Jejunocecostomy in horses-a review of its unique complexities

Jejunocecostomy (JC), or jejunocecal anastomosis, is arguably the most controversial surgical procedure in equine small intestinal surgery. It is also the only option for resection and anastomosis for a third of small intestinal strangulating lesions in horses. Critics of the procedure identify its low survival and high complication rates as reasons to avoid its use. This review is intended to highlight findings of recent research and clinical studies that validate use of the JC, and to provide some insights into technical aspects of the procedure that might improve its survival rates. Jejunocecostomy is more complicated than most anastomoses used in the equine small intestine, and a review of its complexities could help to improve outcomes with this anastomosis. The negative attitude towards its use is not supported by recent research and clinical studies. If the ileum has incurred ischemic changes that necessitate its being bypassed, JC is a valid treatment if owner- and disease-related issues support the cost of resection and anastomosis. Concerns about poor outcomes with JC can lead to an inappropriate anastomosis or euthanasia whenever this anastomosis is indicated. The different methods used for JC might influence its success rate, but all methods applied with recognition of potential pitfalls can have favorable outcomes.