Veterinary Surgery最新文献

Objective: To describe the additional information provided by computed tomography (CT) in planning and assisting repair of comminuted fractures of the middle phalanx (MP) in Warmblood horses.

Study design: Case series.

Animals: Six adult Warmblood horses.

Methods: The case records of horses undergoing CT examination prior to internal fixation of comminuted MP fractures were reviewed. All horses underwent radiographic and preoperative CT examination. A standardized fast protocol (SFP) to assess CT images was used. Surgical repair consisted of fracture repair and proximal interphalangeal joint arthrodesis using two dorsally located plates under general anesthesia. Long-term follow-up was obtained from the clinical records and/or referring veterinary surgeons.

Results: In all cases, CT provided information that could not have been obtained from radiographic examination. Four horses were alive at >6 months follow up and presented with a mild 3/5 AAEP lameness.

Conclusion: The SFP provided additional information regarding fracture configuration that could not have been obtained during radiographic examination in all cases. In two cases it allowed identification of a small navicular bone fracture at the level of its dorsal cortex within the distal interphalangeal joint. In one case it allowed identification of deep digital flexor tendon (DDFT) rupture. Preoperative CT scans helped in planning the positioning of two or more independent 4.5/5.5 mm cortical lag screws to improve construct stability.

Clinical significance: The use of the CT SFP provides surgeons with precise fracture configuration, enables identification of concurrent pathology and optimizes surgical planning, thereby improving construct stability.

Objective: To describe the surgical procedure for pancreaticoduodenectomy with choledochoduodenostomy and pancreaticojejunostomy for carcinoids of the common bile duct (CBD) in a cat and to report its outcomes.

Study design: Case report.

Animal: A 6-year-old neutered male Munchkin cat.

Methods: A small tissue plug causing CBD obstruction was surgically removed from a cat. The obstructive plug was diagnosed histopathologically as carcinoid. Nine months after initial surgery, the cat developed anorexia and vomiting. Diagnostic imaging revealed dilation of both the CBD and pancreatic duct, and the cat underwent a second surgery 11 months after the initial procedure. En bloc resection of the pancreatic body and duodenum, including the site of the CBD obstruction, was performed. Following the duodenal reconstruction with end-to-end anastomosis, the biliary system was rebuilt with end-to-side anastomosis, connecting the CBD's resected end to the duodenum. Pancreatojejunostomy of the distal end of the left pancreatic lobe and jejunum was performed to reconstruct the pancreatic duct.

Results: No postoperative complications such as bile leakage, pancreatic fluid leakage, or pancreatitis were observed. Toceranib therapy was initiated postoperatively. The cat showed good general condition 524 days after the second surgery and exhibited favorable progress at the time of writing.

Conclusion: This is the first report of a successful reconstructive surgery with choledochoduodenostomy and pancreatojejunostomy after en bloc resection of the pancreatic body and proximal duodenum in a cat with recurrent carcinoid-induced ductal obstruction. Pancreatic body duodenectomy may be a viable and effective option for managing pancreatic duct obstruction in cats.

Objective: To determine whether structured and supervised cadaveric surgical training improves technical skills in expert and self-assessments and enhances self-perception of surgical trainees.

Study design: Prospective observational study.

Sample population: Seven small animal ECVS residents and surgical interns.

Methods: A cadaveric orthopedic training program, consisting of six supervised training sessions, weekly self-directed training, and one one-to-one training session with direct feedback, was conducted over 3 months. Each participant performed a set of surgical procedures on feline cadavers before and after the training period. The procedures were videotaped and subsequently evaluated by three board-certified surgeons (expert assessment [EA]) and the participants themselves (self-assessment [SA]) using the objective structured assessment of technical skills (OSATS) global rating scale (GRS). OSATS GRS scores were analyzed using the Wilcoxon signed-rank test, Kruskal-Wallis test, and Cohen's kappa coefficient (Κ).

