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

In this episode of the Simini Equine Surgery Podcast, we explore the soft tissue research from the April 2026 issue (Issue 3) of Veterinary Surgery, where two studies emphasize that successful surgery extends well beyond the operating room. Together, they demonstrate how better postoperative interpretation and systematic quality improvement can dramatically improve patient outcomes. 

One study redefines how surgeons should interpret peritoneal fluid following exploratory laparotomy, while the second shows how simple protocol changes across an entire hospital can nearly eliminate surgical site infections after equine abdominal surgery.

In this episode:

✅ Granello et al. performed a prospective cohort study evaluating postoperative peritoneal fluid changes in 26 horses undergoing exploratory laparotomy for naturally occurring gastrointestinal disease. Serial abdominocentesis performed at 24, 72, and 168 hours demonstrated that although systemic lactate normalized within 24 hours, peritoneal lactate, total protein, and nucleated cell counts remained markedly elevated for up to seven days, regardless of whether the original lesion was strangulating or non-strangulating. These findings indicate that postoperative surgical manipulation itself produces a prolonged inflammatory response within the peritoneal cavity, making serial trends far more valuable than single measurements when deciding whether a horse requires repeat surgical intervention. 

✅ López-Cruz et al. evaluated the impact of a comprehensive hospital-wide quality improvement initiative after postoperative surgical site infection (SSI) rates following exploratory celiotomy unexpectedly increased to 29%. Using a structured root-cause analysis (fishbone diagram), the team identified multiple opportunities for process improvement, including separate personnel for sheath and abdominal preparation, two-step skin preparation with detergent followed by chlorhexidine, single-use clipper blades, standardized closure protocols, and application of medical-grade Manuka honey to the linea alba. Following implementation, SSI rates fell dramatically from 29% to just 2.3%, overall wound complications declined to 6.8%, and no horses required euthanasia because of postoperative surgical site complications. The study highlights how meticulous protocol refinement and team consistency can transform surgical outcomes without requiring expensive new technology. 

Together, these studies reinforce a powerful lesson in equine soft tissue surgery: excellent outcomes depend not only on performing surgery well, but also on interpreting recovery appropriately and continually improving every step of the perioperative process.

🎓 Journal Articles Discussed

• Granello et al. — Serial postoperative peritoneal fluid analyses in horses with naturally-occurring strangulating and non-strangulating gastrointestinal lesions
• López-Cruz et al. — Application of a framework to mitigate the risk of surgical site infection after exploratory celiotomy in horses: A retrospective study

📚 From the April 2026 Issue (Issue 3) of Veterinary Surgery

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Learn More:
www.simini.com

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Transcript

SPEAKER_01 0:04

Hi, I'm Carl Damiani, and this is the Simene 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 April 2026 issue of veterinary surgery, and we're focusing on two studies that aim to improve outcomes for horses undergoing abdominal surgery from postoperative monitoring to hospital-wide quality improvement. First, we'll look at a study by Granello et al. who followed horses after exploratory laparotomy to better understand how peritoneal fluid changes during the first week after surgery. Their findings challenge how we interpret postoperative lactate, protein, and cell counts, offering valuable guidance for clinicians managing horses with postoperative colic and deciding when repeat intervention may or may not be necessary. Then we'll review Lopez Cruz et al. who take a systems-based approach to one of the most frustrating complications in equine surgery, surgical site infection. After identifying a spike in infection rates, their team implemented a structured quality improvement protocol that dramatically reduced postoperative infections, demonstrating how process improvement and team culture can be just as important as surgical technique itself. Two studies. One common theme, improving patient outcomes, doesn't stop when the surgery ends. It depends on better postoperative monitoring, smarter clinical decision making, and continually refining the systems that support surgical care. Let's dive in.

Granello et al. Study: Evaluating Peritoneal Fluid Changes During the First Week After Exploratory Laparotomy in Horses

SPEAKER_02 2:02

If you tap a horse's abdomen, like 24 hours after a perfectly successful colic surgery, the fluid will often tell you the horse is dying.

SPEAKER_00 2:11

Yeah, but it's completely lying to you.

SPEAKER_02 2:13

Right, exactly. So welcome to the deep dive. Our mission today is extracting purely actionable surgical intelligence you can use tomorrow in the OR.

SPEAKER_00 2:22

Aaron Powell And the clinical headache we are looking at today is, you know, your patient is recovering from an exploratory laparotomy and they're showing signs of post-op pain.

