Symposium on surgical techniques in small animal practice. Surgery of the esophagus.

There are many anastomotic techniques available that have been used successfully but no one technique guarantees 100 per cent success. Therefore the surgeon should be capable of altering his planned approach according to the circumstances. No matter what anastomotic technique is selected, for a consistently successful outcome it is imperative that the whole animal be considered in all aspects of care and rude handling of tissues be avoided during the surgical procedure. The simple interrupted approximating suture technique is recommend as one which meets the general goals of intestinal anastomosis in dogs and cats.     

Prospective Evaluation of Two Intracorporeally Sutured Prophylactic Laparoscopic Gastropexy Techniques Compared with Laparoscopic-Assisted Gastropexy in Dogs

Objective— To report technique, surgical time, complication rate, and postoperative activity in dogs undergoing 2 intracorporeally-sutured total laparoscopic gastropexy (TLG) techniques compared with a laparoscopic-assisted gastropexy (LAG) technique.
Study Design— Randomized clinical trial.
Animals— Dogs (n=30) weighing >25 kg.
Methods— Dogs were randomly assigned to 1 of 3 groups. Two TLG techniques were performed using a median 3 portal technique. One of 2 suturing techniques was used to approximate corresponding incisions made in the stomach and body wall; using intracorporeal hand-suturing or a suture-assist device (Endostitch^™). In a 3rd group, a previously reported LAG technique was used. All dogs had an activity monitor placed for 7 days pre- and postoperatively. Linear regression analyses were performed to evaluate the association of surgical procedure on gastropexy time and the percentage change in activity counts.
Results— Median gastropexy time was 28 minutes (range, 20–41 minutes) for LAG, 48 minutes (range, 39–61 minutes) for the hand suture TLG technique, and 56 minutes (range, 30–90 minutes) for the Endostitch^™ TLG technique. LAG was performed faster than TLG ( P <.05). LAG dogs had a greater decrease in postoperative activity than TLG dogs ( P =.005); however there was no difference in surgical time or postoperative activity between TLG techniques.
Conclusions— TLG can be performed safely and effectively in dogs and although it takes longer, it has less impact on postoperative activity compared with LAG.
Clinical Relevance— TLG techniques may have advantages over LAG as measured by a greater willingness of dogs to move around postoperatively.     

Hiatal hernia controversies--a review of pathophysiology and treatment options

OBJECTIVE: To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. DESIGN: Review article. SUMMARY: Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment. Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present. Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.     

Hiatal hernia controversies - a review of pathophysiology and treatment options

Objective To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments.
Design Review article.
Summary Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment.
Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present.
Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplica-tion in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.     

Combined Resection of the Nasal Planum and Premaxilla in Three Dogs

Surgical techniques for removal of tumors that affect the nasal planum or the premaxilla have been described. For extensively invasive malignancies, these techniques may be inadequate if used alone to achieve wide surgical margins. An operative technique that combines resection of the nasal planum and premaxilla has been developed for extensive malignant tumors of the nasal planum or premaxilla. This technique was used in three dogs and resulted in an acceptable cosmetic appearance and good function and tumor control. Complications after surgery included minor bleeding and partial dehiseence of the suture lines in two dogs and stenosis of the nasal orifice in one dog.     

Colopexy as a Treatment for Rectal Prolapse in Dogs and Cats: A Retrospective Study of 14 Cases

Colopexy was evaluated as a treatment for recurrent rectal prolapse in eight dogs and six cats. Cases included in the study were from two institutions; the University of Pennsylvania School of Veterinary Medicine and the University of Tennessee College of Veterinary Medicine. Two different colopexy techniques were used: A simple suture technique was used in two cats and four dogs (University of Pennsylvania), and an incisional technique was used in four cats and four dogs (University of Tennessee). Rectal prolapse had not recurred in any of the 14 animals at the time of follow-up. Incisional dehiscence occurred in two animals and in one instance may have been related to the colopexy procedure. Infection at the colopexy site, secondary to suture penetration of the colonic lumen, is a potential complication of this procedure. Colopexy, using either surgical technique described here, was effective in preventing recurrent rectal prolapse.     

