Veterinary Surgery最新文献

Background: Septic peritonitis (SP) is a complex, life-threatening disease, driven by peritoneal inflammation and microbial contamination, requiring timely and dynamic perioperative management.

Aims: The aim of this review was to synthesize current knowledge on the perioperative management of SP in dogs and cats.

Conclusions: Evidence-based strategies for initial stabilization include fluid resuscitation with balanced crystalloids, asopressors, and antimicrobial therapy targeting polymicrobial infections. Anesthetic management should prioritize hemodynamic stability and a multimodal approach to analgesia. Postoperative management should include early enteral nutrition (which is associated with increased survival) and monitoring and treatment of coagulation derangements. Patients should be closely monitored for recurrent SP after surgery, which is associated with high mortality. Evidence for risk factors of dehiscence such as hypoalbuminemia and interoperative hypotension is inconsistently found in studies. Other potential complications include hospital acquired infection and intra-abdominal hypertension.

Implications: There is significant variation in the treatment approach for small animals with SP, likely due to gaps in evidence. Reported survival rates vary widely between studies due to diverse and inconsistent study populations, highlighting the need for further research to optimize care in veterinary patients.

Objective: To quantify the impact of experimentally induced dorsal nasopharyngeal collapse (NPC) on respiratory performance parameters and assess the efficacy of laser fenestration of the dorsal pharyngeal recess as a treatment option for experimentally induced NPC.

Study design: Experimental interventional study.

Animals: Six adult Standardbreds (one with naturally occurring disease).

Methods: After an 8 week conditioning program, baseline parameters (V̇O₂max, pharyngeal pressure, peak airflows, upper airway resistance) and dynamic endoscopy videos were collected in a high-speed treadmill test (T1). Dorsal NPC was induced via bilateral glossopharyngeal neurectomy, followed by data collection 2 weeks later (T2). Laser fenestration of the dorsal pharyngeal recess was then performed, followed by final data collection 3 weeks later (T3). Respiratory performance parameters for T1-T2, T2-T3, and T1-T3 were compared using paired t-test (p < .05) to evaluate the impact of NPC and efficacy of surgery. Dynamic endoscopy videos were subjectively graded and compared.

Results: Moderate to severe dorsal NPC was successfully induced in five horses, with subjective improvement seen on dynamic endoscopy in 2/5 horses after fenestration. After NPC induction, V̇O₂max, minute ventilation, and peak expiratory flow rates decreased by 63.5 mL/kg/min (p = .006), 78.8 L/min (p = .039) and 21.8 L/s (p = .013) respectively. Following fenestration, peak inspiratory flow rates decreased by 7.1 L/s (p = .03). In the naturally occurring case, V̇O₂max increased by 12.9 mL/kg/min post-fenestration with subjective improvement in the degree of collapse.

Conclusion: Respiratory performance parameters worsened following NPC induction in comparison with the baseline and did not improve following laser fenestration.

Clinical significance: This experimental model did not support clinical application of laser salpingopharyngostomy to treat NPC.

Objective: To describe the technique of and complications associated with excising the nasal septum of horses with the horse standing and to report the outcome of horses undergoing this procedure.

Study design: Retrospective study.

Animals: A total of Twelve horses affected with disease of the nasal septum.

Methods: The septum of each horse was excised with the horse sedated. All horses underwent rhinotomy, and six also underwent laryngotomy, to position three loops of obstetrical wire used to make three of four septal incisions. The sites of laryngotomy and rhinotomy were desensitized by infiltrating local anesthetic subcutaneously at the sites of incision. The septum of all horses was desensitized topically by instilling local anesthetic into both nasal passages. The septum of 11 horses was desensitized by also anesthetizing the maxillary nerves and, for three of these 11, local anesthetic was instilled beneath the septal submucosa at the site of rhinotomy.

Results: The septum of each horse was resected safely. The hemorrhage observed at surgery appeared subjectively to be less than that observed when the same surgery is performed with the horse recumbent. A total of Eleven horses returned to their original and intended use, and one died, presumably from a complication associated with a maxillary nerve block.

