Taking a horse to colic surgery is often met with fear and trepidation from the owner. In early studies in the 1980’s, the prognosis for survival in horses undergoing colic surgery was often guarded. As such, the reputation that horses undergoing colic surgery are never the same or will likely die often dissuades owners from considering colic surgery as a viable treatment option. The focus of this talk is to discuss the reality of prognosis and outcome measures in horses undergoing colic surgery and how the prognosis has markedly improved over time. The aim of this presentation is to go over different surgical colic lesions, what is involved with taking a horse to colic surgery, understanding which factors do affect outcome, what perioperative advances in surgical technique and managing the surgical colic patient have been made and finally the prognosis for both survival and athleticism.