Total hip arthroplasty for treatment of canine hip dysplasia.

Cemented THA is an established procedure for treating arthropathies of the hip in large, healthy mature dogs. CHD with secondary osteoarthritis is the most common indication. Although comparative studies between THA and excision arthroplasty have not been reported, our experience with both procedures and studies in the literature support THA as the best available treatment for crippling degenerative joint disease secondary to CHD in large, mature dogs. Negative aspects of the procedure include high cost, the potential of significant complications, and the sophisticated surgical technique required. Improvements in patient selection, design of implants, surgical technique, and postoperative care have decreased the incidence of complications and improved the success rate to over 90%. However, concerns in human applications about cement disease and the desire to increase the functional life of the prosthesis have renewed interest in cementless systems. Advantages of cementless THA are fixation via bony ingrowth and avoidance of problems associated with PMMA. Important technical aspects of cementless THA relate to optimal fit and fill so that the prosthesis is stable, bone ingrowth is promoted, and weight-bearing forces are transferred to the proximal femur physiologically. Problems recognized with cementless systems include fissure fracture, bone resorption, and excessive motion between the implant and bone. Currently, investigations are being conducted to develop prosthetic materials that more closely match the stiffness of bone, stem designs that provide optimal fit and maintain normal strain patterns in the bone, and coating materials that promote permanent fixation by bone ingrowth. Early clinical results in humans and research results in dogs have been encouraging but have not withstood the test of time. Results of cementless techniques must be compared to the standards set by cemented THA over the last 20 years in humans and the last 10 years in dogs.     

The role of surgery in the management of canine anal furunculosis. A review of the literature and a retrospective evaluation of treatment by surgical resection in 51 dogs

AIMS: To retrospectively evaluate the outcome of surgical management of anal furunculosis (AF) in 51 dogs. To compare the outcome of surgery with those of current medical protocols by way of a review of the literature. METHODS: Dogs referred for treatment of AF (n=51) were treated by en bloc surgical resection of diseased tissue and primary wound closure. This technique was combined with bilateral anal sacculectomy in all cases in which the anal sacs had not been previously removed. Immunomodulatory therapies were not used, with the exception of post-operative metronidazole antibiosis for 7-10 days. Follow-up was performed by the author using a telephone questionnaire. RESULTS: Forty-eight dogs were eligible for post-operative follow-up 1.5 to 36 (mean 17.4, median 18) months after surgery. Lesion recurrence, faecal incontinence and stricture formation occurred in 2%, 4% and 13% of dogs, respectively. The percentage of dogs considered by their owners to have an acceptable level of faecal continence and an improved quality of life was 94%. CONCLUSIONS AND CLINICAL RELEVANCE: The aetiopathogenesis of canine AF remains unclear. Whilst recent advances in medical management by the use of various immunomodulatory medications (such as cyclosporine) hold promise, this approach has yet to be refined with respect to affordability, long-term efficacy and morbidity. With meticulous surgical dissection and reconstruction techniques (anoplasty), excellent success rates can be achieved following a single surgical procedure with minimal complications. Surgery remains a viable treatment option, alone or in combination with immunomodulatory medications, until a more thorough understanding of this debilitating disease is achieved.     

Transarterial coil embolization of patent ductus arteriosus in small dogs with 0.025-inch vascular occlusion coils: 10 cases

