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An enteropexy is a surgical procedure that is often done at the end of an emergency alleviation of an intestinal blockage. These blockages are generally caused by one segment of the intestines folding into the next. The fold will either create a partial obstruction, which causes swelling and other unpleasant symptoms, or a complete obstruction, which stops blood flow and is life-threatening.
An enteropexy is a preventative measure to ensure that the intestine does not once again fold after the surgery to fix the obstruction has been completed. The whole operation should be performed as soon as possible to prevent tissue death in the intestinal tract. Some instances may allow for an elective enteropexy in highly susceptible breeds. This treatment should only be attempted by an ACVS board-certified veterinary surgeon.
Ultrasounds are often used to diagnose an intussusception after a dog presents with symptoms suggesting such an issue. A partial blockage may not show up on an ultrasound. Bloodwork will only be run if the dog's condition allows it, as results may take a period of time. To start the procedure, an incision will be made into the dog's abdomen. If a foreign body is present, it will be surgically removed at this time. If any of the intestinal tissue has begun to darken, it will need to be removed, as it has died. A peritoneal lavage will be completed to clean the abdominal opening and to prevent infection.
After the blockage has been addressed, the enteropexy will be performed. The intestines will be sutured to the abdominal wall to keep them from intussuscepting in the future. Some owners may choose to have this surgery done electively if they have a breed which is prone to the issue. In this case, the procedure may be done laparoscopically, using small incisions and a camera instead of making one large cut to the abdomen. After the intestines have been successfully attached to the abdominal wall, all openings will be sewn or stapled shut.
If an intussusception is found when it is only partial, or if it has very recently occurred, the surgery carries an excellent prognosis. Overall health of the animal will vary based on what caused the intussusception to happen in the first place. Recurrence rates drop well below 20% in dogs who have had an enteropexy following the clearing of a blockage. If an infection sets in, or if upon opening the abdominal cavity it is found that the intestines have twisted, the chance of mortality increases.
While an enteropexy is not vital for the dog to live, it adds no further risk to the surgical procedure and improves the long-term outlook for the dog. Because of its effectiveness, some may even opt to have it done before anything goes wrong if they own an animal with a high risk of intussusception.
The dog will be put on intravenous fluids before the surgery, which will be administered throughout the hospital recovery period. Colloids or potassium supplements may be administered through the IV line. Painkillers are typically used for pain management in dogs who receive abdominal surgery. The dog should be given a very bland diet in the first few days after the operation has been performed, slowly returning to its usual meals.
Broad spectrum antibiotics will be given to the dog to ward off any bacterial infections. If the dog goes into shock, short-acting steroids will also be administered. Antiemetics can be given to reduce nausea or help prevent vomiting. If the animal has ulcers, drugs that protect the stomach lining can help soothe the affected area. The dog's packed cell volumes and other blood levels will need to be closely monitored as the dog recovers in hospital. A follow-up appointment will be needed within one to two weeks after the surgery has been completed to assess healing.
The overall cost of surgery will range greatly depending on if it is preventative or if it is paired with other complications. If the enteropexy is done electively to prevent an intussusception from occurring, it can cost as little as $750-$1,500. If the enteropexy is paired with an intussusception that has already developed (which is the most common case), the surgery can range from $1,500-$10,000 depending on how extensive the internal damage is. On average, this combined operation costs around $3,500.
As most enteropexy procedures are done on an emergency basis and do not add risk to the abdominal surgery, it is unlikely that an owner would opt out of this preventative measure to stop an additional intussusception from occurring in the future. The surgery to alleviate an abdominal blockage does carry serious risks such as septic peritonitis, intestinal tissue death, aspiration pneumonia, a perforation in the intestine, or a split incision, but the alternative to having the surgery is often death. An elective enteropexy does not carry heightened risks other than those generally associated with surgery and the use of anesthesia.
Intussusception most often is seen in dogs under a year of age. It can happen in older dogs if they have developed intestinal cancer, although this is rare. There are no specific ways to avoid this cancer, other than keeping your dog away from known cancer causing toxins and carcinogens, such as car exhaust and cigarette smoke. Metabolic disorders are often genetic and cannot be prevented, but they may be managed.
Consuming a foreign body can lead to intussusception, so do not allow your dog to chew on broken sticks or toys. Keeping young dogs dewormed can lower the chance of a parasitic infection, which, when severe, can also result in intussusception. Always choose an ACVS board-certified veterinary surgeon to perform serious operations involving the abdomen. This can help prevent possible future complications from incorrect procedures. If your dog is high risk for developing intussusception, discuss with your veterinarian whether an elective enteropexy is right for the animal.
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