What do we currently know about incisional complications of colic surgery?

Abstract

Summary It is common for horses to suffer from incisional complications after colic surgery. The complications encountered are oedema, infection, hernia and dehiscence. Oedema is a natural response to surgical trauma but when it is severe it can be associated with additional complications such as infection, hernia and dehiscence. Thus, it is worthwhile preventing marked oedema, and an abdominal bandage is an effective method for that. Infection of the incision is common, but mostly it is mild and does not require significant intervention. Many of the infections manifest after the horse is discharged from the hospital; thus, these infections are markedly underreported. Since multidrug resistance in bacteria are becoming a major problem in equine medicine, sampling the incision for monitoring is important. Hernia formation is typically preceded by incisional infection. Most hernias do not require intervention but some warrant surgical correction. The most simple and effective method to repair them is primary closure of the hernial ring followed by subcutaneous mesh implantation. By this method, one achieves both a strong body wall and a good cosmetic outlook. Complete body wall dehiscence is fortunately uncommon and is often associated with incisional infection and pregnancy. Complete body wall dehiscence usually occurs in about 5 days after surgery and is the most fatal complication. If dehiscence is noticed prior to any evisceration, conservative therapy with close monitoring and a supportive bandage is indicated and has a good chance of success. Once evisceration is noted, emergency secondary body wall closure is indicated, and the prognosis is guarded. To conclude, incisional complications are commonly encountered after colic surgery, most of them have clinically mild implications. Occasionally, these complications may become significant and even fatal. Careful attention to surgical technique and protecting the incision in the immediate post‐operative period can significantly decrease the risk of these complications.

Comparison of incisional bursting strength of a bidirectional absorbable knotless suture material versus a standard continuous absorbable suture material for closure of the equine linea alba

“…In human surgery, closure of laparotomy incisions using barbed sutures has been reported to reduce evisceration incidence and have similar wound‐related complications as conventional sutures 20 . In horses, incisional complications following ventral midline laparotomy are frequently reported and may lead to prolonged hospitalization, increased financial burdens and in some cases increased mortality 21–24 . Complications in horses include local incisional swelling (74%) surgical site infections (7.4%–43%), incisional herniation (5.7%–18%) and dehiscence (1%–3%) 21,22,25 …”

“…In horses, incisional complications following ventral midline laparotomy are frequently reported and may lead to prolonged hospitalization, increased financial burdens and in some cases increased mortality 21–24 . Complications in horses include local incisional swelling (74%) surgical site infections (7.4%–43%), incisional herniation (5.7%–18%) and dehiscence (1%–3%) 21,22,25 …”

“…20 In horses, incisional complications following ventral midline laparotomy are frequently reported and may lead to prolonged hospitalization, increased financial burdens and in some cases increased mortality. [21][22][23][24] Complications in horses include local incisional swelling (74%) surgical site infections (7.4%-43%), incisional herniation (5.7%-18%) and dehiscence (1%-3%). 21,22,25 The use of different suture materials, suture sizes and suture patterns for closure of the equine abdomen have been extensively studied using both ex vivo models and clinical trials in an attempt to reduce postoperative incisional complications.…”

“…[21][22][23][24] Complications in horses include local incisional swelling (74%) surgical site infections (7.4%-43%), incisional herniation (5.7%-18%) and dehiscence (1%-3%). 21,22,25 The use of different suture materials, suture sizes and suture patterns for closure of the equine abdomen have been extensively studied using both ex vivo models and clinical trials in an attempt to reduce postoperative incisional complications. [26][27][28][29][30][31][32][33][34][35][36] The aim of the study described here was to determine whether a bidirectional barbed suture material could be used for closure of the equine linea alba.…”

Incisional complications after skin closure with stainless‐steel skin staples compared to nylon sutures in horses undergoing colic surgery

“…Despite advancements in surgical technique and post‐operative care, incisional complications occur in up to 43% of horses (Anderson et al, 2015; French et al, 2010; Honnas & Cohen, 1997; Isgren et al, 2017; Kobluk et al, 1989; Martinez‐Lopez et al, 2021; Shearer et al, 2020). Common incisional complications include surgical site infection (SSI), incisional oedema, incisional dehiscence and herniation (Kelmer, 2023). SSI is one of the most common complications and may be a substantial cause of morbidity in horses that have undergone abdominal surgery (French et al, 2010; Kelmer, 2023; Mair & Smith, 2005a, 2005b; Wilson et al, 1995).…”