Results: Comparing pre- and post-training assessments, median EA scores increased from 17/35 to 23/35 (p = .001). Median SA scores increased from 17/35 to 25/35 (p = .018). There was slight to substantial inter-assessor agreement (Κ = 0.04-0.65) and poor agreement between SA and EA (Κ = 0).

Conclusion: Trainee surgeons improved their technical skills in expert and self-assessments. However, the interassessor agreement was strong for only two of the three assessors. Despite limitations, the OSATS GRS enhanced the objectivity of technical surgical skills assessment.

Clinical significance: This study represents the first step in devising a meaningful training outside the operating room for veterinary surgical residents. The OSATS GRS as an assessment tool warrants further investigation.

Objective: To describe surgical repair of an orbital wall fracture communicating with the caudal maxillary sinus using a three dimensional (3D)-printed, patient-specific implant (PSI).

Study design: Case report.

Animal: A 25-year-old Haflinger mare (370 kg).

Methods: The mare presented with severe chemosis and emphysema of the left upper and lower eyelid of 2-weeks duration due to a fracture of the ventral floor and inner wall of the left orbit that communicated with the caudal maxillary sinus. Computed tomographic (CT) data were used to design a PSI replicating the inner surface of the unfractured orbit. The data were converted to an STL file and 3D-printed using polylactic acid (PLA) filament. Surgical access was obtained via a concho-frontal sinus flap combined with sinoscopy. To reconstruct and seal the orbit, the PSI was lined with porcine small intestinal submucosa and secured to the inner orbital wall using two 3.0 mm titanium locking screws and synthetic, non-absorbable transosseous fiber loops.

Results: The emphysema resolved postoperatively, and ocular function was unrestricted by the implant. Infection developed subcutaneously adjacent to the transosseous suture fixation at the maxillary bone but resolved with conservative management. Follow-up CT at 11 weeks and owner reports after 18 months confirmed a favorable cosmetic and functional outcome, with only minimal residual ptosis of the left upper eyelid.

Conclusion: Application of a PSI axially to the left orbit successfully reconstructed the orbital wall and resolved the communication with the caudal maxillary sinus.

Clinical significance: Patient-specific implants represent a novel surgical option for the repair of complex orbital wall fractures in horses.

Objective: Hepatic arteriovenous malformations (HAVM) are complex congenital vascular anomalies associated with liver dysfunction. Due to surgical morbidity, alternative treatments including medical management, transarterial glue embolization (TAE), and dominant outflow vein (DOV) occlusion have been pursued. The goal of this study was to compare outcomes in terms of patient survival following medical and surgical techniques.

Study design: Retrospective study.

Sample population: A total of 46 client-owned animals.

Methods: Medical records from an Interventional Radiology (IR) service were reviewed for all HAVM patients treated over a 20-year period. Information collected included patient signalment, presenting clinical signs, diagnostic imaging and biochemical findings, medical, surgical/interventional managements pursued with associated complications, and patient outcomes including medication requirements and median survival times (MST). Patients were excluded from the study if final follow-up information was less than 1 year.

Results: A total of 43 dogs and three cats were identified. In dogs, medical management alone in four animals yielded a MST of 567 days (d) while surgery provided a MST of 1942d. While surgical complications and MST were not significantly different between the surgical treatment groups, the TAE group was significantly more likely to have remaining HAVM blood flow immediately after treatment (44% vs. 5%) and experience HAVM recurrence (53% vs. 15%) prompting additional treatments compared to the DOV group.

Conclusion: Patients with HAVM may have improved outcomes following surgical treatment. TAE and DOV occlusion have similar overall outcomes but different recurrence rates.

Clinical impact: Surgical management of HAVM can be safe and effective. The advantages of individual techniques require further investigation.

Objective: To determine whether a secondary plate on the caudolateral aspect of the scapula increases stiffness and reduces primary plate strain compared to a single plate along the cranial scapula spine in a comminuted fracture gap model.

