Colic surgery is often considered the last resort, and the only alternative for horses that have developed specific types of physical obstructions or dysfunction of their intestine.

It is advised when a specific diagnosis is made that can only be treated surgically. This is usually when a horse is experiencing severe and unmanageable pain or ongoing pain (with or without a diagnosis), or when a horse’s clinical signs worsen despite symptomatic treatment.

Colic surgery is often called the "ultimate diagnostic tool" because exploration of the abdomen sometimes allows the surgeon to actually see the problem, rather than deduce its existence based on other less direct diagnostics.

Colic surgery is only performed at a veterinary hospital that has the requisite equipment and staffing. A horse is placed under general anesthesia and laid on its back in an operating room. A large incision is created through the layers of the lowest part of the belly until the abdominal cavity is entered. Using gloved hands and arms, the abdomen is explored and a diagnosis is made.

The surgical technique needed and the prognosis is discussed with the owner, and the surgery is completed. The abdomen is sutured closed using special suture and technique. The horse recovers from surgery and the post-operative care phase begins.

Colic surgery requires a team of trained professionals to properly anesthetize and successfully fix a mechanical problem within the abdomen.