BCSE Surgery

Colic Surgery, Arthroscopy, and Upper Airway Surgery – BCSE Study Guide

March 28, 2026 30 min read 24 views
Equine surgery represents a critical component of veterinary practice, with colic surgery, arthroscopy, and upper airway procedures being among the most commonly performed interventions.

Equine Surgery

Colic Surgery, Arthroscopy, and Upper Airway Surgery

BCSE Study Guide

Domain 6: Surgery | Species-Specific Procedures

Estimated Read Time: 35-40 minutes | January 2026

Parameter Medical Colic Surgical Colic
Heart Rate Less than 50 bpm or responsive to treatment Greater than 60 bpm, persistent or increasing
Pain Level Mild to moderate, responsive to analgesics Severe, uncontrollable, violent behavior
Nasogastric Reflux None or less than 2-4 liters Greater than 4 liters, continuous
Blood Lactate Less than 2 mmol/L Greater than 4 mmol/L, increasing
Peritoneal Fluid Clear, yellow, protein less than 2.5 g/dL Serosanguinous, elevated protein/lactate
Gut Sounds Present, may be decreased Absent or hypermotile (early obstruction)
Rectal Exam Normal or mild gas distension Distended bowel, tight bands, displacement

Overview and Clinical Importance

Equine surgery represents a critical component of veterinary practice, with colic surgery, arthroscopy, and upper airway procedures being among the most commonly performed interventions. Understanding these procedures is essential for the BCSE, as Domain 6 (Surgery) comprises 22-25 questions and frequently tests knowledge of species-specific surgical approaches. Equine colic is the leading cause of emergency surgery in horses, with approximately 4-10% of colic cases requiring surgical intervention. Arthroscopy has revolutionized equine orthopedic surgery, enabling minimally invasive treatment of joint pathology. Upper airway surgery addresses conditions that significantly impact performance in athletic horses.

High-YieldThe BCSE frequently tests the decision-making process for surgical vs. medical management of colic, indications for arthroscopy, and recognition of upper airway conditions. Know the key prognostic indicators and common surgical techniques!
Lesion Type Surgical Technique Survival Rate Key Points
Large Colon Volvulus Derotation or colectomy if greater than 360 degrees with necrosis 60-80% (early referral); 40-60% (delayed) Time-critical; 270 degrees or less often viable
Small Intestinal Strangulation (Lipoma) Resection and anastomosis (jejunojejunostomy or jejunoileostomy) 75-85% short-term; 70-80% long-term Common in older horses; pedunculated lipomas on mesentery
Epiploic Foramen Entrapment Gentle reduction; resection if devitalized 60-75% Small intestine herniates through foramen; early surgery critical
Nephrosplenic Entrapment Rolling under GA; surgical correction if unsuccessful; colopexy Greater than 90% Left dorsal displacement over nephrosplenic ligament
Right Dorsal Displacement Manual correction; pelvic flexure decompression 85-95% Large colon displaces between cecum and body wall
Enterolithiasis Enterotomy at pelvic flexure or right dorsal colon Greater than 90% Common in California, Southwest US; alkaline diet predisposes

Section 1: Equine Colic Surgery

Colic surgery remains one of the most challenging and rewarding aspects of equine practice. The ventral midline celiotomy is the gold standard approach, providing comprehensive access to the entire abdominal cavity. Success depends on rapid decision-making, proper technique, and excellent postoperative care.

Indications for Surgical Intervention

The decision to pursue surgical intervention depends on multiple clinical parameters. Understanding when to refer is crucial for optimal outcomes - early surgical intervention significantly improves survival rates.

MEMORY AID - "SHARP PAIN" for Surgical Colic Indicators: S - Severe, uncontrollable pain H - Heart rate greater than 60 bpm persistently A - Absent gut sounds R - Reflux (nasogastric reflux greater than 4L) P - Peritoneal fluid abnormalities P - Palpable abnormalities on rectal exam A - Acidosis (metabolic) I - Increasing lactate levels N - No response to analgesics

Medical vs. Surgical Colic Parameters

Surgical Approach: Ventral Midline Celiotomy

The ventral midline approach is the gold standard for equine colic surgery, providing optimal access to all abdominal organs. The procedure is performed under general anesthesia with the horse in dorsal recumbency.

MEMORY AID - "PRISE" for Colic Surgery Steps: P - Position (dorsal recumbency) and Preparation R - Retract ventral midline incision through linea alba I - Inspect systematically (cecum first, then small intestine, large colon) S - Surgical correction (decompression, reposition, resection as needed) E - Evacuate contamination, close in layers

Common Surgical Lesions and Techniques

Intestinal Anastomosis Techniques

When resection is required, proper anastomosis technique is critical for patient survival. The choice of technique depends on the intestinal segment involved and surgeon preference.