Study design: Ex vivo mechanical study.

Sample population: A total of 14 paired canine scapulae.

Methods: A comminuted fracture gap model was created. A 2.4 mm plate was secured along the cranial aspect of the scapula spine in 28 scapulae. A secondary 2.0 mm plate was secured on the caudolateral border of 14 scapulae. Scapula were sinusoidally loaded from -20 to -200 N for 7200 cycles at 2 Hz. The displacement was measured, and stiffness calculated. Digital image correlation calculated primary plate surface strain. A two-way ANOVA assessed displacement and stiffness. Primary plate strain was assessed with a paired t-test. Statistical significance was set at p < .05.

Results: Mean displacement was higher in the single plate group, -0.81 mm (± 0.14) compared to the double plate group, -0.48 mm (± 0.08) (p < .0001). Mean stiffness was lower in the single plate group, 392.8 N/mm (± 13.72) compared to the double plate group, 563.7 N/mm (± 5.89) (p <.0001). There was no difference in primary plate surface strain between the two groups.

Conclusion: Double plate fixation improved stiffness in a comminuted scapula fracture gap model compared to single plate fixation.

Clinical significance: The placement of an additional plate placed on the caudolateral aspect of the scapula improves stiffness in comminuted scapula body fractures.

Objective: To describe the complications of medial retropharyngeal, axillary, and ilio-sacral lymphadenectomy in dogs with malignant tumors, and to identify possible risk factors.

Study design: Retrospective cohort study.

Animals: A total of 140 surgical accesses (86 axillary, 27 ilio-sacral, 27 retropharyngeal) in 127 dogs.

Methods: Dogs with cutaneous/subcutaneous cancer undergoing staging, lymph node (LN) mapping and extirpation of medial retropharyngeal, axillary, and/or ilio-sacral LNs, with a minimum follow-up of 1 month, were included. Retrieved information included signalment, tumor histotype, LN characteristics, excision of contiguous LNs, anesthesia duration, intra- and postoperative complications. Data were statistically analyzed to identify risk factors for complication development.

Results: Intraoperative complications were registered in 3/140 (2%) procedures, including hemorrhage during medial iliac lymphadenectomy (2/27, 7%) and difficulty locating the axillary LN (1/86, 1%). Postoperative complications occurred in 32/140 (23%) cases, with rates of 41% (11/27) following ilio-sacral lymphadenectomy, 26% (7/27) after medial retropharyngeal lymphadenectomy, and 16% (14/86) following axillary lymphadenectomy. Ilio-sacral lymphadenectomy presented a higher risk of intraoperative (p = .033) and postoperative complications (p = .020). Enlarged (p = .030) or metastatic (p = .030) LNs were more prone to develop intraoperative complications. No risk factor retained significance on multivariate analysis. Median follow-up, conducted through physical examination, was 225 days (range, 30-1735).

Conclusion: Medial retropharyngeal and axillary lymphadenectomies were generally safe, associated with minor and easily manageable complications. Conversely, ilio-sacral lymphadenectomy carried a higher risk of intraoperative complications, particularly in cases with enlarged LNs, and postoperative complications, potentially related to the caudal laparotomic approach.

Clinical significance: Lymphadenectomies of medial retropharyngeal, axillary, and ilio-sacral lymph nodes present relatively low complication rates.

Objective: To compare leakage pressure and ligation time of bronchial sealing using barbed sutures, stapling devices, or traditional sutures during total lung lobectomy in dogs.

Study design: Experimental ex vivo study with randomized order of procedures.

Sample population: A total of 30 lung lobes from five canine cadavers weighing 10-13 kg.

Methods: The lobe samples were randomly allocated to the stapling device (ST), traditional suture ligation (TR), or barbed suture ligation (BA) group (n = 10 each). Bronchial ligation time was recorded for each procedure. Each bronchial stump was tested for air leakage for pressures up to 80 cmH₂O.

