Veterinary Surgery最新文献

Objective: To describe a portal venotomy technique and outcome for tumoral thrombus removal in a dog with insulinoma invading the portal vein.

Study design: Case report.

Animals: A 9-year-old entire male West Highland White Terrier.

Methods: The dog was referred for further investigation of recurrent collapsing episodes and weakness. An abdominal ultrasound revealed a pancreatic mass. Biochemical tests were consistent with insulinoma. A dynamic (4D) contrast-enhanced computed tomography (CT) perfusion study showed a large pancreatic mass originating from the left lobe of the pancreas invading both the portal and splenic veins directly. The portal vein was 80% occluded between the gastroduodenal and splenic vein entry points. The dog underwent partial pancreatectomy, splenectomy, and portal venotomy. Following identification of the thrombus by direct visualization and palpation, Rummel tourniquets were used to isolate the segment of the portal vein, and portal venotomy was performed over the thrombus. The venotomy was repaired with primary closure. Intraoperative hemorrhage was absent following the release of the vascular isolation.

Results: Histopathology was consistent with insulinoma. The dog was discharged 4 days after surgery. Short-term follow up revealed an absence of postoperative complications. The dog was started on adjuvant therapy, and the re-examination 3 months after surgery showed an absence of the clinical signs and a good quality of life. One year after surgery, the dog is still alive with confirmed metastatic disease.

Conclusion: Portal venotomy was successful for thrombus removal and this dog tolerated temporary occlusion of the portal vein well. Careful preoperative CT planning is crucial for good surgical outcomes.

Objective: To determine the accuracy and safety of two landmark-guided techniques for shoulder arthrocentesis and injection.

Study design: Ex vivo prospective study.

Animals: A total of 36 paired canine cadaver forelimbs.

Methods: An electronic survey was used to assess the prevalence of injection technique amongst surgeons in clinical practice. Thoracic limbs were randomized to technique for shoulder arthrocentesis and injection (subacromial [SA], n = 18, or supratubercular [ST], n = 18). Repositions, attempts, and the acquisition of synovial fluid was recorded. After the needle was placed, contrast was injected into the joint to determine accuracy of position. The radiographic presence of intra-articular contrast was judged as an accurate injection. Shoulders were disarticulated and India ink assay performed to assess for iatrogenic articular cartilage injury (IACI).

Results: Both SA and ST techniques were not accurate. Completely accurate injection was identified in 50% SA and 44% ST (p = .80). IACI was identified in 50% SA versus 11% ST (p = .027). There were no significant differences in repositions, attempts, presence of synovial fluid (p = .5, p = .6, p = .7).

Conclusion: Landmark-guided shoulder injections performed via SA and ST approaches in cadaveric dog shoulders are overall inaccurate. If performing landmark-guided shoulder injection, ST technique carries a lower risk of IACI than SA in cadaveric shoulders.

Clinical significance: Landmark-guided shoulder injections are inaccurate in dogs and may result in treatment failure. A ST approach may be considered preferable due to the lower risk of cartilage damage. Future studies should assess ultrasound-guided techniques to improve accuracy and safety.

Objective: To investigate the occurrence, degree, and risk factors associated with arthroscopic stifle joint synovitis in dogs with cranial cruciate ligament (CCL) disease.

Study design: Retrospective, observational study.

Sample population: Canine CCL disease (n = 163) from 149 dogs and their arthroscopic video recordings.

Methods: Arthroscopic video recordings were reviewed. A synovitis severity (0-5) and a modified Outerbridge cartilage classification system score were assigned, along with recording the presence or absence of a medial meniscal bucket handle tear. Medical records were reviewed for age, sex, limb, and duration of clinical signs. Univariate analyses were performed via a Fisher's exact test for categorical independent variables, and ordered logistic regression was used for continuous variables. Multivariable ordered logistic regression considered independent variables with a p-value <.2 on univariate analyses. p-value <.05 was considered statistically significant.

