Colic Surgery: Yes or No?

Is your horse a candidate for colic surgery? These five factors can help you decide.

Your gelding started acting a little bit uncomfortable just over an hour ago. By the time your vet arrived, the poor horse was in a full-blown sweat, pawing violently and throwing himself down in the barn aisle no matter how hard you tried to keep him on his feet. Even after IV sedation and a dose of pain medication, he was still uncomfortable. The look on your vet’s face told you everything you needed to know. Her next question confirmed your greatest fear. “Is he a candidate for colic surgery?”


There’s nothing more stressful than a severely colicky horse. And if your horse needs surgery to correct his colic, there’s no other option that’ll save his life. To make things even scarier, time can make the difference between a successful outcome and disaster. When your vet asks you whether your horse is a candidate for colic surgery, she needs an answer, and she needs it now. That’s why it’s best to know that answer before colic ever strikes.

In this article, I’m going to help you determine whether you’d say yes if your horse needed colic surgery. I’ll start by outlining basic facts about the procedure and what you can expect. Then, I’ll explain what things your vet might do differently for a colicky horse where surgery would be the choice, compared to what she’d do if it were not an option. Finally, I’ll outline five factors to consider when making that decision for your own horse.

Mild to moderate colic episodes are commonly due to gas pain or feed blocking a portion of the intestines, and many can be managed medically. jackienix/

First, the Facts

You may have heard all kinds of different things about colic surgery—ranging from the stories of the horses that needed surgery but got better with essential oils, to terrifying tales of those that suffered through a terrible recovery only to colic again. Here are some basic facts you’ll need to understand when making your decision.

When surgery is essential: Mild to moderate colic episodes are commonly due to gas pain or feed blocking a portion of the intestines (an impaction), and many can be managed medically. A surgical colic is a whole new game. If your horse has a loop of intestine that’s become displaced (is in an abnormal position), twisted around itself or somehow become trapped and “strangulated,” his problem won’t be solved with any kind of medical treatment—he’ll require surgery to survive. (That horse that recovered from essential oils didn’t really need surgery in the first place.) When surgery is necessary, it’s important to realize that more pain-relieving medications or “a little more time” won’t help. In fact, longer delays can lead to more damage and a poorer prognosis overall.

Is there a chance that surgery would be recommended but your horse doesn’t really need it? Yes, it’s possible. But with sophisticated diagnostic tools, and the extensive training and experience of most equine surgeons on your side, it’s highly unlikely. Rest assured, no one wants to take your horse to surgery if it isn’t necessary.

Nuts and bolts: If your horse does require surgery, you need to be prepared. Things will happen fast. He’ll have to haul in a trailer to a surgical facility. (Your vet will most likely administer sedation and pain medications for the trip.) Upon arrival the surgical team will evaluate him quickly and efficiently, and be prepared to perform the procedure as soon as it becomes clear it’s needed—even in the middle of the night. If the surgery goes well and there are no complications, your horse will remain at the hospital for a couple of days before he comes home. You’ll need to confine him to a stall or small paddock for a period of two to three months and provide hand walking or other forms of controlled exercise. He may require medications and a special diet for a period of time.

Finances: Cost for basic colic surgery can be as much as $8,000 to $10,000, and most surgical centers will require 50% up front. If you decide that you would take your horse to surgery, you need to have immediate access to these kinds of funds.

Chances for success: I hear horse owners tell me all the time that horses rarely survive colic surgery and come out the other side. This simply isn’t true. Overall colic surgery survival rates can be as high as 90%, and studies have shown that as many as 80% of horses return to athletic activity, some even better than before. That said, there are things that’ll impact your horse’s prognosis ranging from his age and overall health to the type and severity of the colic he’s experiencing. These are all things you’ll need to take into account when making your decision. There are also potential complications you need to be aware of such as the shutdown of his intestines following surgery, infection or breakdown of the surgical incision, or even repeated colic episodes and a need for additional surgery. These complications are hard to predict and can lead to increased costs or a poorer prognosis.


Now Not Later

Every time I’m standing in the barn aisle with the owner of a colicky horse, I ask the question, “Would you take your horse to surgery?” And every time I hold my breath, hoping that owner already knows the answer. Here’s why:

Treatment decisions: If your gelding is a surgical candidate, I might make different decisions about how I treat him. For example, I might administer a smaller dose of pain medication to insure I don’t mask signs of discomfort that can be critical when determining the need for surgery. If surgery is not an option, masking symptoms is less of a concern.

Time matters: If you know that you’d proceed with surgery, every minute counts when colic is severe. In situations where the nearest surgical center is several hours away, I’ll often recommend referral for monitoring, even before I’m convinced your horse needs surgery. I would much prefer he spend a night in the hospital and not need surgery than be standing in a barn aisle hours away from the surgery table when he starts to crash and burn. Early referral can make the difference between a successful outcome and a disastrous one. The worst thing that happens is when an owner initially tells me surgery wouldn’t be an option, then changes their mind many hours later when it becomes clear their horse won’t survive without it. By making this mistake, they’ve compromised their horse’s chances for survival.