SPEAKER_02 2:32

Aaron Ross Powell So naturally you do an abdominocentesis. But how do you actually interpret that fluid when the peritoneal cavity was literally just surgically traumatized?

SPEAKER_00 2:41

Aaron Powell To answer that, we're looking at a prospective cohort study by Granello et al. 2026. They monitored peritoneal fluid in 26 horses following laparotomies for naturally occurring GI lesions.

SPEAKER_02 2:52

Aaron Ross Powell And they were taking serial taps at 24, 72, and uh 168 hours post-op.

SPEAKER_00 2:59

Right. Exactly. Their goal was basically figuring out what normal actually looks like after

Postoperative Peritoneal Biomarkers: Revealing that while systemic lactate normalizes within 24 hours, peritoneal lactate, total protein, and nucleated cell counts remain significantly elevated above baseline for a full seven days post-surgery.

SPEAKER_00 3:03

we've you know been in there handling the gut.

SPEAKER_02 3:04

Aaron Ross Powell Which makes sense because pre-op, I mean, we rely heavily on high high peritoneal lactate and total protein as massive red flags for ischemia or like a strangulating lesion.

SPEAKER_00 3:15

Oh, absolutely. They're the classic alarm bells.

SPEAKER_02 3:17

Right. So if I pull fluid post-op and those numbers are just through the roof, instinct says to rush them back into surgery immediately. Are we saying we should just ignore that instinct?

SPEAKER_00 3:27

Aaron Ross Powell Well, yes, because that instinct is based on pre-op baselines, which are just completely irrelevant here. Granello et al.

SPEAKER_02 3:38

Wait, irrelevant? How so?

SPEAKER_00 3:39

So while systemic lactate normalizes within 24 hours, the peritoneal lactate and total protein remain significantly above normal reference ranges for the entire seven-day study period.

SPEAKER_02 3:49

Oh, an entire week.

SPEAKER_00 3:50

Yeah, full week. And total nucleated cell count, that also spiked really aggressively at 24 hours. And this happened regardless of whether the initial lesion was strangulating or non-strangulating.

SPEAKER_02 4:00

Okay, but biologically speaking, why does the local lactate stay so high if the

The Hypoxia and Glycolysis Cascade: Explaining how physical surgical manipulation creates localized tissue hypoxia, triggering a massive neutrophil influx that relies on anaerobic glycolysis and continuously generates local lactate.

SPEAKER_02 4:05

gut is pink and healthy? I mean, is it just residual from the initial lesion?

SPEAKER_00 4:08

Aaron Powell Not exactly. It's actually the surgical manipulation itself. The physical trauma of the procedure causes localized tissue hypoxia.

SPEAKER_02 4:17

Ah, and that triggers a massive inflammatory cascade.

SPEAKER_00 4:20

Aaron Powell Exactly. You get this flood of neutrophils into the peritoneal space. And those neutrophils rely on anaerobic glycolysis to function, which continually produces local lactate.

SPEAKER_02 4:30

Okay, so the environment is fundamentally altered by the surgery itself, basically generating its own inflammatory markers. Precisely. So using pre-op baselines post-op is essentially like trying to measure a room's ambient temperature while a space heater is actively blowing directly on the thermometer.

SPEAKER_00 4:48

That is a perfect way to put it, yeah. The surgical trauma is the heater and it's entirely skewing the local environment.

SPEAKER_02 4:54

So the baseline is entirely shifted then. What does this actually change for your practice on a Tuesday morning?

SPEAKER_00 4:59

Well, you have to completely abandon static pre-op reference values during post-op recovery. One

Serial Trending Over Static Baselines: Mandating a clinical shift away from pre-op reference values to track serial fluid trends over time, preventing false-positive panic over single high-lactate post-op snapshots.

SPEAKER_00 5:05

high lactate reading doesn't mean you have a necrotic bowel.

SPEAKER_02 5:08

Right, because it's the trend that matters.

SPEAKER_00 5:10

Exactly. You have to track serial measurements to see if that lactate is actively trending upward over time rather than just looking at a single snapshot.

SPEAKER_02 5:18

That completely changes the diagnostic approach. Yeah. I mean, we basically have to accept that we cannot stop that post-op peritoneal inflammation.

SPEAKER_00 5:25

No, you really can't. It's a guaranteed physiological response to the trauma.

SPEAKER_02 5:29

But that brings up a broader surgical philosophy. If we can't control the systemic inflammatory response inside a massive cavity like the abdomen, we have to be absolutely ruthless about controlling the environments we actually can't dictate.

SPEAKER_00 5:43

I completely agree. Especially when we step outside the abdomen into other procedures, like, say, orthopedic closures.