Conclusion: The nasal septum can be excised safely with the horse standing by using sedation and topical, local, and regional anesthesia.

Clinical significance: Removing the nasal septum with the horse standing eliminates the expense and risks associated with general anesthesia.

Objective: To describe outcomes following high-metacarpal deep digital flexor tenotomy (DDFT) combined with Steward clog application in horses and ponies with refractory chronic laminitis.

Study design: Retrospective observational study.

Animals: Client-owned horses and ponies (7 horses, 8 ponies) with severe refractory laminitis.

Methods: Medical records (2018-2019) were reviewed. All underwent standing high-metacarpal DDFT tenotomy proximal to the accessory ligament (AL-DDFT) junction, followed by customized Steward clogs application. Preoperative assessment included radiography and venography. Postoperative management involved nonsteroidal anti-inflammatory drugs (NSAIDs), controlled exercise, and serial monitoring of comfort, alignment, and survival up to 24 months.

Results: Median follow-up was 24 months (range: 6-24 months). Six-month survival was 100% (7/7) in horses and 88% (7/8) in ponies. At 12 months, 43% (3/7) of horses and 88% (7/8) of ponies remained alive and improved to Obel grades 0-2. At 24 months, 43% (3/7) of horses and 50% (4/8) of ponies survived, one returning to light work. Obel grades at 24 months ranged from 0 to 2 (Obel 0: n = 3, Obel 1 = 3, Obel 2 = 1). A single distal interphalangeal joint (DIPJ) subluxation (4%, 1/26 limbs) resolved with corrective farriery. Target palmar angles (3°-10°) were achieved in all cases. The majority of non-survivors had endocrine-associated laminitis.

Conclusion: High-metacarpal DDFT tenotomy, with preservation of the AL-DDFT, combined with Steward clog application provided effective P3 realignment and lameness improvement with low DIPJ subluxation incidence.

Clinical significance: This technique maintained DIPJ stability in 25/26 joints and achieved outcomes comparable to previously described tenotomy methods.

Objective: To compare transarticular screw fixation (TSF), pedicle screw-rod fixation (PSRF), and screws and polymethylmethacrylate (SPMMA) for stabilization of the canine lumbosacral junction (LSJ).

Study design: Ex vivo biomechanical study.

Sample population: Twenty-one L7-S1 canine spine specimens collected from adult, large-breed dogs.

Methods: Specimens were subjected to nondestructive biomechanical testing in flexion/extension (FE), lateral bending (LB), and axial rotation (AR). Subsequently, the L7-S1 joint was destabilized by dorsal laminectomy and partial discectomy of L7-S1 and then stabilized by (1) TSF, (2) PSRF, or (3) SPMMA (n = 7 specimens/group). Stabilized specimens were subjected to nondestructive biomechanical testing, fatigue cyclic testing, and ramped cyclic testing. For nondestructive and fatigue cyclic testing, range of motion (ROM) was calculated for each testing condition/stabilization method, while for ramped cyclic testing the bending moment necessary to reach a ROM of 5.0°, 7.5° and 10.0° and failure mode were recorded. Linear mixed models and Fisher's exact test were used to analyze continuous parameters and failure modes, respectively.

Results: All stabilization methods resulted in an equal reduction in ROM in FE. Fatigue cyclic testing resulted in minor increases in ROM compared to baseline for all groups. Ramped cyclic testing resulted in failure of all groups, with no differences between groups for the bending moment necessary to reach 5.0°/7.5°/10.0° of ROM. The main failure mode for each method was progressive screw loosening.

Conclusion: Transarticular screw fixation, PSRF and SPMMA provided immediate biomechanical stability to the LSJ and were similar when subjected to fatigue and ramped cyclic testing.

Clinical significance: Transarticular screw fixation, PSRF, and SPMMA are biomechanically effective options for stabilizing the canine LSJ. This study supports clinical use of these procedures.

Objective: To evaluate the analgesic properties and adverse effects of liposomal bupivacaine administered via caudal epidural in horses.

