Incomplete Ileocecal Bypass for Ileal Pathology in Horses: 21 Cases (2012–2019)

SIMPLE SUMMARY: The ileal pathologies represent a problem often found during colic. At exploratory laparotomy, in cases where there is involvement of the ileum and there is a suspicion of an ileocecal valve disfunction, the surgeon may be faced with the choice of whether to resect the intestinal tract involved, do nothing, or perform an ileocecal bypass without resection of the ileum. This latter technique may represent a valid alternative to extensive manipulation, and it may reduce the recurrence of ileal occlusion and post-operative complication. This study aims to describe clinical findings, surgical techniques, and post-operative progress of horses who have undergone an incomplete ileocecal bypass in case of strangulating or non-strangulating ileum pathologies. Incomplete ileocecal bypass may represent an effective and safe surgical technique in these cases and in all cases of ileal pathologies treated without resection to avoid recurrence and reduce complications. ABSTRACT: Background: Incomplete ileocecal bypass can be performed in cases in which an ileal disfunction is suspected but resection of the diseased ileum is not necessary. Objectives: To describe the clinical findings, the surgical technique, and the outcome of 21 cases of colic with ileal pathologies that underwent an incomplete ileocecal bypass. Methods: Historical, clinical, and surgical features of cases diagnosed with pathologies involving the ileum or the ileocecal valve that underwent ileocecal anastomosis without ileal resection were retrieved. Clinical (heart rate, duration of symptoms, presence of reflux, age, weight at arrival) and surgical (surgical pathology, duration of surgery, type of anastomosis) data were retrieved and analysed. Data on short term survival and postoperative complications (colic, post-operative reflux, incisional infection, fever), length of hospital stay, and long term follow up were also obtained. Results: A total of 21 horses met the criteria; 13 horses had ileal impaction (one with muscular hypertrophy), 5 horses had epiploic foramen entrapment, and 3 horses had a pedunculated lipoma. An incomplete ileocecal bypass was performed with a two-layer hand-sewn side-to-side technique in 19 cases and with a stapled side-to-side technique in 2 cases. Short term survival was 95.2%. At 12-months follow up, all horses but two were alive, and 13 of the 14 sport horses returned to their previous level of activity. Long term survival was 90.47%. Conclusions Incomplete ileocecal bypass may represent a valid surgical technique in case of ileocecal valve disfunction when ileum resection is not necessary; this technique may represent an alternative to extensive manipulation without subsequent recurrence of ileal impaction.