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Adhesions are fibrous tissue growths formed on your horse's internal organs as a result of tissue disruption or trauma. In horses, abdominal adhesions and adhesions of the reproductive system in postpartum mares are the most common type of adhesions developed.
Your horse’s abdominal cavity contains peritoneal fluid which lubricates abdominal organs, allowing them to slide against each other as your horse moves and the organs digest food. Abdominal adhesions are fibrous bands of tissue that develop between abdominal organs and tissues that interfere with the normal movement of abdominal organs, as they “catch” when they rub against each other instead of sliding smoothly past. These adhesions are a type of scar tissue that occurs as the result of over-healing of internal tissues.
In the abdominal cavity, peritoneal mesothelium tissues may produce adhesions typically after abdominal surgery or trauma. Postpartum trauma in mares is a cause of reproductive organ adhesions. When adhesions prevent organs from moving smoothly past each other, organs can become displaced resulting in strangulation or intestinal obstruction when compression and distortion of the intestine occurs, resulting in life-threatening colic. Surgical intervention by a veterinarian to break down adhesions is required. As laparoscopic surgery techniques improve, this procedure is increasingly performed laparoscopically although it may also be performed by traditional surgery methods as well.
Because adhesions are common in horses, laparoscopic exploration to locate and reduce adhesions may be performed routinely several days after surgery. Additionally, surgery to remove adhesions may proceed from illness your horse experiences as a result of their development. Abdominal adhesion reduction is performed either under general anesthesia by traditional surgical methods or under local anesthetic combined with sedatives via laparoscopic surgical methods by a veterinary surgeon.
Adhesion reduction may be conducted laproscopically, usually through the flank of your horse while standing under local anesthetic and sedation or through traditional surgical techniques which include a ventral midline surgical incision (celiotomy) into the abdominal cavity.
When laparoscopy is performed, your horse remains in the standing position and after local anesthetic is administered a small incision is made in their upper flank and a scope with a camera and specialized surgical instruments are inserted. Adhesions are located and reduced surgically as appropriate. Any vascularization encountered will need to be addressed and ligated a required. The laparoscopic incision is then closed.
If celiotomy is being conducted, your horse will require general anesthetic. Your horse will be administered intravenous anesthetic which will render them unconscious. Your horse will be helped or lowered to the floor to prevent injury. Once rendered unconscious, an esophageal tube will be inserted, your horse will be put on their back on a surgical tale, and the abdomen will be shaved and prepared antiseptically for surgery. A large incision will be made in your horse's abdomen and abdominal organs carefully manipulated to expose organs and tissues where adhesions are located. Minimal disturbance of abdominal organs where adhesions are present will reduce further damage.
When adhesions are located, adhesiolysis will be performed to break down adhesions manually or with electrocautery devices, then dissected or transected to reduce them. The location and size of the adhesion will determine the appropriate procedure for reduction. Electrical vessel sealing devices may be used to reduce adhesions and address bleeding, however the proximity to other abdominal tissues may cause damage and result in further adhesions, so caution must be exercised to determine when this is appropriate. The less trauma inflicted on tissues during reduction of existing adhesions the less chance of further adhesions developing.
Both open surgery or laparoscopy through your horse's flank can be used on abdominal adhesions or reproductive organ adhesions.
Due to the nature of adhesions, they are prone to reform after surgical reduction. Laparoscopic reduction has been associated with an increased risk in adhesions reforming; pre-procedure planning and cautious techniques employed during the procedure will mitigate this. An alternative to adhesion reduction is intestinal bypass surgery to circumvent adhesions, this may be a viable option in some cases. Sometimes, abdominal barriers that separate tissues during internal healing are inserted into the abdomen during abdominal surgery to reduce the likelihood of adhesions occurring. Some medications including antimicrobials, nonsteroidal anti-inflammatories, heparin, and dimethyl sulfoxide may reduce adhesion formation post surgery as well.
Recovery from a laparoscopic procedure is much faster than from open surgery, as the requirement for general anesthetic, which can be difficult for horses, is not required and the surgery is less invasive. As for any surgical procedure, you will need to monitor incision sites for infection or rupture. Your horse should be closely observed for any signs of post-procedure illness that need to be addressed by a veterinarian including fever, pain, or digestive abnormalities. Food will be introduced cautiously and grains avoided, however it is important for intestinal motility to be achieved as soon as possible to prevent the formation of further adhesions. A forage diet is preferable post-surgery, and your horse will need to be kept on stall rest to minimize activity for a few weeks after the procedure. A return to normal activity should be conducted gradually, and will be at a much slower pace if open abdominal surgery was conducted, taking weeks to months. Laparoscopic surgery is associated with a faster return to normal activity levels.
If traditional abdominal surgery technique is employed, adhesion reduction can cost $5,000 to $10,000 or more depending on the degree of reduction and repair required. Laparoscopic surgery costs are less, especially as general anesthesia is not required and recovery is faster.
If adhesions have resulted in strangulation requiring additional surgical procedures or if adhesions occur in very young horses, adhesion reduction is associated with guarded prognosis. If adhesions have not caused severe problems prognosis is much better.
Horses do not respond well to general anesthesia and there is an associated risk with administration and recovery from anesthetic if open surgery is performed. This risk is less with laparoscopic procedures, however, the risk of recurrent adhesions is greater with laparoscopic surgery.
Hemorrhaging and infection are commonly recognized risks associated with surgical procedures and careful adherence to surgical protocols will minimize the likelihood of these occurring.
When abdominal surgery is required in equines, especially young horses, careful adherence to aseptic and atraumatic techniques will reduce the likelihood of adhesions occurring post surgery. Several medications and abdominal barriers administered post surgery can decrease the incidence of adhesion formation as can per-rectal manipulation of the uterus or intestine post surgery. A return to digestive organ functioning with a forage-based diet to achieve digestive motility as quickly as possible after surgery has been shown to reduce adhesion formation and increase natural process reduction of adhesions.
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