A second look inside.

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Surgeons try new technique to speed post-operative healing.

Patients undergoing abdominal surgery have a long way to go in the recovery process before their health improves. most common post-surgical complications is adhesions, which occur when scar tissue attaches the bowels together or to the abdominal wall. Adhesions can cause digestive complications and make recovery difficult.

In human medicine, doctors use a laparos-copy technique that allows them to monitor potential complications more closely. And now, Guelph veterinarians are working on developing a comparable technique in horses. They hope to improve the typically grim prognosis facing one-half of foals and one-fifth of adult horses after abdominal surgery.

Prof. Ludovic Bour? and his team at the Ontario Veterinary College, which includes graduate student Jennifer Lansdowne, are performing “second-look laparoscopy,” a mini-mally invasive surgical technique that allows them to revisit the abdomen after surgery — in effect, giving it a second look. That way, they can locate and disconnect areas of the bowels that are beginning to adhere, before it’s too late.

“Abdominal surgery creates inflammation on the bowels, which disturbs the normal coating tissue that lubricates the area,” says Bour?. “That causes some areas to become damaged. When two such irritated surfaces come together, they are frequently connected by scar tissue. That can make tight turns that can impede bowel movement and digestion.”

Many cases of abdominal adhesions show no symptoms. But once adhesions form, the risk of chronic pain or colic — an often deadly. Once adhesions form, the risk of chronic pain or colic — an often deadly digestive upset — is always present.

“It’s less of a concern in nursing foals,” he says, “but once they’re on a solid diet, which doesn’t pass as freely as milk, the risk increases.”

To determine if second-look laparoscopy is as effective in horses as it is in humans, Bour? performed the procedure on patients known to have abdominal adhesions. After making small incisions to enter the abdomen, he used long instruments and a video camera to disconnect areas of attachment. Later, he re-entered the belly to see if the adhesions had reformed or if any new ones were created.

“In our research, results showed the separated adhesions healed well and the normal lubricating tissue covering the bowels returned,” he says. “Very few new adhesions formed.”
To further avoid even the small numbers of new adhesions that may form post-surgically, Bour? investigated a non-toxic viscous gel used to coat and lubricate the bowels in human surgeries. The gel, added after a second-look laparoscopy, proved as effective in horses as in humans.

Other researchers on the team include clinical studies professors Carolyn Kerr and Simon Pearce. This study was sponsored by the Canadian Institutes of Health Research.