Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010.

Abstract

REASONS FOR PERFORMING THE STUDY: There is disagreement among surgeons over whether jejunoileostomy (JI) or jejunocaecostomy (JC) is the better method of anastomosis following proximal ileal resection. OBJECTIVE: To compare short- and long-term complications and outcome in horses undergoing jejunojejunostomy (JJ), JI and JC and to test the hypotheses that a higher proportion of horses undergoing JI would have short-term complications and mortality compared with horses undergoing JC or JJ and that JC would be associated with a higher long-term mortality and occurrence of colic. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Medical records of horses undergoing celiotomy for a small intestinal obstruction and JJ, JI or JC from 2005 to 2010 were reviewed. Post operative complications were recorded. Short-term outcome was alive vs. dead at hospital discharge and was analysed using a Chi-squared test. Long-term follow-up was obtained and a Kaplan-Meier estimate of the survivor function was performed. RESULTS: There were 112 horses included. A higher proportion of JI horses had a repeat celiotomy during hospitalisation compared with horses undergoing JC. The number of horses alive at hospital discharge was not different between groups: JJ 79% (95% confidence interval [CI] 68-90%), JI 78% (95% CI 61-96%), JC 83% (95% CI 71-96%). Among horses discharged with long-term follow-up, more horses had colic after JC compared with JJ or JI. Long-term post discharge survival based on the Kaplan-Meier survivor function was lower for horses undergoing JC than JJ or JI (P = 0.04). CONCLUSION: While there was no difference in short-term outcome between groups, more horses with JI underwent a repeat celiotomy during hospitalisation. Horses with a JC were more likely to have long-term complications with colic. Horses that were subjected to euthanasia because of colic within 12 months of hospital discharge either had a JC or repeat celiotomy. The results suggest that, when possible, a JI may be the preferred method of anastomosis based on more favourable survival and lower occurrence of colic long term.