Results: The median air leakage pressure was 45.0 cmH₂O (range: 30.0-80.0) for the ST, 47.5 cmH₂O (range: 36.0-80.0) for the TR, and 57.5 cmH₂O (range: 25.0-80.0) for the BA (p = .36). No group showed leakage at physiological airway pressures (< 20 cmH₂O). At pressures up to 80 cmH₂O, leakage was observed in nine of 10 bronchial stumps in the ST, eight of 10 in the TR, and six of 10 in the BA (p = .43). The mean bronchial ligation time was 2.4 ± 0.5 min for the ST, 14.1 ± 3.4 min for the TR and 10.7 ± 1.6 min for the BA (p < .01).

Conclusion: Barbed sutures for bronchial closure provided comparable leakage pressure to stapling devices and traditional sutures and reduced suturing time compared to traditional sutures.

Clinical significance: Barbed suture ligation might be a viable alternative for canine total lung lobectomy.

Objective: To assess the accuracy of intraoperative identification of the tibial intercondylar eminence (TIcE) in the sagittal plane in dogs.

Study design: Ex vivo experimental study.

Animals: A total of 20 stifles from 10 dogs (weight range: 20-30 kg; n = 20).

Methods: Stifles were positioned for a mediolateral radiographic projection with a hypodermic needle placed at the center of the medial collateral ligament (MCL) (C), immediately cranial (Cr), and caudal (Cd) to the ligament. Variables were assessed at the stifle flexions of 90° and 135° with both intact cranial cruciate ligament (CCL-In) and after mechanical transection (CCL-MT). Three evaluators measured the distance (d) between the TIcE and needle center. Statistical analysis involved a linear mixed model, with the Bonferroni test (p < .0125).

Results: Analyses of CCL-In and CCL-MT groups revealed statistically significant differences between needle positions and stifle flexion angles. In the CCL-In group, the C-90° position was closest to the stifle center (d = 0.45 ± 2.39). For the CCL-MT group, the C-135° position was nearest (d = 0.11 ± 2.18).

Conclusion: The center of the MCL in the sagittal plane, at 135° of stifle flexion, served as a reliable anatomical reference for identifying the TIcE in dogs with CCL disease.

Clinical significance: A meticulous intraoperative identification of the TIcE can improve the accuracy of tibial osteotomies, potentially optimizing tibial plateau leveling osteotomy outcomes.

Objective: The aim of this study was to develop and internally validate a machine-learning algorithm, PROSPECT (Predicting Risk Of Surgical complications aftEr CCWO and TPLO), using clinical variables to predict postoperative complications in dogs undergoing high tibial osteotomy for cranial cruciate ligament disease (CrCLD).

Study design: Retrospective multivariable prediction model development.

Sample population: Stifles (n = 670) and dogs (n = 555).

Methods: Complication data with a minimum follow up of 28 days were collected. Clinical variables were preprocessed for machine learning and interaction features were engineered. A multioutput eXtreme Gradient Boosting model was trained on 80% of the sample to predict minor, surgical, and medical complications independently. The trained PROSPECT model was then tested on the independent test set. Model performance was evaluated qualitatively and quantitatively.

Results: Complications occurred in 134/670 (20.0%) stifles, with 50 (7.5%) minor complications, 69 (10.3%) surgical complications, and 26 (3.4%) medical complications. The PROSPECT model achieved Brier scores and accuracies of 0.06379 ± 0.009100 and 91.9% for minor complications, 0.05481 ± 0.008589 and 92.3% for surgical complications, and 0.04102 ± 0.008194 and 94.3% for medical complications.

Conclusion: The PROSPECT model can predict postoperative complications accurately and in a probabilistic fashion following high tibial osteotomy for CrCLD.

Clinical significance: Machine learning may facilitate an individualized approach to risk management with the potential to enhance patient safety and promote safer surgery.