Patent ductus arteriosus (PDA) is the most common congenital cardiac disease in the dog and generally leads to severe clinical signs, including left-sided congestive heart failure. Historically, definitive treatment consisted of surgical ligation; however, the use of vascular occlusion devices by minimally invasive techniques has gained popularity in veterinary medicine during the past decade. Adequate vascular access is a major limiting factor for these minimally invasive techniques, precluding their use in very small dogs. The clinical management of PDA with 0.025-in vascular occlusion coils in a minimally invasive transarterial technique in 10 dogs is described. The dogs were small (1.38 +/- 0.22 kg), were generally young (6.70 +/- 5.74 months), and had small minimal ductal diameters (1.72 +/- 0.81 mm from angiography). Vascular access was achieved, and coil deployment was attempted in all dogs with a 3F catheter uncontrolled release system. Successful occlusion, defined as no angiographic residual flow, was accomplished in 8 of 10 (80%) dogs. Successful occlusion was not achieved in 2 dogs (20%), and both dogs experienced embolization of coils into the pulmonary arterial tree. One of these dogs died during the procedure, whereas the other dog underwent a successful surgical correction. We conclude that transarterial PDA occlusion in very small dogs is possible with 0.025-in vascular occlusion coils by means of a 3F catheter system and that it represents a viable alternative to surgical ligation. The risk of pulmonary arterial embolization is higher with this uncontrolled release system, but this risk may decrease with experience.     

Canine tracheal collapse

Tracheal collapse occurs most commonly in middle‐aged, small breed dogs. Clinical signs are usually proportional to the degree of collapse, ranging from mild airway irritation and paroxysmal coughing to respiratory distress and dyspnoea. Diagnosis is made by documenting dynamic airway collapse with radiographs, bronchoscopy or fluoroscopy. Most dogs respond well to medical management and treatment of any concurrent comorbidities. Surgical intervention may need to be considered in dogs that do not respond or have respiratory compromise. A variety of surgical techniques have been reported although extraluminal ring prostheses or intraluminal stenting are the most commonly used. Both techniques have numerous potential complications and require specialised training and experience but are associated with good short‐ and long‐term outcomes.     

Surgical procedures for glaucoma: what the general practitioner needs to know

Glaucoma can be treated by medical and surgical options. Most ophthalmologists believe that patients with glaucoma are best treated with surgery. Early recognition of clinical signs and selection of the most effective type of surgery depending on the stage of glaucoma and the underlying cause are important factors in glaucoma surgery. Several surgical procedures exist for dogs with primary glaucoma, which may include a cyclodestructive technique or an aqueous outflow bypass procedure or a combination of both procedures. Salvage procedures such as enucleation, evisceration with an intrascleral prosthesis, or chemical intravitreal injection may be advised for chronically blind eyes with no hope of vision. Client compliance and expectations, therapeutic goals, status of vision (visual versus blind), financial constraints, surgical expertise, and underlying systemic disorders should be considered in the selection of the most appropriate surgical option for each patient.     

Transtracheal aspiration in the diagnosis of pulmonary blastomycosis (17 cases: 2000-2005)

Blastomyces dermatitidis is a common etiologic agent of fungal pneumonia in dogs. Definitive diagnosis is based on cytologic demonstration of the organism in affected tissues. Fluid obtained through transtracheal aspiration has previously been reported to have a low diagnostic yield for B. dermatitidis organisms. This retrospective study identified B. dermatitidis organisms in 76% of samples when transtracheal aspiration was performed in 17 nonsedated dogs with pulmonary blastomycosis. Transtracheal aspiration is a noninvasive and simple procedure that should be considered as an early diagnostic test whenever blastomycosis is a differential diagnosis in dogs with pulmonary disease.     

Surgical management of cricopharyngeal dysphagia in dogs: 14 cases (1989-2001)

OBJECTIVE: To determine outcome of and complications associated with cricopharyngeal myotomy or myectomy for treatment of cricopharyngeal dysphagia (CPD) in dogs. DESIGN: Retrospective study. ANIMALS: 14 dogs. PROCEDURE: Medical records of dogs with CPD that underwent cricopharyngeal myotomy or myectomy were examined. Follow-up information was obtained through telephone interviews with owners and referring veterinarians and clinical examinations when feasible. RESULTS: 16 surgical procedures were performed on the 14 dogs. Dysphagia was completely resolved immediately after surgery in 1 dog, and clinical signs did not recur (follow-up time of 8 years); a second dog also had immediate complete resolution of dysphagia, but follow-up time was only 10 days. Three dogs had transient complete resolution with a mean time to recurrence of dysphagia of 12.3 weeks (range, 2 to 36 weeks). Three dogs had permanent partial resolution. Six dogs had no improvement after surgery. Eight of the 14 dogs were euthanatized because of problems related to CPD, including persistent dysphagia (n = 8) and aspiration pneumonia (5). CONCLUSIONS AND CLINICAL RELEVANCE: The failure rate for dogs undergoing surgical treatment of CPD may be high, particularly if concurrent aspiration pneumonia or malnutrition is not addressed prior to surgery. For those dogs with concurrent diseases, more aggressive medical management, such as enteral tube feeding, may be warranted rather than surgery. In dogs with CPD complicated by other anatomic or functional conditions, such as myasthenia gravis, laryngeal paralysis, and esophageal stricture, surgery may also not be indicated.     

