery. It is also the only option for resection and anastomosis for a third of small intestinal strangulating lesions in horses. Critics of the procedure identify its low survival and high complication rates as reasons to avoid its use. This review is intended to highlight findings of recent research and clinical studies that validate use of the JC, and to provide some insights into technical aspects of the procedure that might improve its survival rates. Jejunocecostomy is more complicated than most anastomoses used in the equine small intestine, and a review of its complexities could help to improve outcomes with this anastomosis. The negative attitude towards its use is not supported by recent research and clinical studies. If the ileum has incurred ischemic changes that necessitate its being bypassed, JC is a valid treatment if owner- and disease-related issues support the cost of resection and anastomosis. Concerns about poor outcomes with JC can lead to an inappropriate anastomosis or euthanasia whenever this anastomosis is indicated. The different methods used for JC might influence its success rate, but all methods applied with recognition of potential pitfalls can have favorable outcomes.
© 2026 American College of Veterinary Surgeons.
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Publication Date: 2026-06-26 PubMed ID: 42359465DOI: 10.1111/vsu.70129Google Scholar: Lookup
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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.

Jejunocecostomy (JC) is a debated surgical procedure used in horses with specific intestinal injuries, but recent research suggests it can be effective if done carefully. This review examines why JC is complex, challenges misconceptions about its outcomes, and offers guidance to improve surgical success.

Background and Significance

  • Jejunocecostomy (JC), also known as jejunocecal anastomosis, is a surgical technique that joins the jejunum (part of the small intestine) to the cecum (part of the large intestine) in horses.
  • This procedure is especially used when the ileum, which connects the jejunum to the cecum, is damaged by ischemia (lack of blood flow) during strangulating lesions in the small intestine.
  • JC is considered controversial due to historically low survival rates and frequent complications following the surgery.
  • Despite its controversy, JC is the only viable option for about one-third of small intestinal strangulating lesions requiring resection (removal of damaged sections) and anastomosis (rejoining of intestines).

Review Purpose and Recent Findings

  • The review aims to discuss recent research and clinical studies that support the use of JC, countering negative opinions about the procedure.
  • It highlights technical aspects of the surgery that may help improve survival and outcomes for horses undergoing JC.
  • Recent studies do not support the previously held belief that JC results in poor outcomes, showing that with proper technique and case selection, results can be favorable.

Technical Complexities of Jejunocecostomy

  • JC is more technically challenging than other types of anastomoses commonly performed in equine small intestinal surgery.
  • The complexity arises because the surgery involves connecting two different parts of the intestine with differing sizes, motility, and function — the jejunum and the cecum.
  • Understanding these unique anatomical and physiological characteristics is critical to reduce complications such as leakage, stricture, or motility problems postop.
  • Different surgical methods for performing JC exist, and techniques that anticipate potential complications are key to improving success rates.

Clinical and Owner Considerations

  • JC should be considered a valid treatment option only when the ileum is severely damaged and bypass is necessary.
  • Decisions to proceed depend on both medical factors (extent of ischemia, horse health) and owner considerations (cost, expectations).
  • Negative biases towards JC can lead to inappropriate alternative surgical choices or euthanasia when JC might offer the best chance for recovery.

Implications for Equine Veterinary Surgery

  • Surgeons are encouraged to familiarize themselves with the intricacies of JC to reduce the historical rate of poor outcomes.
  • Refinement and careful choice of surgical technique tailored to the individual case can yield favorable results even in complex intestinal surgeries.
  • Being open to current research and evidence allows equine surgeons to better evaluate when JC is justified and how to perform it safely.

Summary

  • Although previously viewed as a high-risk procedure with poor prognosis, jejunocecostomy can be successful with improved surgical understanding and techniques.
  • The review encourages a shift in perspective, promoting informed and case-appropriate use of JC in equine intestinal surgery.
  • Better surgical planning and owner communication can prevent unnecessary euthanasia and improve survival for horses with complex intestinal injuries.

Cite This Article

APA
Freeman DE, Bauck AG, Chanutin S, Moyer EK, Smith B. (2026). Jejunocecostomy in horses-a review of its unique complexities. Vet Surg. https://doi.org/10.1111/vsu.70129

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English

Researcher Affiliations

Freeman, David E
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Bauck, Anje G
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Chanutin, Sierra
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Moyer, Elizabeth K
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Smith, Bryana
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.

Grant Funding

  • SIMS Foundation
  • Arden and Claudia Sims

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