Complications and outcomes of standing flank versus ventral midline laparotomy for equine nephrosplenic entrapment

Summary Background Nephrosplenic entrapment (NSE) is a common surgical colic in horses. Ventral midline laparotomy (VML) under general anaesthesia (GA) is the standard approach, whereas standing flank laparotomy (SFL) is an alternative approach for surgical correction. However, direct comparisons between these approaches are lacking. Objective To compare outcomes and complications between VML and SFL for the surgical correction of NSE. Study Design Retrospective case series. Methods Medical records of horses surgically treated for NSE from 2015 to 2025 were reviewed. Data included clinical presentation, surgical technique, perioperative complications, short‐ and long‐term outcomes (≥12 months), duration of hospitalisation and return to previous activity, obtained via telephone follow‐up. Statistical comparisons used nonparametric permutation tests. Results Eighty procedures in 75 horses were performed (56 VML, 24 SFL). All but one horse survived to discharge among the VML group and all SFL horses survived to discharge. No significant differences were found in perioperative complication rates or hospitalisation time. Short‐term complications were more frequent in the SFL group ( p = 0.03). Conversely, long‐term complications, specifically recurrent colic, were significantly more common in the VML group ( p = 0.01). There were two cases in the SFL group (8.3%) that required subsequent VML within 24 h to address concurrent colonic impactions. Return to previous activity was achieved in 83.7% of VML and 100% of SFL horses ( p = 0.09). Main Limitations Retrospective design, small sample size for SFL and owner‐based follow‐up information. Conclusions SFL is a viable alternative to VML for the correction of uncomplicated NSE and may allow for simultaneous nephrosplenic space ablation without the risks of GA. While SFL carries a higher risk of short‐term wound‐related complications, it may offer superior long‐term outcomes regarding colic recurrence compared to VML. Careful case selection is essential to exclude concurrent gastrointestinal pathology that would require a midline approach.