Thal Equine Client Handout: Colic Surgery at Thal Equine
This handout is intended to provide our clients with an overview of how we approach colic at our hospital, particularly if a client is considering colic surgery for their horse. Our goal is to provide you the most complete understanding possible, so that you can make an informed decision.
Other recommended reading is a short article I wrote entitled Colic Surgery: What Horse Owners Should Know.
WHAT IS COLIC?
“Colic” is a very general term that is commonly used to describe abdominal pain in horses. Colic is caused by any of a large number of possible problems in the abdomen, mostly related to the intestine, but sometimes wholly unrelated. There are two general classes of intestinal colic:
Intestinal Dysfunction: Includes many conditions, such as colitis- inflammation of the colon, parasite damage, primary gas distension, and spasmodic colic. Most colic types in this category are treated medically, not surgically. Many horses with mild intestinal dysfunction resolve with little treatment. These are the horses that are “fixed” by a shot of Banamine®. Problems involving intestinal dysfunction are much more common than those involving intestinal accidents.
Intestinal Accidents: Physical obstruction of the intestine from impaction, displacement, entrapment or torsion of any of the many parts of the intestine. Horses with these conditions tend to be intensive care and/or surgical candidates. This represents the minority of horses showing colic- about 10%.
Colic pain is shown by many behaviors unique to each individual horse. Examples include – from mild to severe – curling the upper lip, grinding the teeth, stretching, looking at the side, pawing, lying down, rolling, kicking at the belly, as well as other signs. It is impossible to tell from the severity of pain what Condition is causing colic.
Sometimes, more severe pain is associated with more severe Conditions, but this is not always the case. Individual horse temperament must also be considered. Stoic horses with a severe intestinal accident may display only subtle outward signs of pain whereas a horse uniquely sensitive to pain may respond to gas accumulation by violently thrashing and rolling.
Our first goal is to try to determine the specific Condition Causing Colic (CCC). Once a diagnosis is made, a treatment plan can be formulated and a prognosis can be given. We use many factors- the medical history, degree and duration of pain, the results of physical exam, response to treatment, rectal exam, blood work, abdominal tap and other diagnostics to form an idea of what we think is happening. Using all of these diagnostic tools, we often can STILL only provide an educated guess as to what may be going on.
It is not unusual to find surprises once we open the abdomen at surgery, as we sometimes find multiple intestinal problems. This is why surgically opening the abdomen (exploratory laparotomy) is “the ultimate diagnostic test” because we can actually feel or see the lesions and hopefully can correct the problem(s) at their source.
COLIC SURGERY: THE DECISION
The decision for colic surgery should not be taken lightly. Colic surgery is a major undertaking for all involved. The better informed you are, the better the experience will be for everyone. Unfortunately, there are no guarantees, but good communication is vital to a successful outcome. Questions you should be asking:
Do we have a diagnosis? Often at this stage we have an idea of what is wrong with your horse and how severe it is. However, we can never be sure until we explore the abdomen at surgery.
Do we have a prognosis? We can discuss your horse’s post-surgical prognosis once we have made a diagnosis. Once the abdomen has been explored surgically we can give you a more precise prognosis.
Why are we considering surgery? There are several possible reasons for us to be considering colic surgery. We always hope to avoid surgery if possible, but if it is needed.
Colic pain that is unresponsive to medication, difficult to control, or increasing in severity.
Physical exam, rectal exam, nasogastric intubation, abdominocentesis, blood work have been done. After examining the results of these and other pertinent diagnostic tests, it is the veterinarian’s opinion that surgery is the best approach.
A specific surgical condition is definitively diagnosed on rectal exam. Surgery is the only option for treatment.
Conservative treatment and intensive care have been unsuccessful in treating the condition. The problem is the same or is worsening and we must explore the abdomen as the next step in treatment. Euthanasia is the only other option.
WHAT HAPPENS IN COLIC SURGERY?
Colic surgery involves the physical correction of abdominal/intestinal conditions that are causing signs of abdominal pain. This usually means the correction of “intestinal accidents” as mentioned previously.
Following initial evaluation and stabilization, the horse is clipped for surgery and groomed and then put under general anesthesia. Medications are given through an intravenous catheter to start anesthesia. This is done in a padded induction/recovery room. An endotracheal tube is placed through the mouth into the trachea for ventilation. Heavy hobbles are placed on the legs and hooked to a hoist and the horse is lifted and rolled on a trolley to the surgery table. Here the horse is placed on a ventilator and gas anesthesia machine.
Electronic and clinical monitoring of vital signs, blood pressure and other parameters is performed during anesthesia. The abdomen is prepared for surgery. An incision about 12” -16” long is made on the lowest part of the belly. The abdomen is explored manually and visually until a diagnosis is made. Whatever surgical correction is necessary is then made.
A few miscellaneous examples of colic surgery procedures include:
• Untwisting of the large colon in a horse with large colon volvulus. Following this it may be necessary to remove much of the colon if it appears severely damaged at surgery.
