Prevention and treatment of gastrointestinal adhesions.
As with many aspects of clinical medicine, there is yet to be a single or definitive cure for postoperative adhesion formation. Current methods of prevention target risk factors predisposing horses to adhesion formation. Systemic pharmacologic therapies, such as antimicrobials, nonsteroidal anti-inflammatory drugs, Salmonella antiserum, and hyperimmune plasma, help to reduce abdominal inflammation and minimize the effects of endotoxemia. Intra-abdominal or systemic heparin aids in enhancing peritoneal fibrinolysis. Prokinetic therapy promotes early postoperative return of intestinal motility, minimizing the propensity for adhesion formation between apposing adynamic segments of intestine. Mechanical separation of potentially adhesiogenic serosal and peritoneal surfaces is commonly achieved with use of abdominal lavage, protective coating solutions, and barrier membranes. Ongoing and future research is directed toward a better understanding of the local effects of intestinal trauma and the corresponding response of the fibrinolytic system. Recognition of horses at high risk for adhesion formation helps to guide the equine surgeon to an appropriate perioperative and intraoperative plan for adhesion prevention, including good surgical technique and a combination of adjunct therapies.
Eggleston
Randall B
RB
Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA 30602, USA. egglesto@vet.uga.edu
Mueller
P O Eric
PO
D000005:Abdomen / Q000601:surgery; D000818:Animals; D005767:Gastrointestinal Diseases / Q000517:prevention & control / Q000628:therapy / Q000662:veterinary*; D006734:Horse Diseases / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006736:Horses; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy / Q000662:veterinary; D000267:Tissue Adhesions / Q000517:prevention & control / Q000628:therapy / Q000662:veterinary