Surgical procedures are performed both in emergencies and preventatively. The most typical patients requiring urgent surgical care are those suffering from colic, arthritis and tenosynovitis. Preventive surgery is used to treat, among other things, joint mice and hernias, as well as to perform castrations.
Horses can be brought to the Equine Hospital either by referral, or for the necessary preliminary examinations to be carried out on site.
For procedures requiring general anaesthesia, the hospital has two operating theatres, each of which has its own anaesthetic and recovery pen. For surgical procedures, horses are anaesthetised as safely as possible relying on the latest knowledge and using high-quality equipment. Both operating theatres are equipped for inhalation anaesthesia and intravenous medication. Equine anaesthesia is monitored in a number of ways throughout surgical procedures. Often in emergencies, seriously ill horses are anaesthetised and operated on at the Equine Hospital.
The most common non-urgent surgeries include arthroscopy and gelding. From among emergency surgeries, the most common are the treatment of various wounds and other traumas as well as colic surgeries. In addition, a wide range of other patients who may require surgical treatment are received at the hospital. Their ailments include bone fractures, a range of tumours, complicated sinus disorders, problems originating in the foot and abdominal cavity in foals, and difficult cases of foaling assistance for mares or injuries caused by foaling.
Some operations, such as laparoscopy, are performed on horses in an upright position under sedation and local anaesthesia. For this purpose, examination rooms with stocks are available. The most common indications for laparoscopic operations for adult horses include ovarian tumours or cryptorchidisms in the abdominal cavity. Some surgeries on the upper respiratory tract can also be performed on standing horses, in which case transendoscopic laser surgery is utilised, operating a laser device via the endoscope.
Depending on the operation, horses are discharged either immediately after the procedure or, if necessary, hospitalised for monitoring and care. Often, referral patients return to the veterinarian in charge of their care for any follow-up examinations, but, when necessary, these can instead be conducted at the hospital. The veterinarians of the Equine Hospital provide regular consultation in their specialist fields.
Gelding is the most common non-urgent surgical procedure carried out at the Equine Hospital. The largest share of horses brought for gelding are young animals between two and four years of age, but the patient group also includes older horses. Gelding is performed under anaesthesia with the closed method using a laser or traditional techniques. Depending on the circumstances, gelding patients are usually discharged on the same or the next day.
The hospital performs arthroscopies both for patients with appointments and emergencies. Joint flushes under endoscopy are often the best option both with regard to the assessment of the condition and the efficiency of the lavage. The Equine Hospital also performs corrective surgery on fractures.
Horses typically get infected by a cut close to the joint or a trauma reaching the tendon sheath, for example, a kick with a calked horseshoe. Sometimes a joint infection may be caused by prior veterinary medicinal procedures such as joint injection or surgery. Bacteria circulating in the bloodstream may also cause a joint infection, especially in newborn or young foals.
Joint flushing, or lavage, is a primary treatment for joint infections performed either with arthroscopy or needles. Joint flushing is most often and most effectively performed under anaesthesia. The extent of the flushing need depends on the horse’s response to treatment; in most cases the infection is healed with one to three lavages. Arthroscopic joint surgery is used and recommended for a better flushing impact and for assessing the condition of the joint, and also when the patient has not responded to needle flushing. The aim is to take samples of the infected part for a bacteria culture to determine the bacteria’s sensitivity to antibiotics, but it is not always possible to determine this from the bacteria culture.
The prognosis for joint and tendon sheath infections is always conditional and depends on how quickly the horse comes in for treatment after the trauma. The prognosis also depends on the bacteria causing the infection as well as the nature of the trauma. If a joint is already infected, it does not necessarily require flushing during the night, and it can be flushed arthroscopically during the day. In some cases, treatment begun in time does not help, and the infection leads to joint destruction and osteoarthritis. The treatment costs related to a joint infection are on average €2,000 to €4,000 depending on the number of lavages and medication used
Joint mice, or osteochondral fragments, are growth disturbances in the form of loose bodies in joints that occur most commonly at a young age in connection with ossification, resulting in the fragmenting of a piece from the surface of the joint. Non-growth-related joint mice caused by injuries also can occur. Growth-related joint mice occur in horses most commonly in the hock, the fetlock and the hind knee, but joint mice can be found also in other joints. Some joint mice can chafe joint surfaces and consequently cause arthritis. Such bodies should be removed. Joint mice are diagnosed with radiography and, when necessary, ultrasonography. Equine joint mice scans are usually carried out after the horse’s first 18 months of life, after which the discovery of loose bodies is consequential. Foals can also be examined for joint mice if they present lameness or swelling of joints. Joint mice surgeries are performed as endoscopic operations under anaesthesia.
The whole abdominal cavity can be examined while the horse is standing with a laparoscope. It is possible also to take and study tissue samples. Repeated changes of position of the large intestine on top of the spleen can be avoided by attaching the spleen to the wall of the abdominal cavity. Other laparoscopic surgeries include the removal of retained testicles and ovariectomy.
Changes in the larynx can be operated on both under anaesthesia and under sedation with a laser. When needed, the diagnosis can be ascertained with a treadmill examination.
At times the only treatment for horse colic is surgery. Colic surgery is always an emergency and most clinics do not have the capacity to perform the operation and its aftercare. At the Equine Hospital, colic surgeries are performed by experienced surgeons assisted by younger veterinarians.
If a horse has colic requiring surgery, its final diagnosis and the horse’s prognosis are usually confirmed only during the operation. The survival prognosis of large intestinal colic is about 75% and small intestinal colic about 50%. The horse will spend one week on average at the hospital after the surgery.
Complication risks related to colic surgery include problems related to anaesthesia (muscle injury, nerve damage, death under anaesthesia, injuries occurring during waking up, pneumonia), problems related to the healing of the surgical wound (wound infection, stiches coming loose, hernia), problems related to the healing of the intestine (constipation), and the body’s inflammatory responses and the compensatory anti-inflammatory response (endotoxemia, peritonitis, vasculitis, laminitis) as well as, in individual cases, chronic repeated colic (attachments). It is impossible to list all of the possible problems but small intestinal colic and a twisted large colon are both more prone to complications. The convalescence period after a successful operation to the normal condition is approximately four months. A colic surgery will not remove a horse’s predisposition to colic, and the horse will have a statistically higher risk for recurring colic than a horse that has never had colic.
The price estimate for colic surgery is from 7,000 euros upwards, but the overall price varies a great deal depending on the time of the operation (daytime/on-call hours/night) and the amount of aftercare required by the horse. For example, in small intestinal colic, where part of the intestine has to be removed and there is no bowel movement for several days after the operation, the total price may rise to over €10,000 due to the enormous volume of liquid required by the horse and aftercare.