MEMORY AID - Anastomosis Types by Location: "JJ for Jejunum, JI for Ileum, JC for Cecum" • Jejunojejunostomy (JJ): Jejunum-to-jejunum - most common SI anastomosis • Jejunoileostomy (JI): Jejunum-to-ileum - when ileum is partially preserved • Jejunocecostomy (JC): Jejunum-to-cecum - when entire ileum is resected Remember: JC has the lowest survival rate of the three!

High-YieldResearch shows that short-term survival for horses undergoing small intestinal resection and anastomosis is approximately 84% to discharge. Jejunocecostomy is associated with lower survival rates compared to jejunojejunostomy. The single-layer continuous Lembert pattern is equally effective as the double-layer technique with similar complication rates.

Postoperative Complications

MEMORY AID - "POST-COLIC" for Complications: P - Postoperative ileus (POI) O - (O)edema at incision site S - Surgical site infection T - Thrombophlebitis C - Colic recurrence O - (O)bstruction (adhesions) L - Laminitis I - Incisional hernia C - (C)olitis/diarrhea

Technique Description Key Considerations
End-to-End (Hand-sewn) Single or double layer closure using absorbable suture (PDS, Vicryl). Continuous Lembert pattern most common. Transect at 60 degrees to maximize lumen diameter. Close mesenteric defect. 85-93% survival rate.
Side-to-Side (Stapled) GIA stapler creates functional end-to-end anastomosis. TA stapler closes blind ends. Faster technique. Reduces surgical field contamination. Similar survival to hand-sewn in experienced hands.
Jejunocecostomy Side-to-side anastomosis of jejunum to cecal base when ileum is completely resected. Higher complication rate. Bypasses ileocecal valve. Higher incidence of postoperative colic and repeat laparotomy.

Section 2: Equine Arthroscopy

Arthroscopy has revolutionized equine orthopedic surgery since its introduction in the 1970s. This minimally invasive technique allows direct visualization of intra-articular structures, diagnosis of joint pathology, and surgical treatment with reduced morbidity compared to open arthrotomy. The BCSE tests knowledge of indications, common joints treated, and expected outcomes.

Indications for Arthroscopic Surgery

MEMORY AID - "OCD FLIM" for Arthroscopy Indications: O - Osteochondritis dissecans (OCD) C - Chip fractures (osteochondral fragments) D - Debridement of cartilage lesions F - Fracture repair assistance (intra-articular) L - Lavage of septic joints I - Inspection and diagnosis M - Meniscal and soft tissue injuries (stifle)

Common Joint-Specific Approaches and Pathology

High-YieldResearch demonstrates that 89% of Thoroughbred racehorses returned to racing after arthroscopic removal of dorsoproximal P1 chip fractures, with 82% racing at the same or higher class. The fetlock joint is the most commonly treated joint arthroscopically in racehorses, followed by the carpus.

Essential Arthroscopy Equipment

MEMORY AID - "SCOPE IT" for Arthroscopy Equipment: S - Scope (arthroscope: 4mm standard, 2.7mm for small joints) C - Camera and video system O - (O)ptics (light source and cable) P - Pump for fluid distension E - Egress cannula I - Instruments (rongeurs, curettes, probes, motorized shaver) T - Triangulation technique for manipulation

Joint Common Pathology Positioning Prognosis
Fetlock (MCP/MTP) Dorsoproximal P1 chip fractures (most common), OCD of sagittal ridge, synovitis Dorsal recumbency Excellent: 82-89% return to racing at same or higher level
Carpus (Midcarpal and Radiocarpal) Carpal chip fractures (C3 most common), slab fractures, OCD Dorsal recumbency Good: 70-85% return to racing; chip removal better than large slab fractures
Stifle (Femoropatellar/Femorotibial) OCD of lateral trochlear ridge, meniscal tears, subchondral bone cysts, cruciate injuries Dorsal or lateral recumbency Variable: OCD excellent (greater than 85%), meniscal fair (50-70%)
Tarsus (Tarsocrural) OCD of distal tibia, talus, lateral and medial malleoli Dorsal recumbency Excellent for OCD: greater than 80% athletic soundness
Shoulder (Scapulohumeral) OCD of humeral head, bicipital bursitis, infraspinatus tendon injury Lateral recumbency Fair to good: depends on lesion chronicity and size

Section 3: Upper Airway Surgery

Upper respiratory tract disorders significantly impact performance in athletic horses. The most common conditions requiring surgical intervention include recurrent laryngeal neuropathy (RLN), dorsal displacement of the soft palate (DDSP), and arytenoid chondritis. Dynamic endoscopy during exercise has revolutionized diagnosis, revealing that many horses have multiple concurrent abnormalities.

Recurrent Laryngeal Neuropathy (Laryngeal Hemiplegia)

RLN is the most common upper airway condition in horses, with prevalence of 2.6-11% in light breeds and up to 38% in draft breeds. It results from degeneration of the recurrent laryngeal nerve, most commonly on the left side, causing paralysis of the cricoarytenoideus dorsalis muscle and subsequent collapse of the arytenoid cartilage during inspiration.