SPEAKER_02 5:50

Right, because the standard of care there is often just saline for interopering.

SPEAKER_00 5:54

Yeah, but independent head-to-head studies show that saline leaves 42% of bacteria

Simini Protect Lavage Study: Contrasting standard saline's 42% bacterial remainder with a 60-second surfactant alternative that achieves complete pathogen clearance for orthopedic closures.

SPEAKER_00 5:59

behind in those surgical sites, which is huge.

SPEAKER_02 6:02

42%. When you're dealing with orthopedic hardware or delicate tissue planes, that is a massive blind spot.

SPEAKER_00 6:09

It really is. Leaving nearly half the bacterial load in a compromise site is just inviting a post-op nightmare.

SPEAKER_02 6:14

Which is exactly why protocols are shifting towards solutions like Semony Protect Livage.

SPEAKER_00 6:19

Right. Because in those same head-to-head studies, Semony left zero percent of bacteria behind.

SPEAKER_02 6:24

The mechanism there is exactly what we need. I mean, it's a non-antibiotic lavage used right before suturing. It doesn't disrupt your established surgical protocol.

SPEAKER_00 6:34

No, it just simply reinforces it by clearing out the resistant bacteria and biofilms that saline physically cannot wash away.

SPEAKER_02 6:41

And obviously, as clinical guidelines state, we don't use it in soft tissue body cavities like the abdomen or thorax, but for orthopedic closures, guaranteeing that sterile environment is absolutely critical.

SPEAKER_00 6:52

It's all about eliminating doubt where we actually have the power to do so.

SPEAKER_02 6:56

Which brings us to the final takeaway for today.

SPEAKER_00 6:59

Right. The main thing to remember is that surgical intervention fundamentally alters the peritoneal environment for over a week. Always rely on serial fluid trends, not static pre-op baselines when evaluating a post op colic case.

SPEAKER_02 7:12

And I want you to think about the broader implications here. If surgical trauma disrupts our standard diagnostic baselines for well over a week in the abdomen, how might that lingering invisible inflammation be silently altering other systemic recovery markers we haven't even thought to measure yet?

SPEAKER_01 7:33

Here's what we found in the next paper.

López-Cruz et al. Study: A Systems-Based Quality Improvement Protocol to Reduce Postoperative Surgical Site Infections (SSI).

SPEAKER_00 7:40

Imagine, uh, you're an equine veterinary surgeon, right? You are doing everything completely by the book, but suddenly your colic surgery post-op infection rates just well, they quadruple out of nowhere.

SPEAKER_02 7:53

Yeah, that is a total nightmare scenario for any surgeon.

SPEAKER_00 7:56

Right. Because usually when a horse presents with a surgical abdomen, you do a systematic diagnostic workup to find the lesion. But today, our mission for this deep dive is extracting actionable surgical intelligence from a scenario where surgeons had to basically turn that diagnostic lens away from the patient and, you know, point it directly at themselves.

SPEAKER_02 8:15

Aaron Ross Powell Exactly. We are looking at a recent paper, uh Lopez Cruz et al. 2026. It's a retrospective review of 448 horses where the surgical team essentially had to diagnose their own hospital's operating room protocols.

SPEAKER_00 8:28

Aaron Powell 448 horses. I mean, that's a massive sample. And the clinical context here is just stark, isn't it?

SPEAKER_02 8:35

Oh, absolutely stark. Back in 2020, this hospital's surgical site infection rate, their SSI, it just spiked to an alarming 29% following exploratory psiliotomies.

SPEAKER_00 8:44

Wow, 29%.

SPEAKER_02 8:46

Yeah, nearly one in three. And these weren't just like minor incisional swellings. We are talking about severe life-threatening complications, stuff like peritonitis and herniation. Trevor Burrus, Jr.

SPEAKER_00 8:56

So to figure out why the team audited their entire process using a wait, what do they call it? A fishbone diagram.

SPEAKER_02 9:04

Right, a fishbone

The Fishbone Diagram Audit: Tracking a retrospective review of 448 horses where the clinical team diagnosed their own OR protocols to address a sudden 29% SSI spike following exploratory celiotomies.

SPEAKER_02 9:05

diagram. It's this visual tool that maps out every potential root cause of a problem across different categories. Right. So you look at equipment, personnel, methods. It essentially forces you to look at how all your daily habits intersect.

SPEAKER_00 9:18

See, when a hospital's infection rate suddenly hits 29%, my first instinct is, well, it's got to be a massive environmental failure. Like I'd be looking for a compromised HVAC system pumping spores into the OR or something. I mean, did they have to completely rebuild the surgical suite to fix this?