Results: Synovitis was identified in 100% of the stifles examined. The most frequent synovitis severity score was 3/5. Univariate analysis showed a significant association between synovitis severity score and bodyweight (p = .005), median cartilage score (p = .002), and being female (p = .032). On multivariable analysis, the synovitis severity score was significantly associated with median cartilage score (p = .042) and duration of clinical signs (p < .001).

Conclusion: Synovitis was arthroscopically always identified in stifles with CCL disease. The severity of synovitis was associated with more progressive damage to the articular cartilage and a longer duration of clinical signs.

Clinical significance: Earlier intervention in dogs with CCL disease may be warranted to decrease synovitis and progression of osteoarthritis.

Objective: To describe the outcome of metacarpophalangeal (MCPJ) and proximal interphalangeal joint (PIPJ) arthrodesis using a locking compression-distal femur plate (LCP-DFP) in Thoroughbred racehorses with traumatic disruption of the suspensory apparatus (TDSA) at risk of PIPJ subluxation.

Study design: Multicenter retrospective study.

Animals: Twenty-six Thoroughbred racehorses.

Methods: Records of Thoroughbred racehorses with TDSA that had undergone MCPJ and PIPJ arthrodesis using an LCP-DFP at three referral hospitals between 2020 and 2024 were reviewed for inclusion. The preoperative data collected included signalment, affected limb, and type of injury. All postoperative complications were recorded. Long-term outcomes were obtained from medical records and telephone interviews.

Results: Nine females, 14 geldings, and three intact males with TDSA were treated via double arthrodesis using an LCP-DFP. The most common postoperative complications included support limb laminitis, incisional drainage, implant infection with osteomyelitis, and distal interphalangeal joint subluxation. No horses developed PIPJ subluxation. Twenty (76.9%) horses developed short-term complications. Thirteen (50%) horses survived long term (>6 months, range 6-32 months) and were reported to be pasture sound without receiving any analgesic or antiinflammatory medication.

Conclusion: Metacarpophalangeal and PIPJ arthrodesis using an LCP-DFP in racehorses resulted in a stable construct with no horses developing subluxation of the PIPJ joint postoperatively. Arthrodesis using an LCP-DFP was associated with a fair prognosis for pasture soundness.

Clinical significance: Application of an LCP-DFP may prevent subluxation of the PIPJ; however, the prognosis is still affected by the high prevalence of other complications and associated mortality among horses that suffer TDSA.

Objective: To describe the surgical technique and clinical outcome following revision of osteointegrated acetabular cups.

Study design: Retrospective case series.

Animals: Nine client-owned dogs undergoing revision surgery for total hip replacement (THR) with an osteointegrated cup.

Methods: Cases were recruited retrospectively from a single referral hospital for dogs undergoing revision surgery following THR. Cups were explanted using a combination of an osteotome and air burr and new cups were implanted. Owners were contacted to determine the medium- to long-term outcome.

Results: Surgery was performed at a median of 587 days (range 97-994 days) after initial surgery. Indication for revision was luxation (7), stem fracture (1), and stem loosening (1). All cups (8 BFX, BioMedtrix, 1 Helica) were successfully explanted and replaced with a BFX, BioMedtrix cup. Seven revisions required replacement with a larger cup than the primary cup size. Eight cases had minimal lameness 6 weeks postoperatively; one dog experienced repeat luxation, which resolved after open reduction and hobble placement. One dog presented with septic cup loosening 540 days postoperatively. Radiographically, all cups were stable at short-term follow up (median 45 days, range 35-618 days). Medium- to long-term functional outcome (median 621 days, range 251-1903 days) for the 6 dogs available was graded as good to excellent.

Conclusion: Cup revision of stable, osteointegrated cups can be successfully performed with the BFX BioMedtrix cup but often requires use of a larger sized implant compared to that used for the primary procedure.

Clinical significance: Revision of osteointegrated acetabular cups is a viable technique, with minimal complications encountered.

Objective: To determine the impact of a two-stage rumen cannulation on the health and rumen function of lactating dairy cows.

