A Pilot Randomised Clinical Trial Comparing a Short-Term Perioperative Prophylaxis Regimen to a Long-Term Standard Protocol in Equine Colic Surgery

Background: For surgical interventions classified as clean or clean-contaminated, including laparotomy, guidelines in human and veterinary medicine recommend a short-term perioperative antibiotic prophylaxis (PAP). In equine colic surgery, however, PAP commonly exceeds 24 h. Objectives: The aim of this study was to compare a single-shot to a 5-day lasting PAP considering surgical site infections (SSI) and other adverse effects probably associated with the particular antimicrobial regimen. Study design: The study was designed as a randomised non-inferiority pilot study including horses subjected to colic surgery while receiving one of two distinct PAP regimens. Methods: All horses (n = 67) included in the study received the standard physical examination before and after surgery. Colic surgery was performed according to the current standard of the clinic. Horses were randomly assigned to two groups, receiving either the “single-shot” or the “5-day lasting” antibiotic prophylaxis. The “single-shot” group (n = 30) received penicillin and gentamicin only once before and, if needed, during surgery, whereas the “5-day lasting” group (n = 37) received antibiotics for five days. In addition to the standard laboratory examinations, serum amyloid A and fibrinogen were determined preoperatively and during five days after surgery. SSI, postoperative colitis and haemolytic anaemia were classified as postoperative complications potentially related to antibiotic use. Results: The outcome of this preliminary non-inferiority clinical trial showed that the occurrence of postoperative adverse events (i.e., SSI, postoperative colitis and haemolytic anaemia) lacked significant differences between the study groups. Main limitations: The main limitations of this study are the limited group sizes and our inability to blind the study. Conclusions: Single-shot PAP seems to be an alternative approach considering the 5-day lasting protocol commonly used in equine abdominal surgery. However, a proper hygiene management together with a close clinical and laboratory monitoring of the equine patient is indispensable.

Evaluation of Clinical, Laboratory and Ultrasonography Variables as Prognostic Indicators in Equine Colic Surgery

Background: Equine colic surgery is an expensive procedure and availability of reliable prognostic indicators aid in decision making process. This study aimed to evaluate clinical, hemato-biochemistry, ultrasonography, surgery and peritoneal cytology / intestinal histology as prognostic indicators (based on strangulating vs non-strangulating lesion) for equine colic surgery. Methods: Fifteen equines {13 females and 2 males; 5 Thoroughbred, 9 Marwari and one mule} operated for intestinal colic were investigated. The feeding history, pre and post-surgery clinical, hematological and biochemical findings were recorded. Pre and post-surgery ultrasonography, peritoneal cytology and intestinal histology were done. Three equine were euthanized intra-operatively and 12 were followed for short and long term outcome. Result: On surgery, three equine were diagnosed for strangulating (right dorsal displacement of large colon, large colon volvulus and small colon strangulation) and 12 for non-strangulating colic {impaction (3), fecalith (5), sand colic (2), foreign body (1) and small intestine ileus (1)}. Detection of polymorphonuclear cells alone or with lymphocytes on peritoneal fluid cytology was indicator of good prognosis. Feeding of wheat straw is major predisposing factor for non-strangulating colic in Marwari breed but had favorable surgical prognosis (7/9=77.78%). While Thoroughbreds, not on wheat straw, are susceptible to strangulating colic that require early referral for favorable surgical outcome. Prolonged capillary refill time, injected mucous membranes, absent borborygymi, high serum creatine kinase and glucose are poor prognostic indicators for colic surgery. Thoroughbred equine with severe pain, elevated levels of Hb, neutrophils, packed cell volume (PCV), serum glucose and low peritoneal total protein are indicators of strangulating lesion. The equine colic surgery bears a very good short term (10/12=83.33%) and excellent (10/10=100%) long term outcome.

Evaluation of Diagnostic, Prognostic Indicators and Surgical Outcome in 20 Cases Treated for Equine Intestinal Colic

Background: Colic is one of the most common and challenging problem encountered by equine practitioners. In practise majority of horses suffering from colic can be treated with medical management but around 10% of horses with colic require surgical intervention in an effort to save the life of animal. In India, equine abdominal surgery is not popular because there is lack of infrastructure, manpower and expertise therefore, there is a need to conduct clinical studies to document outcome of equine colic cases managed surgically. The present report describes diagnostic, prognostic indicators and post-operative outcome of exploratory celiotomy performed to manage various cases of colic surgical outcome of colic surgery in Indian horse breeds.Methods: The present study was conducted on 20 horses having intestinal colic (n=20). The affected patients were selected for exploratory celiotomy on an emergency basis having moderate to severe persistent abdominal pain, lack of response to medicinal treatment with absence of intestinal borborygmi. Preoperative physical assessment, biochemical analysis and peritoneal fluid analysis were done in all the clinical cases. The preoperative physical assessment and various blood parameter estimation helped in decision making.Conclusion: The result of intestinal colic cases showed that mean heart rate and respiration rate (mean±SE) were significantly higher in non-survivors as compared to survivors. Blood lactate level was significantly higher in non survivors than survivors. Large colon affectation (n=8) were the primary cause of the colic, followed by small colon (n=6), cecum (n=3) and small intestine (n=3). Postoperative complications were peritonitis and ileus (n=6), subcutaneous seroma (n=7), pyrexia (n=4), diarrhoea (n=6). Short term survivability in intestinal colic patients was 55% and long term survivability was 50%.