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Indications for relaparotomy
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Prevalence and risk factors
Relaparotomy (RL) is undertaken in 8.2 – 10.6% of horses that have undergone laparotomy for the treatment of acute gastrointestinal disease. It is more frequently required in horses that initially presented with strangulating small intestinal lesions (63%) and strangulating large intestinal lesions (20%) compared to other lesions. Risk factors for RL include epiploic foramen entrapment (OR 4.23, 95%CI 1.43-12.39, P=0.016) and postoperative ileus (POI) (OR 3.88, 95% CI 1.51-9.97, P=0.008). The decision of whether or not to perform RL can be difficult and it is important for owners and surgeons to have information about likely survival and complications to assist informed decision making.
Indications and timing
Indications for RL include: Persistent or recurrent postoperative pain, POI or persistent reflux >48-72h, mechanical obstruction at an anastomosis, progressive deterioration of intestinal viability/peritonitis, correction of surgical errors, incisional complications including colic associated with incisional breakdown and abdominal haemorrhage. As in human medicine, it is difficult to make specific guidelines about the optimal timing of RL, where required. In humans, with abdominal sepsis (which includes ischaemia and necrosis of intestine) the outcome is generally considered to be more favourable when reintervention is performed at an early stage, although no currently there remains no data to support this. In horses in which RL was performed during initial hospitalisation, the median duration between the first surgery and RL was 2.5 - 3 days.
Surgical approach and findings
RL is performed through the original ventral midline laparotomy, via a paramedian laparotomy or less frequently via a flank incision. In two studies, RL was performed through the original ventral midline laparotomy incision in 99% and 89% of cases. This surgical approach is supported by a recent study which demonstrated that there are no differences in healing, inflammation, infection, tissue necrosis and tensile strength between horses undergoing repeat ventral midline laparotomy compared to a right ventral paramedian laparotomy. The latter surgical approach was also found to have histologically less mature incisional apposition. [...]
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