Your horse needs colic surgery.” This is the statement horse owners hope they never hear from their veterinarians. Unfortunately, colic, or abdominal pain, is common in horses, and approximately 10% of cases require surgical intervention. Improvements in recognizing when horses need referral to a surgical facility, more advanced diagnostic capabilities, and safer anesthetic protocols developed over the past few decades have improved prognoses for horses undergoing colic surgery. Yet, many owners still perceive colic surgery in a negative light. They might know someone whose horse had colic surgery, or people have told them how horses do after it. The outcome in those cases, instead of the facts, can heavily sway decisions to pursue surgery. Let’s look at which common rumors are just myths.
Myth: My horse is too old for surgery
Age is not a disease. As veterinary care and horse husbandry have improved, horses’ athletic careers and life expectancies have been extended. Many horses are being ridden well into their 20s, and surgical centers have seen an increase in colic surgeries performed on older patients in recent years. Researchers have even investigated whether age is a significant factor in predicting outcome in adult horses undergoing colic surgery. A University of Pennsylvania team compared outcomes in mature (4-15 years old) horses to those in geriatric (>20 years) horses and found similar postoperative complication incidence and survival. These and other researchers have concluded that age alone is not associated with outcome and not a reason to decline colic surgery.
Myth: My horse will never go back to the same level of performance after colic surgery
While colic surgery is a major procedure with a relatively long recovery, horses can and do commonly go back to their previous performance levels. Typically, recovery consists of around three months of restricted exercise, with most horses back to full exercise in four to five months. Most tendon or ligament injuries recover much more slowly. Immonen et al. recently reviewed records of 200-plus horses of varying breeds and disciplines that had undergone colic surgery to determine how many went back to work. They found that 84% could perform at their previous or intended disciplines after surgery and 79% were performing at the same level or higher. If horses are discharged from the hospital, there’s a good chance they can go back to their prior jobs.
Myth: After a resection, a horse is never the same
Resection and anastomosis (removing the damaged portion of the bowel and putting two healthy ends together) indicate surgeons encountered a more serious problem with the intestines during surgery. More important than whether they performed a resection, however, is the section being resected. Horses appear to tolerate resections involving the middle of the small intestine (jejunum) much better than those involving its end (ileum); recently scientists reported survival rates of at least 75% in jejunum-only resections. Large colon resections are often longer, more complicated surgeries, but researchers still report good long-term success (65-75%) in these cases. Therefore, a resection alone does not indicate a poorer prognosis or a lifetime of problems, but it is important to consider the bowel portion being resected and the patient’s overall health.
More evidence needed: My horse will always be more prone to colic after having surgery
The incidence of postoperative colic in the first year after hospital discharge varies from 0 to 35%, depending on the study. Factors that appear to be important in predicting postop colic include the bowel portion affected and the surgical procedures performed. Horses undergoing surgery due to a problem with the large colon appear to be at a higher risk of subsequent colics. Many will have had frequent colic episodes prior to the surgical one; therefore, it is unclear if surgery truly increases the risk or whether these horses are just more prone to colic. Adhesions (scar tissue between bowel parts or between bowel and other abdominal organs) seem to be more common in surgeries involving the small intestine and are often blamed for subsequent colic episodes. However, significant adhesions are uncommon findings on post-mortem exams and occur in only 6-13% of surgeries involving the small intestine. Generally, if a horse doesn’t colic in the first year after surgery, his risk of experiencing subsequent episodes is similar to that of a horse that did not have surgery.
Putting a horse through colic surgery is a big decision. Many horses survive surgery and go back to living and performing as they were, but each horse and case is unique. So, it is important to discuss all the options with your vet. When making the decision, consider factors such as diagnosis, prognosis, cost, and the emotional toll of surgery and rehabilitation.