Original Research
Effects of Jejunal Manipulation During Surgical Laparotomy Techniques and Its Evaluation Using Physical, Clinical, and Echographic Parameters in Horses

https://doi.org/10.1016/j.jevs.2017.08.010Get rights and content

Highlights

  • Intestinal manipulation altered physical and clinical parameters in laparotomy with enterectomy.

  • Increases in postsurgical intestinal thickness during jejunal manipulation on enterectomy.

  • Enterectomy shows highest degree of pain and increased heart rate 24 hours postoperatively.

Abstract

The laparotomy surgical procedure allows for the identification and correction of intestinal lesions associated with acute abdomen in horses. The clinician relies on various laparotomy techniques to diagnose and treat this syndrome, and to date, the postsurgical effects of these techniques have not been clarified. The aim of this study was to evaluate the effects of jejunal manipulation during three laparotomy techniques through physical and clinical parameters and echography. Fifteen healthy horses were randomly assigned to three groups: animals in G1 (n = 5) were subjected to an exploratory laparotomy, animals in G2 (n = 5) to a laparotomy with an enterotomy, and animals in G3 (n = 5) to a laparotomy with an enterectomy. Degree of pain, jejunal wall thickness, and clinical parameters were evaluated before and after surgery. Horses in G3 had higher heart rates, respiratory frequency, degree of pain, and jejunal wall thickness compared with G1. Clinical variables during the postsurgical period were compared among the laparotomy techniques, and higher values of erythrocytes, leucocytes, neutrophils, and proteins were found in horses belonging to G3 compared to those in G1. Intestinal manipulation during the surgical procedure altered the physical and clinical parameters, as well as the results of the echography evaluation, with more significant effects from laparotomy with enterectomy. In the postsurgical period, the heart rate of horses in G3 was higher (P = .02) than the values obtained in G1 and G2. Upon the evaluation of degree of pain, statistically significant differences (P = .04) were identified between horses in G1 versus G3. G3 animals presented a higher degree of pain. Regarding the erythrocytes (L/L), higher values were measured in G3 (P = .001) in comparison with G1 and G2. These results suggest that meticulous tissue handling is essential to minimize intestinal trauma and inflammation.

Introduction

Acute abdomen is a term for a group of signs indicative of abdominal pain originating with the digestive system or other abdominal organ [1], which can be caused by intestinal obstruction and block of food passage through the intestines. Acute abdomen has an approximate clinical incidence of 3.5–10.5 cases per 100 horses per year [2]; between 7% and 10% of the acute abdomen cases require immediate surgical treatment [3]. Acute abdomen can be diagnosed and treated with a laparotomy surgery, which is performed to localize, identify, and correct the intestinal lesion [4]. Surgical laparotomy techniques performed in horses with signology of acute abdominal syndrome may include at the discretion of the surgeon, manipulation of the jejunum or other tubular organs to perform the correction, other techniques of laparotomy as a surgical approach, and hand-assisted laparoscopic correction exist [5]. The degree of pain and thickness of the intestinal wall at jejunum level varies according to the technique used [6]. To date, there are no studies in horses with or without sinology of acute abdominal syndrome that indicates the degree of pain caused by the jejunal manipulation or the increase in the thickness of the intestinal wall based on physical and ultrasound techniques. It is therefore necessary to carry out evaluations of the effect of manipulation on horses without acute abdominal syndrome, in order to identify the effect of manipulation.

Laparotomy techniques commonly used by the clinician are exploratory laparotomy, laparotomy with enterotomy, and laparotomy with enterectomy [7]. Hopster-Iversen et al [8] suggested that inflammation of the small intestine or intestinal manipulation can result in disease. Currently, the postoperative effects including inflammation and degree of pain generated by surgical manipulation of the jejunum during each of the surgical procedures mentioned above have not been evaluated. The objective of this study was to evaluate the effects of jejunal manipulation in the three surgical techniques using physical, clinical, and echographic parameters in horses without acute abdomen.

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Animals and Experimental Treatments

The study included 15 male, intact or castrated, mixed breed horses with an average age of 10.5 years and average weight of 183.5 kg. The bioethics and animal welfare commission of the FMVZ—UAEMex approved the investigation. The horses were transported to the Large Species Hospital of the UAEMex, according to the eighth section of the Official Mexican Norm NOM-024-ZOO-1995 [9], animal health specifications and features for the transport of animals, their products and by-products, chemical,

Presurgical Evaluation of Physical, Clinical, and Echographic Parameters

When comparing the laparotomy techniques mentioned above, no statistically differences were observed. There were no statistically differences in the heart rates (P = .98) nor in respiratory rate (P = .41). The degree of pain was zero in the three groups. Jejunal wall thickness was not different among groups (P = .74).

When making a comparison between the laparotomy techniques, no statistically differences were identified in any of the variables. No differences were observed for G1, G2, and G3 in

Discussion

In the equine population in this study, an increased heart rate during the enterectomy technique with an average of 45 beats per minute was identified. Moore and Moore [16] reported that the heart rate is a very sensitive indicator of pain, hypovolemia, and endotoxic shock in horses. Proudman et al [3] reported a heart rate of 50 ± 19 beats/min between 15 and 25 hours after abdominal surgery in 341 horses aged 10 ± 6.4 years old. The highest heart rate value recorded was 45 beats/min in horses

Conclusions

The laparotomy surgical techniques is one of the most common procedures performed on horses hospitalized due to signology of acute abdominal syndrome. The manipulation of the jejunal during the enterectomy technique increased heart rate and pain level in the first 24 hours which returned to normal at 72 hours postoperatively. The comparison of the different surgical techniques performed in this study shows that the enterectomy technique is the procedure with the greatest adverse effects in the

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    Animal welfare/ethical statement: All methods and procedures used in this study were in compliance with the guidelines of the Mexican law “Official Mexican Standard # 062-ZOO-1999 of the technical specifications for production, care and use of laboratory animals”. On the protection of animals used for scientific purposes, and were approved by the Animal Ethics Committee for the Care and Use and Animals of university of Autonomous of State Mexico, México.

    Conflict of interest statement: The authors declare that they don’t have any conflict of interest.

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