Surgical treatment of epiploic foramen entrapment in 142 horses (2008-2016)

Objective To report the clinical features, outcomes, and prognostic factors associated with the surgical treatment of epiploic foramen entrapment (EFE). Study design Retrospective study at a single referral hospital. Animals Horses (n = 142) undergoing surgery (n = 145) for EFE. Methods Preoperative, perioperative, and postoperative data of surgeries on horses that underwent exploratory laparotomy for EFE were obtained. The postoperative outcome was assessed by follow-up telephone calls with the owners/caregivers. Factors associated with postoperative reflux (POR), relaparotomy, hospital discharge, colic after hospital discharge, and survival after discharge were assessed. Results In total, 145 surgeries were performed on 142 horses (recurrence rate, 3%). Warmblood horses represented 85% of the horses that underwent surgery. Windsucking/crib-biting was confirmed in 60% of these surgery cases. Left-to-right entrapment was diagnosed in all horses. Ileal involvement was recorded in 74% of the cases. Uncontrollable intraoperative hemorrhage was encountered in 6% of the surgeries. One hundred seven (74%) horses recovered from surgery, and 65% of those survived to discharge. The rate of survival to discharge of all surgeries was 48%. The median survival of the cases that were discharged exceeded 3193 days. Horses requiring intestinal resection were predisposed to POR, and those undergoing jejunoileostomy were more prone to POR than those undergoing jejunojejunostomy. Horses with POR were less likely to be discharged than those without POR, and those that underwent resection had shorter life expectancy after hospital discharge than those that did not undergo resection. Conclusion Surgical treatment of EFE was associated with high morbidity and mortality, with recurrence in at least 3% of surviving horses. Clinical significance Owners of horses with EFE should be informed of the guarded prognosis associated with current surgical treatment.