Veterinary Surgery Deep Dive: Equine Soft Tissue — February 2026 Edition

In this episode of the Simini Equine Surgery Podcast, we explore the soft tissue research from the February 2026 issue (Issue 2) of Veterinary Surgery, where two studies demonstrate how thoughtful surgical decision-making can improve both immediate postoperative outcomes and long-term quality of life. 

One study introduces a modified stapled jejunostomy technique designed to eliminate a common mechanical weakness of traditional intestinal anastomoses, while the second provides reassuring evidence that life-saving surgery for large colon volvulus does not have to end a Thoroughbred broodmare's reproductive career.

In this episode:

✅ Freeman et al. introduced a modified stapled (MS) jejunostomy technique that creates a wide, triangular stapled stoma while eliminating the traditional oversewn blind jejunal end. Unlike conventional side-to-side stapled anastomoses, which leave a blind pouch that may serve as a lead point for impaction or intussusception, the modified technique creates a more direct flow path using a single application of a GIA-100 stapler. In an experimental study of six healthy horses, the authors demonstrated that operative time and final stoma size were comparable to traditional methods while removing an important structural risk factor. The resulting spatulated geometry may also compensate for localized loss of circular muscle fibers by improving passive intestinal flow through the anastomosis. 

✅ Knudsen et al. performed a 17-year retrospective study evaluating reproductive outcomes in 29 Thoroughbred broodmares following either large colon resection (LCR) or colopexy for recurrent large colon volvulus. Despite the greater surgical complexity of LCR, mares undergoing resection achieved a 60.5% live foal rate per mare served, while the colopexy group achieved 68.2%—both comparable to the national Thoroughbred breeding average of 64.3%. Although fewer LCR mares produced foals during the first breeding season after surgery, this appeared to reflect postoperative recovery and missed breeding opportunities rather than permanent reductions in fertility. The findings support selecting the surgical procedure based entirely on tissue viability and anatomical considerations without compromising long-term reproductive expectations. 

Together, these studies reinforce an important principle of equine soft tissue surgery: small technical refinements during surgery and evidence-based decision-making afterward can profoundly influence both surgical success and the patient's long-term quality of life.

🎓 Journal Articles Discussed

• Freeman et al. — Modified stapled jejunocecostomy in horses
• Knudsen et al. — Reproductive success in Thoroughbred broodmares post large colon resection or colopexy

📚 From the February 2026 Issue (Issue 2) of Veterinary Surgery

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Transcript

SPEAKER_01 0:04

Hey, I'm Carl Damiani, and this is the Simony Equine Surgery Podcast, your fast focused update on what matters most from the latest equine surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into practical surgical insight you can use. Today, not someday. This episode covers the soft tissue section from the February 2026 issue of veterinary surgery, and we're focusing on two studies that examine how surgical technique can improve both immediate outcomes and long-term quality of life in equine patients. First, we'll look at a study by Freeman et al. Introducing a modified stapled jejuno psychostomy technique designed to simplify surgery while creating a wider, triangular stoma that may improve intestinal flow and reduce the risk of postoperative complications. The authors compare this new approach with traditional techniques and explore how a small technical change could make a meaningful difference in small intestinal surgery. Then we'll review Newzen et al. who tackle a question that's especially important for breeders and surgeons alike. What happens after recovery? Their retrospective study compares reproductive success in thoroughbred brood mares following large colon resection or colopexy, and provides reassuring evidence that both procedures can preserve future breeding performance without compromising long-term reproductive outcomes. Two studies. One important theme, advancing equine soft tissue surgery, not only by improving surgical techniques, but by maximizing long-term patient outcomes and quality of life. Let's dive

Freeman et al. Study: Evaluating a Modified Stapled (MS) Jejunostomy Technique in Horses.

SPEAKER_01 1:54

in.

SPEAKER_00 1:54

In surgery, a blind spot isn't just uh a lack of visibility. I mean, sometimes it's a physical liability you intentionally leave behind in the patient simply because, well, that's how the textbook says to do it. Welcome to today's deep dive.

SPEAKER_03 2:09

Yeah, right. It's the accepted mechanical risk of a standard protocol. We get so used to the routine that we, you know, we just stop seeing the danger right in front of us.