• Removal of a section of dead small intestine that has been strangulated by a fatty tumor (lipoma) and re-attachment of healthy intestine.
• Removal of a hard feed impaction from the small colon of a pony.
These are just examples. There are countless other procedures and combinations of procedures.
If you are considering surgery, and your horse is insured, you need to call your insurance company immediately. Although your horse is insured, you are still responsible for all payment as described above. Your insurance company will reimburse you later.
ADDITIONAL QUESTIONS YOU SHOULD BE ASKING
Why is colic surgery so expensive?
• Colic surgery requires a large team of highly trained staff working in unison. Often colic surgery is performed at night or on weekends and holidays, meaning that staff must be compensated extra for after hours and overtime wages.
• Colic surgery requires a very large, up-front investment in equipment and medications by the hospital. Equipment such as gas anesthesia machine, mechanical ventilator, a specialized hydraulic surgery table, electric hoist to lift the horse onto the table, padded recovery room, and numerous smaller equipment, disposable supplies such as sterile drapes and gowns and large volumes of medications all add up to a huge investment by the hospital which must be accounted for in the cost to you.
• Colic surgery often requires intense post-operative care 24 hours a day for days following surgery. Typically horses are kept on 40-80 liters of IV fluids per day, and other medications, adding up to a cost of $1000-2500.00/day. Horses that are very ill following the more severe conditions may require plasma at a cost of $300.00/liter and other costly medications. This follow up care also requires numerous late night hours from trained staff and veterinarians.
• For the reasons we have described, colic surgery is very expensive no matter where you go. Our prices are comparable to most other similarly equipped equine clinics across the country.
If we fix the problem in the abdomen, what are the chances that this will happen again?
Recurrence is more likely with some lesions. Ask about the general recurrence rate for the specific problem that we treat at surgery. Here are two examples of recurrence rate percentages:
• Large colon volvulus: 5% non-broodmare, 15+% broodmare
• Left dorsal displacement of large colon: 5%-20%
What are some risks and complications of colic surgery and postoperative complications?
• Anesthesia of the colic patient poses a substantial risk. Horses with severe intestinal problems are often in shock, making anesthesia more difficult and risky.
• Horses that have had colic surgery are somewhat more likely to be injured in recovery or to have problems with muscle damage from pressure during surgery. This is because they are weakened by their illness and often have low blood pressure under anesthesia.
• Postoperative complications are linked to the type of colic, the duration of colic, the physiologic condition of the horse and the findings during surgery. Some of the more frequent postoperative complications include peritonitis (infection of the abdominal cavity), colitis (inflammation of the large intestine which can lead to severe diarrhea), laminitis, ileus (paralysis of the intestine following surgery), and adhesion formation between the intestine and other organs. Horses can be very ill for days after surgery and almost always require some intensive care after surgery.
Are some horses not good colic surgery candidates?
Yes. Horses that have had multiple bouts of colic historically, or those with other significant health problems do not have as good a prognosis for long term success. We will help you understand the significance of the factors in your horse’s particular case.
Are older horses poor colic surgery candidates? Surprisingly, evidence shows that older horses tolerate colic surgery well, as long as their general health is good. The same factors that affect survival in younger horses also affect older horses.
How long will my horse have to be at the hospital?
This depends on factors like the type and duration of colic, the severity of intestinal damage and occurrence of complications. The average hospital stay after surgery at our hospital is 7 days.
What kind of after care will be required once my horse leaves the hospital?
Strict stall confinement until the abdominal incision heals. This is typically 60 days of stall confinement with hand walking, then 30 more days in a stall and run, also with hand walking. It takes months for the abdominal incision to heal with much strength. Until healing of the abdominal wall takes place, exercise at speed must be avoided to prevent breakdown of the incision from stress. Skin staples or skin sutures will need to be removed at about 14 days after surgery. During this time it will be important that you monitor the horse carefully for any signs of a problem. You would call immediately if you were to see any of the following signs:
• Loss of appetite, depression or any change of attitude or behavior
• Swelling or drainage at the incision site
• Colic signs- lying down
• Swelling of the jugular vein area of the neck
• Signs of laminitis- stiffness or soreness when walking.
Your horse’s diet and management may be modified according to the recommendations of the veterinarian.
If things do go well, will my horse be able to return to prior level of performance after colic surgery?
If a horse ultimately has a good outcome, then they have a good chance to return to their prior level of performance. There are many winning performance horses that have had life-saving colic surgery at some point in their lives. Of course, no guarantees can be made when it comes to this involved process.
If you have any questions about colic or colic surgery, please communicate freely with us. When it comes to colic surgery, good communication is critical to mutual understanding and successful outcomes.
By Douglas O. Thal DVM Dipl. ABVP
Board Certified in Equine Practice
Thal Equine LLC
Last Updated August 2015