Study design: Pharmacodynamic study.

Animals: A total of 10 healthy adult horses.

Methods: Liposomal bupivacaine (10 mL; 1.3%) was administered into the caudal epidural space via an indwelling epidural catheter inserted to a length of 15 cm. Mechanical nociceptive threshold (MNT) testing with pressure algometry was used to measure analgesia at four anatomic locations for 72 h following injection. Physical examinations (including rectal temperature, heart rate, respiratory rate, and ataxia scores) were performed every 4 h to monitor for adverse effects, and fecal and urine output were recorded.

Results: There were no significant differences detected at any time point in rectal temperature, heart rate, respiratory rate, or MNT at any anatomic site compared to baseline. Ataxia scores were significantly elevated from 24 to 36 h following epidural injection. Adverse events included recumbency in two horses, urinary retention necessitating urinary catheter placement in three horses and decreased fecal output requiring manual manure removal from the rectum in six horses.

Conclusion: Liposomal bupivacaine administered as a caudal epidural in horses resulted in ataxia and clinically relevant adverse effects but no detectable analgesia.

Clinical significance: Based on these findings, caudal epidural administration of liposomal bupivacaine in horses at the dose evaluated in this study is not recommended.

Objective: To compare diagnostic findings in neutral and flexed magnetic resonance imaging (MRI) of the lumbosacral joint (LSJ) performed for presurgical assessment in dogs with clinically suspected, diagnostically confirmed degenerative lumbosacral stenosis (DLSS), and to assess if these findings support the need for decompressive dorsal laminectomy/partial discectomy and/or foraminotomy in combination with distraction-stabilization techniques.

Study design: Retrospective, comparative study.

Animals: A total of 24 dogs with clinically suspected, MRI-confirmed DLSS that underwent dynamic LSJ imaging.

Methods: Medical records and MRI findings of included cases from three referral hospitals were reviewed. Quantitative and qualitative assessments of the LSJ (LSJ angle, protrusion ratios, degree of intervertebral disc [IVD] protrusion, ventral bulging of the ligamentum flavum [VBLF], foraminal compression) were compared in neutral and flexed positions. Their correlations with the degree of IVD degeneration or spondylosis was evaluated. Interindividual agreement was assessed among three observers.

Results: Degree of IVD protrusion, foraminal stenosis, VBLF, and protrusion ratios, were significantly reduced in flexion compared with neutral position (p < .001 for all comparisons). No dogs had persistent compression of the cauda equina or completely occluded foramina in flexion. The response of IVD protrusion to flexion was significantly directly correlated to the degree of IVD degeneration (p = .004), but not of spondylosis.

Conclusion: In flexed position, IVD protrusions, VBLF and foraminal stenoses improved in all cases, with resolution of all compression sites.

Clinical significance: With LSJ distraction-stabilization techniques, the need for concurrent decompressive dorsal laminectomy/partial discectomy or foraminotomy should be questioned, unless performed for IVD-spacer placement. Surgical case-control studies are required to investigate this further.

Objective: To identify pre- and intraoperative risk factors for complications occurring within 2 weeks following hepatic mass resection in dogs.

Study design: Retrospective case series.

Animals: A total of 96 client-owned dogs that underwent hepatic mass resection.

Methods: The evaluated preoperative variables were the signalment, clinical signs, presence of underlying diseases, blood test results (e.g., hematocrit), and computed tomography (CT) findings (mass location, maximum diameter, mass volume, and distance between the mass and the caudal vena cava [CVC]). The evaluated intraoperative variables were the surgical time, procedure details (e.g., surgical techniques), presence of intraoperative hypotension and hypoxemia, and blood transfusion. Comparisons were made between dogs with severe postoperative complications (including mortality) and those with mild or moderate complications. Univariable logistic regression was performed, and significant variables were used to construct multivariable models by combining them.