MEMORY AID - "LEFT ROAR" for RLN: L - Left side affected (95% of cases) E - Exercise intolerance F - "Flap" of arytenoid collapses on inspiration T - Taller horses predisposed (longer nerve) R - Recurrent laryngeal nerve degeneration O - "Open" arytenoid with laryngoplasty (Tie-back) A - Arytenoid paralysis R - "Roaring" sound on inspiration

Laryngeal Function Grading (Havemeyer System)

Surgical Treatments for RLN

Dorsal Displacement of the Soft Palate (DDSP)

DDSP occurs when the caudal border of the soft palate displaces dorsal to the epiglottis during exercise, obstructing the airway. It is characterized by a sudden onset of abnormal respiratory noise and exercise intolerance. The condition may be intermittent (iDDSP) or persistent (pDDSP).

MEMORY AID - "FLAP SOUND" for DDSP: F - Flutter of soft palate L - Loss of performance (sudden) A - Airway obstruction P - Palate displaces DORSAL to epiglottis S - "Swallowing" motion to replace it O - (O)nset is sudden during exercise U - Usually intermittent in racehorses N - Noise is gurgling/flapping expiratory D - Dynamic endoscopy required for diagnosis

Surgical Treatments for DDSP

High-YieldDynamic endoscopy has revealed that 48-59% of horses with poor performance post-laryngoplasty have collapse of structures OTHER than the arytenoid cartilage (vocal fold, aryepiglottic fold, soft palate). Always recommend dynamic endoscopy before repeat surgery for suspected laryngoplasty failure!

Arytenoid Chondritis

Arytenoid chondritis is an inflammatory/infectious condition of the arytenoid cartilage. It can occur as a primary condition or as a complication of laryngoplasty (1-9% incidence). Clinical signs include inspiratory noise, respiratory distress, and dysphagia. The affected cartilage appears enlarged with abnormal echogenicity on ultrasound.

MEMORY AID - "SWOLLEN ARY" for Arytenoid Chondritis: S - Swelling of arytenoid cartilage W - (W)heeze and stridor at rest O - Often post-laryngoplasty complication L - Luminal mass may be visible L - Long-term antibiotics often needed E - Enlarged on ultrasound N - (N)eeds arytenoidectomy if severe ARY - ARYtenoidectomy is definitive treatment

Grade Description Treatment
Grade I Synchronous full abduction and adduction of left and right arytenoid cartilages None (normal)
Grade II Asynchronous movement (hesitation, flutter) but full abduction achieved and maintained Usually none; monitor
Grade III Asynchronous movement; full abduction not achieved or not maintained Surgical if symptomatic
Grade IV Complete paralysis; no abduction of arytenoid cartilage Surgical
Procedure Description Outcomes and Complications
Prosthetic Laryngoplasty ("Tie-back") Suture placed from muscular process of arytenoid to cricoid cartilage to abduct arytenoid permanently. Usually combined with ventriculocordectomy. Most common procedure. 70-85% improvement. Complications: coughing (43%), aspiration, loss of abduction (2-15%), infection (0.5-6%), chondritis (1-9%).
Ventriculocordectomy (Vocal Fold Resection) Removal of laryngeal ventricle and vocal fold. Can be performed standing (laser) or under GA. Often combined with laryngoplasty. Reduces noise. As standalone: 50-60% success. Combined with laryngoplasty improves results significantly.
Partial Arytenoidectomy Removal of arytenoid cartilage (except muscular process) via laryngotomy. Reserved for failed laryngoplasty, chondritis, or as primary treatment in some practices. Can be performed standing. Complications: aryepiglottic fold collapse, granuloma formation. Modified technique aims to prevent fold collapse.
Laryngeal Reinnervation (Nerve-Muscle Pedicle) Implantation of nerve-muscle pedicle from omohyoideus or sternothyrohyoideus to reinnervate CAD muscle. Aims to restore active abduction. Experimental technique. Takes 6-12 months for effect. Combined with temporary laryngoplasty. Shows promise but limited long-term data.
Procedure Description Success Rate
Laryngeal Tie-Forward Sutures placed from thyroid cartilage to basihyoid bone to advance larynx rostrally, increasing tension on soft palate. 60-70% for iDDSP; best results in horses without other URT pathology
Staphylectomy (Soft Palate Resection) Laser resection of caudal margin of soft palate to shorten and stiffen it. 50-60% as standalone; often combined with tie-forward
Palate Cauterization/Thermal Palatoplasty Laser or electrocautery to induce scarring and stiffening of soft palate. Variable; minimally invasive option
Myectomy of Palatinus/Palatopharyngeus Muscles Transection of muscles to reduce active palate elevation. Variable; often combined with other procedures

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