What is Enteroplication?
Enteroplication refers to a surgical procedure of the small intestine. "Entero" refers to the gut, whilst "plication" means to fold. Indeed, the procedure of enteroplication involves arranging the small intestine in folds and then suturing it in this arrangement so as to prevent intussusception.
Intussusception is a condition whereby spasm of the bowel causes the gut to telescopic inside itself. This is a life threatening disorder which needs prompt surgical correction. Once the intussusception has been cleared, there is nothing to say a repeat occurrence won't happen again. This is where enteroplication comes in, because stabilizing the bowel in position with sutures reduces the risk of a repeat.
Enteroplication Procedure in Cats
A cat diagnosed with an intussusception must be stabilised prior to surgery. Typically this means administering intravenous fluids, correcting electrolyte imbalances, giving pain relief and antibiotics.
A full anesthesia and laparotomy (surgically opening the abdomen) are required. The entire gut is checked for problems that may not have shown on diagnostic scans. The intussusception is then exteriorised and assessed.
If the intussusception has only recently happened, it may be possible to un-telescope the bowel using manual pressure alone. However, it's more likely that adhesions have already formed, in which case that segment of gut must be surgically removed.
With the intussusception corrected, the surgeon then has to decide whether to perform an enteroplication or not. To go ahead involves carefully exteriorized the entirety of the small intestine and arranging it in zigzag loops. The adjacent loops are then sutured together with fine absorbable suture material. The idea being that each loop is attached to neighbors on either side so that it can no longer slide inside itself.
The abdomen is closed, and the patient returned to intensive care for observation during the immediate postoperative period.
Efficacy of Enteroplication in Cats
Enteroplication works to prevent intussusception, but is not without controversy as a procedure. Performing a full enteroplication takes time, during which the cat remains under anesthesia. In a sick or critical patient, then a short anesthetic is preferable. There is also a risk of accidentally puncturing the bowel whilst placing the sutures, plus the procedure involves exteriorizing the bowel, which could increase the risk of it drying out or of infection.
But the most serious complication is the risk that a foreign body swallowed in the future, cannot negotiate the hairpin turns created during enteroplication. In certain scenarios, this could lead to a long straight object, such as a stick, penetrating the bowel wall and causing peritonitis.
Enteroplication Recovery in Cats
Laparotomy in itself is a major procedure, and those cats operated on for an intussusception are liable to be in poor condition prior the procedure. This all adds to the risk of postoperative complications such as electrolyte imbalances, infection, wound breakdown, or shock.
The cat must be rested for 10 days post-op, which means no jumping or energetic play. They will need a check-up after three days, and suture removal from the skin incision at 10 days.
During the recovery period, the cat may need to take pain relief and antibiotics. The cat must not lick the abdominal incision, and so wearing a cone is advisable.
Cost of Enteroplication in Cats
Laparotomy and bowel surgery is costly, not least because it's often performed as an emergency. It is reasonable to expect a bill of $1,600 to $3,000 upwards at a first opinion vet practice. The enteroplication is performed as part of this larger surgery, and may represent a further hour of surgical time.
For an 'unusual' procedure such as enteroplication some practices charge by the hour, rather than per procedure. The charge for surgical time varies but expect to pay $150 to $600 per hour, depending on the experience of the surgeon.
As already mentioned, enteroplication is not without controversy. There is no alternative method of stabilizing the bowel, but some would argue the priority is to get the patient awake, rather than extend surgical time.
Cat Enteroplication Considerations
The benefit of enteroplication means eliminating the risk of a repeat intussusception. However, the procedure adds to the time a sick patient is kept under anesthetic. Thus the surgeon makes a judgement call about how stable the cat is and whether it is wiser to wake the patient up, rather than extend surgical time.
Enteroplication Prevention in Cats
Intussusception can occur for no reason, but is most commonly linked to diarrhea in young animals. This may be the result of a sudden change of diet, infection, or parasites. Indeed, coccidial infections such as giardia thrive when there are multiple animals in close contact, such as a litter of kittens.
Good husbandry of young kittens is therefore crucial when it comes to preventing the conditions which could lead to enteroplication. For example, litter trays must be emptied daily with the whole tray washed and disinfected at least weekly. Soiled bedding should also be put through the wash.
Any kittens with diarrhea should receive prompt veterinary attention. A diagnostic workup may be required, such as fecal analysis to investigate the presence of worms, and therefore which dewormer is required.
Kittens that soil their coat with feces also need gentle bathing. This washes away contaminants from the coat which could be a source of reinfection.
Some causes of diarrhea in kittens, such as giardia, campylobacter, or salmonella are infectious to people. Therefore any persons in contact with sick kittens should observe scrupulous personal hygiene and wash their hands immediately after contact with them.