Results: Severe postoperative complications were observed in 17 dogs (17.7%), including six deaths (6.3%). Multivariable logistic regression analyses identified the presence of underlying diseases (OR: 2.703; p = .007), corrected distance from the mass to the CVC (OR: 0.666 per 0.1 cm/kg increase; p = .017), and intraoperative hypotension (OR: 3.589; p = .019) as risk factors for severe postoperative complications.

Conclusion: Among preoperative variables, both the presence of underlying diseases and the corrected distance from the mass to the CVC were associated with severe postoperative complications.

Clinical significance: Preoperative CT evaluation of the distance between the hepatic mass and the CVC, along with screening for underlying diseases, may contribute to improve the prediction of surgical risk.

Objective: To compare the biomechanical stability of a novel arytenoid implant (tie-bolt, TB) with a suture anchor (SA) and standard laryngoplasty using suture alone (control) in equine larynges.

Study design: Randomized ex vivo controlled experimental study.

Sample population: Thirty equine cadaver larynges.

Methods: Larynges were randomly assigned to TB, SA, or control groups (n = 10 each). The force of abduction was measured for each construct, then constructs underwent cyclic loading (5-50 N for 3000 cycles) to assess elongation, followed by load-to-failure testing to assess ultimate load, displacement, stiffness, and mode of failure.

Results: The SA required less force to achieve 88% abduction (8.31 ± 2.46 N) than the TB (11.48 ± 3.6 N, p = .07) and controls (11.86 ± 2.99 N, p = .04). The TB had less construct elongation (2.62 ± 0.61 mm) than SA constructs (3.87 ± 1.25 mm, p = .01) and was stiffer (31.05 ± 3.38 N/mm) than both control (23.48 ± 2.06 N/mm, p < .0001) and SA constructs (18.53 ± 4.15 N/mm, p < .0001). The TB construct failed at higher ultimate load and displacement (367.25 ± 66.98 N and 19.11 ± 2.51 mm, respectively) than the control (238.14 ± 19.46 N and 14.23 ± 1.6 mm; p < .0001 for both) and SA constructs (196.55 ± 47.17 N and 16.23 ± 2.02 mm; p < .0001 and p = .01, respectively). The primary modes of failure were suture cut-through for control, implant pullout for SA, and arytenoid fracture for TB.

Conclusion: The SA required the least force for abduction. The TB was a stiffer construct that resulted in higher failure loads.

Clinical significance: The SA may reduce construct loading during abduction. The TB offers superior mechanical stability, potentially reducing long-term degradation from cyclic loading.

Objective: To determine the outcome and prognostic variables associated with survival and complications in dogs undergoing right divisional hepatic lobectomies.

Study design: Multi-institutional retrospective case series.

Animals: A total of 70 client-owned dogs with right divisional hepatic masses.

Methods: Medical records of dogs undergoing right divisional hepatic lobectomies and partial lobectomies from January 1, 2008 to January 1, 2022 were reviewed and key variables were extracted. Univariable logistic regression estimated effects of risk factors. Kaplan-Meier survival curves estimated overall survival times (OST) and median survival times (MST).

Results: Intraoperative complications occurred in 38/70 (54.3%) dogs. A total of 15 dogs (21.4%) required blood transfusions. No surgical method was associated with intraoperative (p = .566), immediate postoperative (p = .756), or short-term complications (p = .799). Perioperative mortality risk was 2.9% and 30-day mortality risk was 12.1%. There were differences in survival based on the requirement for advanced hemodynamic support (p = .004). Hepatocellular carcinoma (HCC) was the most common diagnosis at 52.9%. The 1-, 2-, and 3-year survival rates for dogs with HCC were 77%, 55%, and 12%, respectively, with 35.3%, 48.8%, and 65.8% lost to follow-up at 1, 2, and 3 years.

Conclusion: Right divisional hepatic lobectomies were associated with a high intraoperative complication risk, with 21% of dogs requiring blood transfusions; however, no intraoperative deaths occurred. No surgical method was associated with greater risk of complications.

Clinical significance: Despite high intraoperative complication risks, right divisional lobectomy and partial lobectomy may carry a lower risk of perioperative mortality than previously considered.