Financial planning: If you have plans in place to pursue surgery, you have a chance to put financial plans in place. It’s hard to generate several thousands of dollars in the middle of the night without a plan.

If your horse continues to be uncomfortable, even after a dose of pain medication, you might need to consider colic surgery. Birgit Hassmann/

Five Factors to Help You Decide

With this basic information in hand, it’s time to consider your own horse and whether he’d be a good candidate for surgery. The following five factors will all come in to play:

Factor 1: Age and pre-existing conditions

Age is one of the most common considerations when making the colic surgery decision. Can your older horse survive a surgery? Absolutely! Will it be harder on him than it would be on his younger barn-mates? Yes, it will. I’ve seen horses approaching 30 years old recover from a colic surgery. I’ve also seen older horses struggle. Unfortunately, there’s no real cut-off point for “how old is too old,” but there’s no doubt that advancing age is a legitimate factor for making the decision to say no, especially if your horse already has health problems such as Cushing’s disease.

Overall health isn’t just a consideration for your older horse. Any horse with pre-existing health problems such as chronic laminitis or kidney disease may not be a good candidate for surgery. If you’re not sure about your horse’s chances, have a conversation with your veterinarian at your next routine visit. She can help you assess your horse’s overall condition so you’ll know what decision you should make.

Factor 2: Temperament

Does your horse have the temperament to handle surgery, recovery, and a long rehabilitation process? Some surgeons believe that a horse’s temperament can be a major factor for a successful outcome. In rare cases where a horse is extremely difficult to handle, surgery may be impossible. If your horse is likely to be very stressed by handling or stall confinement, you may simply feel it would be too hard on him to go through the process of surgery and recovery. You know your horse best. Consider his temperament when making your yes or no decision.

Factor 3: Money matters

No one wants to put a price on their horse’s life. Even so, cost is often one of the most common reasons why horse owners say no to colic surgery. If you’re lucky and have cash to spare, the financial burden won’t be something you have to consider. For some, the monetary value of the horse simply isn’t enough to justify surgery—even if they can afford it. For others, the emotional attachment you have to your horse means you’d do absolutely anything to save his life. If this is how you feel, it’s especially important that you make your decision ahead of time so that you know how you’ll handle the finances.

Consider establishing an emergency fund in a separate bank account, with money earmarked specifically for medical emergencies. Another option would be to purchase an insurance policy on your horse. Major medical/surgical insurance can be added to most equine mortality insurance to cover surgery costs. Some companies offer automatic colic surgery coverage with any mortality policy, although the amount of coverage will be less than if you purchase a separate medical policy. Some supplement companies also offer programs such as SmartPak’s ColiCare. This program provides up to $10,000 worth of colic surgery reimbursement if you purchase one of the company’s “approved” supplements (most contain probiotics or other supplements designed to support gastrointestinal health) and agree to an annual physical and dental exam, and vaccinations and deworming administered by your veterinarian. Finally, if you just don’t have the cash to set up a savings account, and aren’t interested in insurance, consider applying for a credit program that specifically designates funds for medical emergencies, such as CareCredit. Although interest rates are high, if you are pre-approved with this type of credit plan you’ll be able to pay for your horse’s care in an emergency, with a future pay-off schedule.


Factor 4: Availability

Is there a surgical facility nearby? And do you have access to a truck and trailer? If there is no surgical center available or you can’t get your horse there, surgery won’t be an option. If the nearest surgical center is 10 hours away, it may be much more difficult (or even impossible) to make the trip in time. Be aware of the location of the closest available facility. If it’s very far away, be prepared to transport your horse before signs are severe. If your answer would be “yes” based on all of the other factors, make sure you have access to a truck and trailer, including one that would be available in the middle of the night if you don’t own it yourself. It’s also super important that your horse has been trained to load—it won’t’ be easy to put him in the trailer for the first time when he’s sick and stressed.

Factor 5: Prognosis

Finally, specifics about the colic episode your horse is experiencing may impact his chances for survival and influence your decision. A simple displacement that gets on the table quickly will have a much better chance (and fewer complications) than a strangulated section of small intestine that has been brewing long enough to cause a lot of damage. Unfortunately, this isn’t always something you can decide on ahead of time. That said, knowing where you stand on the other four factors can help you navigate your decision at the time. If you’re on the fence with an older horse that has a history of mild laminitis, you might decide to say no if your vet feels it is something with a poor prognosis, but give a green light for a simple problem.

One important thing to realize is that the most accurate diagnosis of the nature and severity of your horse’s problem will happen on the surgery table, after the surgeon has made her incision and directly examined your horse’s abdomen. If you want to give your horse the best possible chance, but don’t want him to suffer a difficult recovery with likely complications, you can always make the decision to euthanize when your horse is on the table. 

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