Evaluation of an endoscopically assisted gastropexy technique in dogs

OBJECTIVE: To evaluate the use of endoscopy in conjunction with a gastropexy technique in dogs as a potential means to aid prevention of gastric dilatation-volvulus. ANIMALS: 12 healthy adult medium- and large-breed dogs. PROCEDURES: 12 adult research dogs that had no abnormal physical examination findings each underwent an endoscopically assisted gastropexy procedure. On completion of the procedure, the dogs were euthanized and exploratory laparotomies were performed to evaluate the surgical site. Data recorded included anatomic location of the gastropexy, gastropexy length, and duration of procedure as well as any complications. RESULTS: Mean+/-SD gastropexy length was 3.3+/-0.25 cm, and mean duration of surgery was 18+/-7 minutes. In each dog, the stomach was located in its normal anatomic position and all gastropexies were sutured to the abdominal wall at the level of the pyloric antrum. The only complications during the procedure were needle bending and breakage at the time of stay suture placement. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of these findings, it appears that endoscopically assisted gastropexy is a simple, fast, safe, and reliable method of performing a prophylactic gastropexy in dogs when undertaken by a person who is skilled in endoscopy. Such a procedure maximizes the benefits of decreased morbidity and shorter duration of anesthesia associated with minimally invasive surgery. Further clinical studies are warranted to evaluate the long-term efficacy of this procedure in dogs at risk for development of gastric dilatation-volvulus.     

Myocardial concentrations of fatty acids in dogs with dilated cardiomyopathy

OBJECTIVE: To compare myocardial concentrations of fatty acids in dogs with dilated cardiomyopathy (DCM) with concentrations in control dogs. SAMPLE POPULATION: Myocardial tissues from 7 dogs with DCM and 16 control dogs. PROCEDURE: Myocardial tissues were homogenized, and total fatty acids were extracted and converted to methyl esters. Myocardial concentrations of fatty acids were analyzed by use of gas chromatography and reported as corrected percentages. RESULTS: The amount of docosatetraenoic acid (C22:4 n-6) was significantly higher in myocardial samples from dogs with DCM (range, 0.223% to 0.774%; median, 0.451%), compared with the amount in samples obtained from control dogs (range, 0.166% to 0.621%; median, 0.280%). There were no significant differences between DCM and control dogs for concentrations of any other myocardial fatty acids. CONCLUSIONS AND CLINICAL RELEVANCE: Although concentrations of most myocardial fatty acids did not differ significantly between dogs with DCM and control dogs, the concentration of docosatetraenoic acid was significantly higher in dogs with DCM. Additional investigation in a larger population is warranted to determine whether this is a primary or secondary effect of the underlying disease and whether alterations in fatty acids may be a target for intervention in dogs with DCM.     

