Ovariohysterectomy Lecture 2016 PDF

SURG II – LECTURE 3 Ovariohysterectomy VETC 2016 OVARIOHYSTERECTOMY OHE Spayed Fixed Altered Neutered Surgical removal of the ovaries and uterus  Besides unwanted pregnancy why should we spay our dogs and cats? Neoplasia, trauma infection or injury of reproductive tract Preven...

SURG II – LECTURE 3 Ovariohysterectomy VETC 2016 OVARIOHYSTERECTOMY OHE Spayed Fixed Altered Neutered Surgical removal of the ovaries and uterus  Besides unwanted pregnancy why should we spay our dogs and cats? Neoplasia, trauma infection or injury of reproductive tract Prevention/treatment of neoplasia elsewhere in the body influenced by reproductive hormones (mammary tumours) Dystocia OVARIOHYSTERECTOMY  Uterine torsion Stop heat cycle Stabilization of other systemic diseases (Diabetes, epilepsy) Congenital OVARIOHYSTERECTOMY abnormalities WHEN TO SPAY? < 3 months of age higher rate of urinary incontinence post-op **Before first estrus (5-6 months)** If sexually mature 2 months after estrus (heat cycle) If recently had a litter- 6-8 weeks after weening If unsure whether pet is spayed or not shave abdomen and look for ventral midline scar MAMMARY TUMOURS Approx 35-50% of canine and 90% of feline tumours are malignant Many are hormone dependent and can be prevented if spayed before 1 year of age MAMMARY TUMOURS o Risk of developing mammary tumours if dog is spayed before the first estrus cycle 0.05% Increases to 8% after first estrus Increases to 26% after second estrus cycle Cats if spayed before 1 year of age only have a 0.6% risk of developing mammary carcinoma SURGICAL ANATOMY Right ovary more cranial than left Long uterine horns Short uterine body Tough and fibrous suspensory ligament attaches ovaries to fascia Ovarian artery and vein in suspensory ligament Ovarian horns suspended by Broad ligament DIFFERENCES (DOGS VS CATS) Dogs Cats More fat in ovarian pedicle Less fat in ovarian pedicle Ovaries are tightly attached Base of uterus tightly attached INSTRUMENTS General Surgery Pack Spay Hook (Snook-Hook) OVARIOHYSTERECTOMY SURGERY Procedure VIDEOS Surgical Prep (Feline Spay) https://www.atdove.org/video/abdominal-surgery-patient-prep Feline Ovariohysterectomy https://www.atdove.org/video/feline-ovariohysterectomy-spay Canine Ovariohysterectomy (& Gastropexy) https://www.atdove.org/video/ovariohysterectomy-and-gastropexy-part-1-of-2 https://www.atdove.org/video/ovariohysterectomy-and-gastropexy-part-2-2 PREPARING THE PATIENT Clip from xiphoid to pubis Ventral midline incision Dog: incision starts 3-6cm caudal to the umbilicus Cat: incision starts 3-4cm caudal to umbilicus Aseptically prep area ENTERING THE ABDOMEN Incision through skin and SQ to expose linea alba Linea alba is tented outward and a stab incision is made into abdominal cavity Linea incision is extended cranially and caudally using Mayo scissors FINDING THE OVARY A spay hook is inserted along the left abdomen wall (caudal to the kidney) and is turned medially to hook the uterine horn to facilitate exteriorization from the abdomen Caudomedial traction on the uterine horn allows caudolateral digital strumming and breakdown of the suspensory ligament to facilitate exteriorization of the ovary A hole is made in the broad ligament caudal to the ovarian pedicle and 2 Carmalts are placed across the ovarian pedicle proximal to the ovary  A Carmalt is placed on the suspensory ligament just distal to the ovary and gentle traction is maintained to aid in exteriorization 2 circumferential ligatures are placed in the crushes while flashing the 2 distal Carmalts A mosquito hemostat is placed on the suspensory ligament just distal to the ligatures and the ovarian pedicle is transected PEDICLE between the hemostat and ovary LIGATION PEDICLE LIGATION Pedicle is observed for bleeding and replaced back in the abdomen The Left uterine horn is traced to the uterine body and followed up the opposite uterine horn to the right ovary Right ovary is removed in the same procedure  Bilaterally a window is made in the Broad ligament adjacent to the uterine body, and uterine artery and vein 2 Carmalts are placed across the broad ligament on each side of the uterine body and transected in between Gentle traction is placed on the uterine body and a Carmalt is clamped across the uterine body to UTERINE BODY facilitate exposure  2 transfixtion ligatures are placed caudal to the clamp, through the uterine body, just cranial to the cervix Mosquitos are applied to the uterine wall near the ligatures while the uterine body is transected between the Carmalts and the ligatures Uterine body is removed Uterine stump is observed for hemorrhage and returned to abdominal UTERINE BODY cavity CLOSURE Abdominal wall closure achieved in 3 layers Linea Alba Subcutaneous tissue Skin INTRA-OP CONCERNS Hemorrhage-higher risk in older, obese animals or animals in estrus (in heat) ‘Dropped pedicle’- Don’t panic! Extend incision and go find it! Friable uterus Ensure all of the ovary is removed Ureter/Urethral ligation POST-OP CARE Recovery Food and Water Keep patient warm Small amounts once recovered Quiet area Exercise Restriction E-collar to prevent Self trauma No off-leash activity, short leash walks Monitor for: only for 10-14 days Hemorrhage Keep cats indoors 10-14 days Pain Have Owners Analgesia Check incision daily Opioids in hospital Keep E-collar on until sutures out!! NSAID (if not contraindicated) Give prescribed pain medication  Hemorrhage Ureter/urethral ligation Recurring Estrus (Ovarian Remnant) OVARIOHYSTERECTOMY COMPLICATIONS Cervical Pyometra (Stump Pyo) Urinary Incontinence Incision Problems https://www.youtube.com/watch?v=a1iXbSFcUkE Canine spay https://www.youtube.com/watch?v=-wMmpC5YSow Feline spay