Review finds thin evidence on horse pelvic flexure enterotomy closure
Bottom line
A new scoping review in Veterinary Sciences examined the literature on pelvic flexure enterotomy closure in horses and found that, despite how commonly the procedure is used during equine colic surgery, the evidence base remains remarkably thin. The authors — Valeria Albanese, Paola Straticò, and Amelia S. Munsterman — screened 22,146 records covering January 1996 through February 2026, but only five studies met inclusion criteria, and all were ex vivo studies using healthy equine colon specimens rather than live clinical cases. The review’s central takeaway is that no closure technique can currently be called clearly superior based on the published evidence, even though two-layer absorbable suture closure remains the standard recommendation in the broader literature. (beva.onlinelibrary.wiley.com)
Why it matters: For equine surgeons and referral teams, this review is less about changing practice tomorrow and more about clarifying how much of current technique selection still rests on tradition, surgeon preference, and ex vivo biomechanical endpoints such as closure time, luminal narrowing, and bursting pressure. Prior reviews and technique papers have described substantial variation across hand-sewn, reversed suture line, stapled, and barbed suture approaches, while also noting that consensus has not been established. That means veterinary professionals should read the new paper as a map of evidence gaps: there’s still little direct clinical data comparing complications such as leakage, adhesions, hemorrhage, or long-term outcomes across closure methods in actual horses. (beva.onlinelibrary.wiley.com)
What to watch: The next meaningful step will be prospective or multicenter clinical studies that compare closure techniques in live horses, not just cadaveric or ex vivo colon models. (beva.onlinelibrary.wiley.com)
Key facts
- Study type
- Scoping review
- Journal
- Veterinary Sciences
- Topic
- Pelvic flexure enterotomy closure in horses
- Records screened
- 22,146
- Studies included
- 5
- Study period
- January 1996 through February 2026
- Study model
- All included studies were ex vivo, using healthy equine colon specimens
- Main finding
- No closure technique could be called clearly superior based on the published evidence
- Common recommendation
- Two-layer absorbable suture closure remains the standard recommendation in the broader literature
A new scoping review is putting a sharper point on something many equine surgeons already suspected: pelvic flexure enterotomy is common in colic surgery, but the published evidence guiding exactly how to close it is still surprisingly limited. According to the review, published in Veterinary Sciences, just five studies qualified for inclusion out of 22,146 records screened from 1996 through February 2026, and every included paper was an ex vivo study on healthy equine colon tissue rather than a live-horse clinical trial. (beva.onlinelibrary.wiley.com)
That matters because pelvic flexure enterotomy sits at the center of a wide range of surgical scenarios in horses, including evacuation of large-colon contents during colic surgery and management of some obstructive lesions. A 2024 narrative review by the same lead author in Equine Veterinary Education described the procedure as commonly performed and noted that a two-layer closure with absorbable suture is generally recommended, but also emphasized that no true consensus has been established on the best technique. Broader equine surgical literature likewise continues to describe routine two-layer closure, especially when contamination control and secure apposition are priorities. (beva.onlinelibrary.wiley.com)
The available comparative studies have mostly focused on mechanical and procedural endpoints rather than patient-centered outcomes. Earlier work has compared traditional double-layer hand-sewn closure with stapled closure, finding that stapling can reduce closure time without a statistically significant difference in bursting strength in ex vivo tissue. Other studies compared one-layer, traditional two-layer, and reversed suture-line techniques, again focusing on variables such as surgical time, luminal diameter reduction, and bursting pressure. A separate ex vivo study evaluated barbed versus unbarbed sutures for caecal and pelvic flexure enterotomies, adding to the technical literature but not resolving the larger clinical question of which method performs best in living horses over time. (pmc.ncbi.nlm.nih.gov)
The industry and expert perspective, at least from the published literature, is cautious rather than disruptive. The 2024 review in Equine Veterinary Education concluded that many techniques have been described and tested, but that results vary within and between techniques. That framing suggests the new scoping review is not a practice-changing endorsement of one method over another, but a more formal confirmation that the comparative evidence is fragmented and low on clinical applicability. The absence of in vivo comparative trials is especially notable in a procedure where surgeons care not just about speed or bursting pressure, but about contamination, adhesion risk, hemostasis, postoperative ileus, dehiscence, and long-term survival. (beva.onlinelibrary.wiley.com)
For veterinary professionals, the real value of the new review is in how clearly it defines the evidence gap. Ex vivo models are useful for screening techniques, but they can’t fully capture what happens in anesthetized horses with compromised bowel, variable tissue quality, contamination, hemodynamic changes, and postoperative healing. Even studies that support faster closure with stapling or acceptable bursting pressures with alternative suture patterns don’t necessarily answer the questions clinicians and hospital teams face in practice: Which method minimizes complications, which is most forgiving under field or referral-hospital constraints, and which delivers the best outcomes for the horse and pet parent. (pmc.ncbi.nlm.nih.gov)
There’s also a reminder here that technical details still matter beyond simple closure strength. Published reports have flagged issues such as potential hemorrhage from enterotomy or anastomosis sites, the need to consider hemostatic effects of closure technique, and the importance of minimizing contamination and tissue handling. In that context, the review supports a familiar but important message: current technique selection is still being made in a zone where evidence, experience, and case-specific judgment overlap. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For equine surgery services, residency programs, and referral centers, this review is a useful benchmark for protocol discussions and research planning. It suggests that many surgeons are working from a literature base that is narrower than expected for such a common procedure. That could influence how teams discuss standard operating procedures, teach closure options to trainees, counsel pet parents about surgical risk, and prioritize future studies. It also underscores an opportunity for multicenter outcome tracking in colic surgery, where even relatively routine technical decisions may still lack strong comparative evidence. (beva.onlinelibrary.wiley.com)
What to watch: Watch for prospective clinical comparisons, retrospective multicenter datasets, or guideline-style reviews that move beyond ex vivo biomechanics and toward complication rates, survival, cost, and case selection in live horses. (beva.onlinelibrary.wiley.com)