Long-term survival in horses with strangulating obstruction of the small intestine managed without resection.

The research explores the outcomes in horses with strangulated small intestine which was not removed surgically but was assessed to be viable. Techniques used and the resulting long-term survival rates are discussed, highlighting an alternative method to intestinal resection and anastomosis, which may potentially reduce costs and complications significantly.

Study Overview

• This retrospective study reviews the cases of 35 horses, between 1996 and 2011 from two university hospitals, that suffered from colic caused by small intestinal strangulation, and underwent surgery without resection by two surgeons.
• The surgeons used a clinical grading system to assess whether the affected sections of intestines could be salvaged, thus avoiding the need for resection and anastomosis.
• Kaplan-Meier statistical analyses were deployed to examine long-term survival rates of treated horses.

Key Findings

• All the horses managed to survive their initial discharge from the hospital, implying a 100% success rate.
• Post-operative complications did occur, with 11 of the horses (31%) experiencing issues.
• Three horses (around 8.6%) needed a second surgery due to persistent pain or reflux, but responded well to decompression of the distended intestine.
• Although ten horses unfortunately died after discharge at various points, 12 were known to be still alive at follow-up – between 20 to 192 months after surgery. There was, however, information on 13 horses that was missing post-discharge, as they were lost to follow-up.
• The median survival rate according to Kaplan-Meier analysis was 120 months (10 years), showcasing a favorable long-term survival probability.

Study Conclusions

• The study presents a subjective method for assessing small intestinal viability in horses suffering from strangulated small intestine, indicating that it can reduce the need for resection and anastomosis, along with associated complications and high costs.
• The reasonable post-operative course witnessed in operated horses under this technique hints that early referral can sidestep the need for resection and enhance survival probabilities.
• However, the study does note that for horses with severe changes that were not resected, the sample size in this study was too small. Therefore, conclusive remarks couldn’t be made on whether it’s feasible to leave such segments in place, indicating a further requirement of additional criteria to guide such decisions.