SPEAKER_00 2:18

Exactly. And our mission today is delivering actionable surgical intelligence straight to the OR, focusing on technique and clinical impact. So today's single source is Freeman et al. 2026 on equine jejinosychostomy. Okay, let's unpack this. What real-world clinical challenge does this paper actually address?

SPEAKER_03 2:37

Aaron Ross Powell Well, if you're dealing with small intestinal strangulation in horses, you know the standard side-to-side scapel

Eliminating the Oversewn Blind End: Exploring how the MS approach completely eliminates the traditional jejunal blind end to bypass postoperative intussusception or impaction lead points.

SPEAKER_03 2:43

drill, but the traditional side-to-side stapled anastomosis, uh, it inherently leaves an oversown jejinal blind end.

SPEAKER_00 2:50

Aaron Powell And that blind end is basically a ticking clock, right?

SPEAKER_03 2:52

Aaron Ross Powell Exactly. It can physically protrude right into the anastomosis. So it acts as a very dangerous lead point for like an intenoception or an impaction.

SPEAKER_00 3:00

It's basically a dead-end street where things can just get stuck. Well, wait, I have a pushback here. Standard protocol exists for a reason. If we're dealing with a high-stakes strangulation, doesn't completely changing the established technique add, you know, unnecessary time and complexity to the surgery?

SPEAKER_03 3:16

You'd really think so. But what's fascinating here is that it actually doesn't. They ran an in vivo experimental study testing a modified stapled or MS method on six healthy horses and compared it directly to historical controls.

SPEAKER_00 3:31

Wow, okay. And what did the data show?

SPEAKER_03 3:33

The time to complete the MS

Operational and Stoma Metrics: Reviewing in vivo data showing that the MS anastomosis matches historical controls in execution time and stoma size.

SPEAKER_03 3:35

anastomosis and the resulting lumen size at necropsy, well, they were statistically similar to the historical controls.

SPEAKER_00 3:41

Okay, so you aren't losing time and you aren't sacrificing stoma size. Here's where it gets really interesting, though. The MS method completely eliminates the need for that dangerous oversown blind end.

SPEAKER_03 3:53

Yeah, structurally it makes so much more sense. Instead of two parallel roads merging with a dead end, you're forming a T intersection.

SPEAKER_00 3:59

Right, because the surgeon inserts the GIA 100 stapler straight through the open jejunum and into a perpendicular secal incision, which, you know, it creates a wide triangulated stoma.

SPEAKER_03 4:11

Exactly. And we really need to look at the mechanics of why that triangulated spatulated shape is so critical. Anytime you use a stapler in this area, you are transecting circular muscle fibers.

SPEAKER_00 4:22

Hold on. If we are cutting those circular fibers, aren't we just killing the peristalsis in that exact area? How is that an upgrade if the gut can't actively push anything through?

SPEAKER_03 4:32

That is the absolute brilliance of the MS method because it creates a wider spatulated profile. It acts almost like a funnel.

SPEAKER_00 4:40

Oh, I see. So it just flows through naturally.

SPEAKER_03 4:42

Right. Even with that localized loss of peristalsis, gravity and the pressure from the active bowel behind it can easily push contents through that wide opening. It mechanically compensates for the dead muscle fibers.

SPEAKER_00 4:54

That makes total sense. You're bypassing the need for local muscle contractions just by changing the geometry of the plumbing. Plus, you only have to apply the stapler once, right?

SPEAKER_03 5:04

Yes, just a single application. Which simplifies the whole procedure and minimizes hardware costs.

SPEAKER_00 5:10

So what does this all mean for you listening? It means you can upgrade a standard protocol to

Simini Protect Lavage Study: Overcoming the 42% bacterial remainder left by standard saline with a 60-second surfactant wash to completely eliminate microscopic risks before closure.

SPEAKER_00 5:15

remove an aeromical risk factor completely without disrupting your workflow.

SPEAKER_03 5:19

And if we connect this to the bigger picture, improving surgical outcomes is really all about reinforcing existing protocols by removing hidden risks. You're eliminating a macroscopic blind spot here.

SPEAKER_00 5:31

Which definitely makes you wonder about the microscopic blind spots we're leaving behind.