SPEAKER_02 9:35

No, actually, that's the amazing part. The solutions they found were entirely procedural, very low cost, and uh highly actionable for you to use in the OR tomorrow.

SPEAKER_00 9:44

Wait, really? Just procedural.

SPEAKER_02 9:46

Yeah. The fishbone diagram forced them to break down routines they usually just ignored. For instance, by mapping out personnel flow, they realized the exact same person prepping the heavily contaminated sheath was often turning right around and while prepping the abdomen. Oh, wow. Right. So the fix was immediate. They assigned different personnel to scrub the sheath versus the abdomen to just completely eliminate that cross-contamination pathway.

SPEAKER_00 10:12

Aaron Ross Powell That makes so much sense. And they also found that standard chlorexine wasn't cutting through the organic debris on the skin, right?

SPEAKER_02 10:18

Exactly. So they implemented a two-step dirty scrub.

SPEAKER_00 10:21

Using like basic off-the-shelf detergent soap first.

SPEAKER_02 10:24

Yeah, just to degrease the area before the actual surgical scrub. Such a simple change.

SPEAKER_00 10:29

I also saw they mandated a brand new clipper blade for every single patient, which, you know, makes perfect sense from a pathology standpoint.

SPEAKER_02 10:37

Oh, for sure. Dull reused blades cause these microscopic epidermal tears. Aaron Powell Right.

SPEAKER_00 10:42

And that microtrauma acts as tiny pockets where bacteria can just hide from the surgical prep. Then they seed an infection after closure.

SPEAKER_02 10:49

Exactly. And speaking of closure, they also changed their closure protocol itself. Before skin closure, they began applying medical-grade manuka honey directly to the linea alba instead of a traditional topical antibiotic like amicasin.

Manuka Honey Closure Mechanics: Replacing topical amikacin with medical-grade Manuka honey directly on the linea alba to combat multidrug-resistant E. coli and Enterobacter through high osmotic pressure, low pH, and enzymatic hydrogen peroxide generation.

SPEAKER_00 11:04

Okay, here's where it gets really interesting for antimicrobial stewardship because the study's cultures isolated multidrug resistant E. coli and enterobacter.

SPEAKER_02 11:12

Yeah, some really nasty superbugs.

SPEAKER_00 11:14

But manuka honey doesn't rely on targeting specific bacterial proteins the way amicosin does, which is, you know, how bacteria build resistance in the first place.

SPEAKER_02 11:23

Right. It kills pathogens through sheer physical and chemical forces.

SPEAKER_00 11:26

Exactly. The high osmotic pressure dehydrates the bacteria, the low pH creates a hostile environment. And there's an enzyme in the honey that continuously generates hydrogen peroxide.

SPEAKER_02 11:36

It's brilliant. It gives you broad spectrum effects without breeding more superbugs. And the clinical punchline of combining that honey with the new scrub and clipping

Plunging SSI Rates: Documenting the massive clinical success of the new protocols, plummeting the SSI rate to just 2.3% and reducing SSI-related euthanasias to absolute zero.

SPEAKER_02 11:44

protocols is just phenomenal.

SPEAKER_00 11:45

Aaron Powell What were the final numbers?

SPEAKER_02 11:47

Well, after implementation, that 29% SSI rate plummeted to just 2.3% by 2024.

SPEAKER_00 11:55

Down to 2.3%. That's incredible.

SPEAKER_02 11:57

Yeah, and total surgical site complications dropped to 6.8%. But most importantly, once the new protocol was enforced, zero horses required euthanasia due to surgical site complications.

SPEAKER_00 12:10

Zero. Wow. So I mean, what does this all mean for the surgeon listening right now?

SPEAKER_02 12:15

Well, the real take-home message is that consistent, simple protocol adjustments drastically improve patient survival. Implementing a rigorous two-step scrub, enforcing single-use clipper blades, and dedicating specific staff to sheath prep it dramatically reduces post-op infections.

SPEAKER_00 12:32

And you don't need massive ICU resources or hospital board budget approvals to pull this off.

SPEAKER_02 12:37

Exactly. It's entirely in your control.

SPEAKER_00 12:39

It all comes back to being willing to look critically at your own routine. So think about it. If a simple, honest group audit can drop surgical site infections from nearly 30% down to 2%, what hidden procedural blind spots might be quietly affecting outcomes in your own hospital's OR right now?

SPEAKER_01 13:00

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.