Study design: Experimental study.

Animals: Six lactating Holstein cows.

Methods: We performed a two-stage rumen cannulation in six Holstein cows that were 49 ± 11 days in milk. The following clinical health parameters and digestion-associated variables were analyzed on seven measurement days, from before the first surgery until 28 days after the second surgery: body temperature, heart rate, respiratory rate, pain score, rumen fill score, fecal score, wet sieving, auscultation and palpation of the rumen, bodyweight, body condition score, and activity.

Results: The pain score of the cows was constantly zero. Similarly, the body temperature and respiratory rate remained within physiological ranges, whereas the heart rate was slightly higher immediately after the second surgery. No differences were observed in rumen fill (2.00-2.67; p = .10) and fecal consistency scores (2.17-2.67; p = .42). The fecal particle size distribution showed negligible differences. The cows lost approximately 43 kg of bodyweight during the experiment (p < .01), which was reflected in a 0.5-point body condition score loss (p < .01).

Conclusion: A temporary minimal negative effect of a two-stage rumenostomy on the health and body condition of early lactating Holstein cows was observed, whereas digestion was unaffected. Considering the limited sample size, further studies are required to substantiate these findings.

Clinical significance: Given that animals are appropriately medically managed, experimental rumenostomy of lactating dairy cows may not compromise their health or rumen function.

Objective: To compare the effectiveness of a modified surface gelatin sponge to a plain collagen sponge for hemostasis of parenchymal hepatic bleeding.

Study design: Prospective, randomized trial of two hemostatic agents.

Animals: A total of 45 dogs undergoing elective liver surgery were randomly allocated into two groups: 22 in the adhesive gelatin (AG) group and 23 in the plain collagen (PC) group. A total of 20 patients per group underwent liver biopsy to create a uniformly sized bleeding surface, with the remaining patients (AG = 2, PC = 3) undergoing liver lobectomy.

Methods: Evaluation of hemostatic effectiveness and tissue adhesion of each sponge type was performed by the operating surgeon using structured scoring systems. Hemostatic parameters were primarily evaluated at the liver biopsy site to maintain homogeneity of bleeding surface size.

Results: For the liver biopsy group (n = 40), 5 min after hemostatic sponge application, 10/20 dogs were bleeding in the PC group, compared to 2/20 in AG group (p = .0138). The PC bleeding was significantly higher than AG across the 3 to 6 min evaluation period (p < .001). When surgeons tested the adhesion of the sponge across the whole cohort (n = 45), AG scored 2 (of 3) against 1 for PC (p < .001). In group PC, 5/23 sponges dislodged during abdominal lavage and preparations for closure and had to be replaced due to recurrence of bleeding, compared with no AG sponges dislodging (p = .042). There were no further complications related to the use of either sponge.

Conclusion: In the dogs with hepatic parenchymal incision, use of an adhesive gelatin sponge improved intraoperative attachment and haemostatic effectiveness, compared to a collagen sponge.

Clinical significance: Based on our clinical experience in these cases, adhesive gelatin sponges could be considered an effective option when selecting a hemostatic agent for liver surgery in dogs.

Objective: To report a radical surgical technique for perianal melanomas involving the anal margin in standing horses.

Study design: Observational retrospective study.

Sample population: Twenty client-owned horses presented for surgical excision of extensive (≥4 cm) perianal melanomas.

Methods: Demographic data, surgical technique, intraoperative, immediate- and late-postoperative complications were reviewed.

Results: All horses (median age 15, Q1-Q3 12 to 17.3 years) were operated under standing sedation and epidural anesthesia. Median hospitalization period was 6.5 days (Q1-Q3 5 to 8.3 days). The anal margin was fully resected in 14 cases. A deep perirectal dissection was performed in 16 cases. Eight cases required additional local anesthetics. One case bled profusely during and after the procedure. One case became recumbent during the procedure, showed intense postoperative pain, and was eventually euthanized 6 weeks later because of ataxia. During hospitalization, one horse displayed colic signs and 10 others required manual evacuation of the rectum because of decreased fecal output. Complications after hospital discharge included mild colic signs (n = 4), partial wound dehiscence (n = 1) and hypergranulation of the wound (n = 2). All other cases healed without complications in 6 to 12 weeks. Median follow-up period was 11.8 months (Q1-Q3 6.3 to 27.2 months). Six horses developed new melanomas with only one in the perianal region.

