Colic: what's best after surgery?
The progress achieved in the field of horse surgery and anaesthesia over the last two decades has led to increasingly encouraging results in the field of abdominal surgery.
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- #horse health
The objectives achieved allow us to today consider surgery in the event of colic as not only as a procedure needed to save the life of a horse but also, and above all, to return the horse to a life of normal stables with resumption of its previous sports activity. For this reason it is of increasing interest in management of the horse that has been operated on for colic in the medium and long term. Before addressing this topic, it is necessary to briefly discuss the factors that may influence the postoperative horse.
Recovery of a horse that has been operated on for colic is influenced by several factors: the type of intestinal problem for which it was operated on, the type of surgery, the surgical technique and the surgical manual skills applied, the general condition of the horse at the time of the operation, the site and size of the surgical wound and any complications that may have developed during the immediate post-operative clinical stay period. It is good to remember and to always bear in mind that in order to obtain the best result in this type of intervention and to minimise complications, early intervention is of the utmost importance when the horse and its intestine are still in a good condition. It is universally acknowledged that when a horse is colic, surgery should not be considered as a last attempt to save it but as a valuable therapeutic option that if necessary must be undertaken as soon as possible to ensure the best result. There are in fact specific diseases that are not always extremely painful but which from their onset can only be solved with surgical intervention. In these cases, the sooner it is performed, the lower the risk of complications in the medium and long term and the greater the chances of a full return to normal life and to normal sports activity. Surgery for colic involves in the immediate postoperative period a stay in a clinic which normally varies from one to two weeks, depending on the type of intervention that the horse has undergone or any complications that may have developed. After major surgery, a number of frequent complications may occur that normally develop in the immediate postoperative period, during the clinic stay, and which may influence the management of the horse that has been operated on for colic once back in the stable. In case of surgery without complications, with discharging of the horse that has received surgery, on the eighth or fourteenth day, a return of the horse to normal stable management is recommended. The horse's diet must include abundant mixed grass hay of excellent quality and with the constant availability of balanced feed, possibly not molassed, flaked, extruded or laminated, to ensure the best digestibility. Hay and feed should be administered in adequate amounts to ensure proper maintenance of physical condition. It is normally good practice to administer for a certain period supplements based on lactic ferments and gastroprotective components. Fasting, which is required of clinic patients, administration of antibiotics, possible laxatives, peristaltic drugs or periods of intestinal stasis and the stress of colic, of the operation and of subsequent hospitalisation cause evident alterations in all subjects of the intestinal microbial flora and clear cases of gastritis and even the development of actual gastric ulcers. For horses that, due to stress or a delay in resumption of their normal diet in the clinic have lost a significant amount of weight, caloric diet integration may be required which, if it cannot be achieved by increasing the amount of feed, can be obtained with the addition of fats to the diet in the form of oil, rice products or fatty feed. Proper nutrition of the horse at the time of its return to the stable in addition to ensuring the maintenance or achievement of a good level of nutrition to be physically ready for when it returns to work ensures adequate and sufficient caloric intake to ensure the energy necessary for correct and rapid tissue healing. The recovery time of a surgical patient that has not developed serious complications is estimated to be approximately sixty days from the date of surgery. During this period, a work regime of approximately 20 minutes twice a day in the first month, led by hand, is recommended. During the second month, physical activity should include 30-45 minutes of walking twice a day, perhaps one led by hand and the other mounted, if the wound is significant. During this time the paddock is out of bounds because a freely running horse will not sustain controlled activity and this would be considered normal work, due to the effort and solicitation of the anatomical structures. In fact, a horse free in the paddock without being subjected to work, is however free to trot, gallop and buck. In reality, a period of rehabilitation of this length is dictated by the need to wait for complete healing of the abdominal wall and of the scarring of the operative breach. The point of incision, normally located ventrally in the abdomen, immediately in front of the navel, begins to regain tension and near normal resistance 60 days from the surgery which also coincides with reabsorption of the suture inside, even if the timing in this case may change considerably depending on the type of suture used. Wound care is essentially external disinfection with everyday detergents and disinfectants and sterile gauze, applying antibiotic ointment, ensuring the removal of any scabs and the application of adequate pressure during cleaning, thereby ensuring that any serum that may have accumulated between the lays of the suturing is drained off. There are a number of complications that may develop in the short term and therefore occur during the period of stay at the clinic which may influence management of the horse that has undergone surgery after its discharge and return to the stable. Firstly, it is important to remember that the discharging of a horse always takes place when the clinic that is treating it believes the patient, even if suffering from a certain complication, can be treated without problems in the stable, where it will be seen daily by the owner and need only be periodically examined at the supervising veterinarian clinic. If complications do occurr, as wound infection, phlebitis or laminitis, the horse must absolutely be assisted by the vet who establishes the terms and timing of therapy to be made. It is important to consider that even when complications do occur, the horses normally return to their previous level of activity without significant problems, although in certain cases with periods of recovery that are a little longer than the normal sixty days.