Evaluation of carbon dioxide laser and conventional incisional techniques for resection of soft palates in brachycephalic dogs

OBJECTIVE: To compare clinical outcome, healing, and effect of tracheostomy in conventional incisional and carbon dioxide (CO2) laser techniques for resection of soft palates in brachycephalic dogs. DESIGN: Prospective randomized trial. ANIMALS: 20 adult brachycephalic dogs. METHODS: Dogs were randomly allocated into 4 groups, and 1 of the following was performed: palate resection by use of a CO2 laser; incisional palate resection and closure with suture; and palate resection by use of a C02 laser or incision with tracheostomy. A clinical score for respiratory function was assigned to each dog at 0, 2, 8, 16, and 24 hours. Biopsy specimens of incision sites obtained at days 0, 3, 7, and 14 were examined. Data were analyzed to determine the effects of technique on clinical and histologic outcome. RESULTS: Mean surgical time for laser (309 seconds) was significantly shorter than for sharp dissection (744 seconds). Surgical technique significantly affected clinical scores at 3 of the 5 postoperative time points, but differences were not clinically apparent. Tracheostomy significantly affected clinical scores at 3 of 5 postoperative time points. After tracheostomy tube removal, clinical scores were similar to those of dogs without tracheostomies. Inflammation, necrosis, and ulceration were evident in all groups at day 3; these lesions had almost resolved by day 14. Most complications were associated with tracheostomy. CONCLUSIONS AND CLINICAL RELEVANCE: Clinical outcomes appear to be similar with the laser and incisional techniques. Regarding surgical time and ease, laser resection of the soft palate appears advantageous. Tracheostomy is not warranted in dogs that have uncomplicated surgeries and recoveries.     

Effectiveness of an enzymatic rawhide dental chew to reduce plaque in beagle dogs

Tooth brushing is considered a superior technique for reducing plaque accumulation. Other methods of maintaining oral hygiene have been investigated since many owners may not be willing or able to brush their dog's teeth. Following a professional teeth cleaning procedure, 11 dogs were offered a rawhide dental chew BID for 7-days, while 11 other dogs were fed the same diet without receiving the chew device. Dogs in the treatment group had significantly less plaque formation during the trial period compared with dogs in the control group. The rawhide dental chew provided in the study reported here decreases plaque formation in the short-term and may be beneficial in the prevention of progressive periodontal disease associated with attachment loss if provided on a long-term basis.     

Combined Kirschner-Ehmer apparatus and dorsal spinal plate fixation of caudal lumbar fractures in dogs: biomechanical properties

The strength and rigidity of a new surgical technique for the stabilization of caudal lumbar fractures in dogs, using a Kirschner-Ehmer apparatus and a dorsal spinal plate (KE/DSP), were compared with 2 other methods of internal spinal fixation and with intact (control) spines, using a spinal test system that subjected the spines to 4-point bending. The fixation devices were applied to isolated canine lumbosacral spines (L1 to S3) from cadavers. A complete spinal separation was made in the spine implant specimens at L5-L6 by sharp dissection of all ligamentous structures connecting the two vertebrae. Bending moment vs L5-L6 angular deformation curves, and rigidity and load sustained at 10 degrees angular deformation (failure) were recorded for each fixation method and for the control spines. Values were compared by statistical analysis. The combined KE/DSP fixation and a combined vertebral body plate/dorsal spinal plate (VBP/DSP) fixation were stronger and more rigid than were the control spines and those fixed with a modified segmental-fixation method (P less than 0.05). There were no statistical differences in strength and rigidity between the 2 combined-fixation techniques. Although the VBP/DSP technique is not applicable to clinical caudal lumbar (L5-L6) fractures, it was compared in this study to the KE/DSP technique because a similar VBP/DSP technique was reported strongest in a similar study of L3-L4 simulated fractures, compared with 3 other spinal-fixation techniques that have been used in repair of caudal lumbar fractures. The technique has been used successfully in 6 dogs with caudal lumbar fractures.     

Survival data for canine oral extramedullary plasmacytomas: a retrospective analysis (1996-2006)

In a 10-year period, extramedullary plasmacytomas (EMP) represented 5.2% of all oral tumors found in the dog (16/302). These 16 oral EMP comprised 28.5% of all EMP within the same time period. Eleven dogs died with a median survival time of 474 days. Five dogs remain alive at the time of this writing. Dogs without complete surgical removal of the EMP and no adjuvant therapy had a median survival time of 138 days. Oral EMP have a clinical behavior consistent with EMP arising from other tissues. They have no obvious correlation with multiple myeloma, and complete surgical resection may be curative.