Conclusion: This technique of surgical excision of extensive perianal melanomas was efficiently performed on standing horses with minimal local recurrence. This procedure led to high client satisfaction. Early postoperative pain was commonly encountered. Owners should be warned of the potentially large surgical wound that will be created.

Clinical significance: This technique allowed for removal of large perianal melanomas with limited recurrence during the long term follow up and may improve the quality of life of affected horses.

Objective: To describe unicondylar humeral fracture (UHF) repair using cannulated transcondylar screws, report postoperative fracture reduction, healing, and complication rates.

Study design: Retrospective.

Animals: A total of 49 client owned dogs with UHF.

Methods: Surgical technique and approach (i.e., open, limited open, or minimally invasive) were recorded. Articular step defect (ASD) and gap (Gap) at the humeral condylar articular surface were measured on pre- and postoperative images and reported as percentages. Fracture healing was graded on follow-up radiographs. Functional outcome was based on client questionnaire over the phone. General linear models were used to assess the impact of surgical approach on %ASD, %Gap, whereas Cox regression was used to assess prognostic factors of full fracture healing.

Results: A total of 49 fractures repaired with a transcondylar screw with or without an antirotational pin(s) were included. Surgical approach did not have an impact on postoperative %ASD, %Gap or development of complications. The overall complication rate was 26% (11/42), with no revision surgery necessary. Of the dogs that encountered complications, 50% required pin and/or screw removal after fracture healing. For 29 dogs with a minimum of four-month owner telephone questionnaire follow-up, 90% reported no lameness and only three reported intermittent lameness. Achieving complete fracture healing was affected by increased postoperative %ASD (p = .033).

Conclusion: The UHFs repaired by transcondylar cannulated screws had acceptable outcomes and fracture reduction with complication rates being similar regardless of the surgical approach.

Clinical significance: Cannulated screws can be implanted with varying surgical approaches to successfully repair UHFs with comparable clinical outcome to previous reports.

Objective: To describe a modified closed sacculectomy technique for non-neoplastic anal sac disease in dogs, and to describe the management and short-term outcomes in dogs undergoing sacculectomy by the described technique.

Study design: Retrospective case series.

Sample population: A total of 50 dogs.

Methods: Electronic medical records were reviewed to identify dogs undergoing bilateral anal sacculectomy for non-neoplastic anal sac disease using the described closed technique between January 1, 2013 and February 1, 2024.

Results: A total of 50 dogs underwent bilateral anal sacculectomy for non-neoplastic anal sac disease. Intraoperative anal sac perforation was reported in five dogs (10%). A total of 43 dogs were available for two-week follow-up. Grade 1 complications were reported in 14/43 dogs (32%), grade 2 complications in 2/43 dogs (5%), and grade 3B in 2/43 dogs (5%). At two-weeks postoperatively, 13/14 dogs (93%) had resolution of grade 1 complications. Both dogs with grade 2 complications had resolution reported at two weeks postoperatively, and both dogs with grade 3B complications had resolution reported at two weeks following revision surgery.

Conclusion: Intraoperative complications consisted of anal sac perforation without further complication. Minor postoperative complications were mostly self-limiting, supporting previous literature. Major complications were infrequent and resolved following single revision surgery.

Clinical significance: The technique reported provides an alternative to excise intact and non-neoplastic anal sacs in dogs. The key features of this technique are immediate anal sac identification by following the anatomic path of the duct, minimal peri-saccular dissection, no requirement for packing of the anal sac, and complete removal of the duct and anal sac.