SPEAKER_03 5:35

It's exactly the same principle. I mean, we blindly trust standard saline lavages, but head-to-head studies show they actually leave 42% of bacteria behind at closure. That is a massive invisible liability.

SPEAKER_00 5:48

Yeah, 42% is huge.

SPEAKER_03 5:49

Right, but by switching to something like the non-antibiotic Semity Protect Lavage,

Knudsen et al. Study: Retrospective Comparison of Long-Term Reproductive Success in Broodmares Following Large Colon Resection (LCR) vs. Colopexy.

SPEAKER_03 5:53

that number drops to 0%. It removes biofilms and resistant bacteria in under 60 seconds, slotting perfectly into your existing routine, just like the MS stapling method.

SPEAKER_00 6:03

It's all about upgrading your protocol to eliminate the risks we used to just accept. So to wrap up, Freeman et al. 2026 shows us that the MS technique for Gigino psychostomy is a streamlined single stapler alternative that completely removes the structural blind end to facilitate much better GI flow. As always, you can find the full article linked for you in the show notes.

SPEAKER_03 6:24

And this raises an important question to leave you with. If veterinary surgeons are actively innovating to eliminate a mechanical blind spot like a genital blind end, how many other routine steps, like blindly trusting a saline rinse, are leaving invisible microscopic risks behind in your patients?

SPEAKER_02 6:44

Continuing with the next published study.

SPEAKER_00 6:51

You know, picture this. You're standing in the OR. The postpartum thoroughbred on the table has recurrent large colon volvulus. You have to save her life right now, but like you're also playing chess.

SPEAKER_03 7:03

Right. You're hyper focused on the immediate emergency, but you also have to think three moves ahead to her future breeding career.

SPEAKER_00 7:09

Exactly. Because if she's already survived a first episode, well, we know that recurrence rate can hit an 80% wall after a second one.

SPEAKER_03 7:16

Yeah, 80% is massive. So you absolutely need a preventative strategy.

SPEAKER_00 7:20

Aaron Powell Right. And that leaves you choosing between two very different paths. You can do a colapsi or uh take the leap to a large colon resection. But the question is, does picking the LCR compromise that future?

SPEAKER_03 7:32

Aaron Powell Well, that's been the eternal debate in the field. Because opting for the LCR is, I mean, it's undeniably more invasive, right?

SPEAKER_00 7:40

Sure, for sure.

SPEAKER_03 7:41

But this retrospective study we're looking at today, not in et al. 2026, it finally gives us the hard data to settle that debate.

SPEAKER_00 7:48

Okay, but let's look at the reality on the ground here. As surgeons, we know LCR is kind of the nuclear option. I mean, we're generally only doing it when we open her up, and that colon is already severely

Long-Term Equivalence: Analyzing a 29-mare, 17-year study to demonstrate zero statistical difference in long-term reproductive performance between the two procedures.

SPEAKER_00 7:59

compromised, right?

SPEAKER_03 8:00

Exactly.

SPEAKER_00 8:00

So intuitively, wouldn't we just assume the LCR group is going to have terrible long-term reproductive outcomes compared to just a simple colapexy?

SPEAKER_03 8:09

You would think so, but that's exactly the assumption this study just completely dismantles.

SPEAKER_00 8:14

Wait, really?

SPEAKER_03 8:15

Yeah. Nutzen et al. 2026 tracked 29 thoroughbred brood mares over a 17-year period. Aaron Powell Okay.

SPEAKER_00 8:22

So a pretty solid time frame.

SPEAKER_03 8:24

Right. They looked at 19 who had an LCR and 10 who underwent a colopexy. And the absolute main takeaway here is that there is zero statistical difference in long-term reproductive success between the two techniques.

SPEAKER_00 8:37

Aaron Powell Wait, literally zero difference? How does the mare's body just bounce back from losing a massive portion of her digestive tract and then go right back to carrying a full?

Systemic Health Rebound and Adaptation: Removing necrotic bowel to shut down chronic endotoxemia and inflammation cascades, enabling intestinal adaptation and metabolic stabilization.

SPEAKER_03 8:46

Well, you have to look at the systemic picture. When you perform an LCR, yes, you are removing a massive amount of tissue. But you know, you're also removing the primary source of endotoxemia and chronic inflammation. Once that necrotic tissue is gone, the systemic inflammatory cascade just shuts down.

