Appleton Endowed Professor University of Florida, College of Veterinary Medicine Citra, Florida
Our preoccupation with major steps in surgery can distract us from smaller steps that can favor a smooth and safe procedure. The focus of this presentation is to describe some procedures in colic surgery that can expedite the surgery and reduce intraoperative failures. Because colic surgery involves so many steps at each phase from anesthetic induction to recovery, the opportunities for errors and oversights abound. A surgical safety checklist is used for this purpose, similar to that developed for the World Health Organization and used in small animal hospitals. Checklists can also be used to ensure that preoperative and intraoperative medications have been administered in a timely manner, particularly perioperative antimicrobial drugs. A table system that positions the horse on the table with shoulder support and rope ties on the forelimbs to keep it centered and secure, and with the hindlimbs splayed, allows access from the caudal aspect of the horse so that more than one procedure can be performed simultaneously. Surgery of the cecum will be addressed, specifically typhlotomy, jejunocolostomy, and cecocolic intussusception. These procedures can be technically challenging and mistakes can lead to complications. Cecocolic intussusception is complicated by misunderstandings of the fate of the intussusceptum if not resected. Appropriate draping of the colotomy site is critical and reduces contamination that is life-threatening. Complete bypass of the uncorrected intussusception with a jejununocolostomy has been used as an alternative to colotomy, usually based on the erroneous assumption that the ileum is “involved” in the intussusception. Other items to be covered are closure of the epiploic foramen, enlargement of the epiploic foramen, types of laparotomy sponges, small intestinal decompression and enterotomy, package prices for surgery and approach to postoperative feeding.
