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

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.