Review finds thin evidence on horse pelvic flexure enterotomy closure
Bottom line
A new scoping review in Veterinary Sciences found that the evidence base for closing pelvic flexure enterotomies in horses is surprisingly thin, despite how common the procedure is in equine colic surgery. The authors screened 22,146 records published from January 1996 through February 2026, but only five studies met inclusion criteria, and all five were ex vivo studies using healthy equine colon tissue rather than live-horse clinical trials. Across the available literature, no single closure method emerged as clearly superior, although two-layer hand-sewn closure remains the most commonly recommended approach in prior review literature. (theherd.news)
Why it matters: For equine surgeons and referral teams, the review is a reminder that a familiar intraoperative decision is still being made with limited comparative evidence. The included studies largely assessed closure time, bursting pressure, luminal narrowing, contamination, and cost, with mixed results: a 2013 ex vivo comparison found two-layer hand-sewn closure had the highest bursting pressure, while a 2017 cadaveric study found no significant bursting-pressure difference among one- and two-layer suture techniques, and a 2019 study suggested barbed sutures may shorten closure time without reducing bursting strength. A retrospective clinical study of 84 cases also found TA-90 stapled closure had survival and complication rates comparable to hand-sewn closure, underscoring that technique choice in practice still depends heavily on surgeon preference, case context, and priorities such as speed, contamination control, and cost. (pubmed.ncbi.nlm.nih.gov)
What to watch: The next meaningful step is prospective in vivo research that links closure technique to clinical outcomes such as leakage, adhesions, surgical site infection, recovery, and return to function. (theherd.news)
Key facts
- Study type
- Scoping review
- Journal
- Veterinary Sciences
- Records screened
- 22,146
- Search period
- January 1996 to February 2026
- Eligible studies
- 5
- Study model
- All five were ex vivo studies in healthy equine colon tissue
- Main finding
- No single closure method was clearly superior
- Commonly recommended technique
- Two-layer hand-sewn closure
A new scoping review is putting a spotlight on a basic but unresolved question in equine surgery: what’s the best way to close a pelvic flexure enterotomy? Writing in Veterinary Sciences, Valeria Albanese, Paola Straticò, and Amelia S. Munsterman report that after screening 22,146 records from January 1996 to February 2026, they found just five eligible studies, all of them ex vivo investigations in healthy equine colon tissue. In other words, one of the most familiar procedures in colic surgery still rests on a very small comparative evidence base. (theherd.news)
That gap matters because pelvic flexure enterotomy is a routine tool during equine colic surgery, commonly used to decompress and empty the large colon. A 2024 narrative review by many of the same authors noted that two-layer closure with absorbable suture is generally recommended, but that no true consensus has been established and published results vary across techniques and outcome measures. The literature has also long reflected broader concerns around postoperative contamination, adhesion formation, ileus, and incisional complications after laparotomy, all of which shape how surgeons think about enterotomy closure even when direct comparative data are sparse. (beva.onlinelibrary.wiley.com)
The studies identified over the years have mostly focused on bench-style endpoints rather than patient-centered outcomes. In a 2013 ex vivo study of 48 cadaveric specimens, the traditional two-layer hand-sewn approach produced the highest bursting pressure, while the TA-90 stapling technique had the lowest bursting pressure and the highest cost. A 2017 cadaveric comparison of three suture techniques found that a one-layer simple continuous closure was faster than both two-layer approaches, with no significant difference in luminal diameter or bursting pressure. Then, in a 2019 ex vivo study, barbed sutures shortened closure time and used less suture material than unbarbed sutures, while maintaining similar bursting pressure, though at higher cost. (pubmed.ncbi.nlm.nih.gov)
There is at least some clinical follow-through in the literature, but not much. A 2012 retrospective study of 84 pelvic flexure enterotomies performed from 2001 to 2008 found no significant difference in short- or long-term survival between TA-90 stapled and hand-sewn closure. Seventy-seven of 84 horses survived to discharge, and long-term follow-up suggested similarly acceptable outcomes across methods. That kind of study is useful, but it still doesn’t answer the central question the new review raises, because retrospective case series can’t fully control for case selection, surgeon preference, or intraoperative complexity. (pubmed.ncbi.nlm.nih.gov)
Some of the most practical findings in the surrounding literature are less about strength than about contamination control and workflow. A 2017 ex vivo study found that wiping sutures, instruments, and gloves with wet sterile gauze significantly reduced bacterial contamination during pelvic flexure enterotomy closure. For surgeons and OR teams, that supports the idea that small technique and handling choices may matter at least as much as the exact closure pattern when trying to reduce downstream complications. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary professionals, especially equine surgeons, residents, and referral hospitals, the takeaway isn’t that current practice is wrong. It’s that current practice is under-evidenced. The available studies compare speed, cost, bursting pressure, and luminal reduction, but they don’t provide the prospective in vivo data needed to link a closure method to leakage, adhesions, surgical site infection, postoperative ileus, hospitalization time, or athletic return. Until those data exist, surgeons will likely continue to rely on training, familiarity, tissue condition, contamination risk, and case urgency when choosing between one-layer, two-layer, barbed, or stapled techniques. (pubmed.ncbi.nlm.nih.gov)
There’s also a broader research message here. The new review suggests that even widely performed procedures in equine surgery may have surprisingly limited comparative evidence behind them. That creates an opportunity for multicenter prospective studies, or at minimum standardized retrospective datasets, that capture clinically relevant outcomes rather than laboratory surrogates alone. Recent ex vivo work in other equine intestinal settings, such as small-colon enterotomy closure, shows the field is still actively testing closure methods, which may help build momentum for more rigorous pelvic flexure-specific studies. (link.springer.com)
What to watch: Watch for prospective in vivo trials, multicenter surgical registries, or consensus guidance that moves this topic beyond cadaveric and ex vivo performance measures toward real-world outcome data. (theherd.news)