SPEAKER_00 9:03

Ah. Okay. So the metabolic health stabilizes.

SPEAKER_03 9:06

Aaron Ross Powell Exactly. And structurally, the remaining bowel adapts remarkably well. As long as her systemic health rebounds, her reproductive axis doesn't inherently, you know, know or care that she's missing part of her colon.

SPEAKER_00 9:19

Aaron Powell That actually makes a lot of sense. The reproductive system is looking for overall metabolic stability, not like a complete colon. But how do the actual numbers play out?

SPEAKER_03 9:28

So for the LCR group, the live full per mayor served rate was

Tracking Industry Averages: Comparing LCR's 60.5% live foal rate and colopexy's 68.2% rate to confirm alignment with the 64.3% Australian national baseline.

SPEAKER_03 9:32

60.5%.

SPEAKER_00 9:33

Okay.

SPEAKER_03 9:33

And for the colapsi group, it was 68.2%. To put that in perspective, the Racing Australia national average is 64.3%.

SPEAKER_00 9:41

Oh wow. So both groups are operating right in line with the industry baseline.

SPEAKER_03 9:44

Yeah, exactly.

SPEAKER_00 9:45

That is incredible given what these mayors have been through. But um looking closely at the LCR timeline, I do see a pretty glaring drop-off.

SPEAKER_03 9:53

Oh, you mean the first season?

SPEAKER_00 9:54

Yeah. In the very first breeding season post-surgery, only five out of the 17 live LCR mares actually produced a full.

First-Season Management Constraints: Dissecting the first-year breeding dip where strict two-month pelleted diet transitions and recovery timelines simply shift mares outside their optimal seasonal calendar window.

SPEAKER_00 10:03

That's a huge hit right out of the gate. Does the trauma of the LCR temporarily shut down their fertility?

SPEAKER_03 10:09

Not biologically, no. When the researchers corrected the data, that initial dip wasn't statistically significant. Oh, really? Yeah, but it highlights a really crucial management reality that you need to communicate to owners. Think about the post-op protocol. An LTR requires a much longer, more intensive healing process.

SPEAKER_00 10:28

Aaron Powell Right, the strict two-month transition to a pelleted diet.

SPEAKER_03 10:32

Exactly. So it's a timing issue. The mayor's body is putting all its energy into healing the anastomosis and adapting to the new GI reality.

SPEAKER_00 10:39

Ah, so it's a calendar problem, not a biological one.

SPEAKER_03 10:42

Right. By the time they've healed and transitioned diets and regained body condition, they've just completely missed that strict optimal breeding window for the year.

SPEAKER_00 10:50

So owners need to understand that the first year might be a wash, but uh her lifetime breeding career is still entirely viable.

SPEAKER_03 10:56

100%.

SPEAKER_00 10:57

So bringing this all the way back to the surgical suite tomorrow, you have a mare on the table with a compromised colon. What changes for you?

SPEAKER_03 11:04

Aaron Ross Powell Your intraoperative decisions must be dictated entirely by anatomical factors and tissue viability, period.

SPEAKER_00 11:11

Right.

SPEAKER_03 11:12

If the colon needs to come out, you take it out. You should never, you know, shy away from an LCR out of fear that you're ruining her reproductive prognosis.

SPEAKER_00 11:21

Aaron Powell Secure the anatomy first and the systemic recovery will follow.

SPEAKER_03 11:25

Exactly.

SPEAKER_00 11:26

And you know, since the data also notes that younger mares with prior foaling success recover their breeding careers best, it leaves us with a really interesting clinical challenge.

SPEAKER_03 11:35

Oh, for sure.

SPEAKER_00 11:36

Next time you're doing your pre-op workup, how might you integrate a mare's complete reproductive history into your real-time risk assessment before you even make the first incision?

SPEAKER_03 11:45

That's a great question to think about.

SPEAKER_00 11:47

Definitely something to consider. Well, that wraps up this deep dive. The full article for Nudson et al. 2026 is linked in the show notes.

SPEAKER_02 11:59

That's it for this episode of the Semini Surgery Podcast. This show is brought to you by Semini Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. Thanks for listening, and we'll see you in the next episode.