Postoperative complications of abdominal surgery

POSTOPERATIVE COMPLICATIONS OF ABDOMINAL SURGERY GARY M. BAXTER, VIVID,MS Associate Professor of Surgery Department of Clinical Sciences, Veterinary Teaching Hospital Colorado State University, Fort Collins, Colorado 80523

The Italian equine veterinary journal, Ippologia (vol 7, no. 3, 1996), published an excellent review on postoperative complications of abdominal surgery in horses, by Dr. Gary Baxter, of Colorado State University. He said that recognizing and managing complications after abdominal surgery in horses is critical to optimize the success of the surgical procedure. The number and severity of complications in each surgical patient is variable, but are often related to the time at which surgery was performed after the onset of clinical signs of colic, the patient's condition at the time of surgery, the severity of the particular gastrointestinal lesion, and the surgeon's technical expertise. In general, horses with small intestinal lesions and those with strangulating lesions experience more postoperative complications than do patients with large intestinal problems or nonstrangulating lesions. The majority of these problems, if they develop, occur within a few days of surgery and are treated at the surgical referral hospital, and not by referring veterinarians in the field. However, several problems can and do develop after the horse has been discharged from the hospital (5-7 days after surgery). Therefore, equine veterinary practitioners must be aware of these problems and their appropriate therapy. Dr. Baxter outlined treatments for seven important complications to equine abdominal surgery: Hypovolemla, endotoxemia 9 IV fluid replacement 9 Anti-endotoxin

plasma or serum 9 Fiunixin meglumine 9 Parenteral antimicrobials 9 Hypertonic saline 9 Polymyxin B ? Ileus

9 Gastric decompression 9 Supportive care (IV fluids) 9 Correct electrolyte abnormalities 9 Cisapride 9 Metociopramide? 9 Neostigmine? Recurrent abdominal pain (treatment dependent on cause)

9 Medical management with IV fluids, analgesics and laxatives 9 Change of diet to more palatable feed 9 Repeat surgery if necessary Peritonitis

9 Prevent with aseptic surgical technique and perioperative antimicrobials

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JOURNAL OF EQUINE VETERINARY SCIENCE

9 Antimicrobials based on culture sensitivity 9 NSAIDs (flunixin meglumine) 9 Heparin? 9 Peritoneal lavage? Intra-abdominal adhesions Prevention 9 Good surgical technique o'Perioperative antimicrobials 9 NSAIDs 9 Heparin 9 Intraoperative abdominal lavage? 9 Intraperitoneal sodium carboxymethylcellulose? Treatment 9 Medical- analgesics, change of diet, laxatives 9 Surgical- adhesiolysis with removal of affected intestine or bypass of obstructed bowel Incisional problems/herniation 9 Prevent with good surgical technique, restricted postoperative activity, and antimicrobials 9 Protect incision from environmental contamination 9 Manage cellulitis and drainage/infection with local wound care and antimicrobials 9 If herniation occurs, delay repair for 2 to 3 months. Repair by direct suture apposition or mesh implantation

Laminitis .9 Acepromazine IM 9 Phenylbutazone or other NSAIDs 9 IV DMSO? 9 Isoxsuprine hydrochloride orally 9 Stall confinement in sand or soft bedding 9 Wrno" ~ l l n n n r t

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Volume 17, Number 1, 1997

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