Veterinary Surgery最新文献

Objective: To report the use of a pericardial patch graft to repair a post-traumatic caudal vena cava cicatrix in a dog.

Study design: Case report.

Animals: A 1 year-old Rottweiler presenting with ascites following presumed blunt thoracic trauma.

Methods: Kinking of the caudal vena cava and resultant Budd-Chiari-like syndrome was diagnosed on echocardiography and computed tomographic angiography (CTA). Surgical exploration via right sixth intercostal thoracotomy was performed. Release of the cicatrix was unsuccessful in reducing the pressure gradient and a pericardial patch graft repair of the thoracic caudal vena cava was therefore performed to relieve the obstruction.

Results: The dog recovered from surgery and was discharged after 3 days. Follow-up at 6 weeks showed resolution of ascites and all clinical signs. Owner telephone follow-up at 24 months post-surgery confirmed that the dog remained clinically normal.

Conclusion: A pericardial patch graft technique can be used successfully to reconstruct the thoracic caudal vena cava, in cases of traumatic kinking where dissection of the fibrotic band alone fails to reduce caudal caval pressure.

Objective: To measure truncated face and open face versions of the biological fixation (BFX) cup in a three-dimensional (3D) model simulating the ventrodorsal radiographic projection with different cup and pelvis positions.

Study design: Computer simulation.

Methods: Simulated ventrodorsal views were generated in silico using 3D models of a BFX cup and a medium-sized canine pelvis. Truncated face and open face versions of the BFX cup were defined and measured with various angles of cup version, cup inclination, and pelvic extension.

Results: Truncated face version was different from and underestimated open face version by 12° to 22° (p < .001). Open face version varied with inclination while truncated face version was unaffected by inclination. Open face version was dependent on the degree of pelvic extension while truncated face version was unaffected.

Conclusion: Open face version differed from truncated face version. Changes in open face version were not consistently matched by a change in truncated face version.

Clinical significance: The open face of the cup may be excessively retroverted without this being reflected by truncated face retroversion as seen on a ventrodorsal radiographic view. However, in this study, BFX cups placed with truncated face version and inclination in the normal range and an ALO of 45° yielded predictable open face version.

Objective: To describe the technique for anastomosis of the caudal thoracic duct (TD) to the 10th or 11th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) device in dogs and assess patency of the anastomosis on days 0 and 30.

Study design: Experimental study.

Sample population: Six adult Beagle dogs.

Methods: Under general anesthesia, fluoroscopic popliteal lymphangiography was performed and the TD identified. A right ninth or 10th intercostal thoracotomy was performed. Using an operating microscope, the TD and the 10th or 11th ICV were isolated, ligated, and anastomosed using a 1.5 or 2.0 mm MAC. Fluoroscopic popliteal lymphangiography was repeated immediately after surgery and on day 30.

Results: The anastomosis was successful and lymphangiography documented flow into the azygos vein in all six dogs immediately after surgery. At day 30, the anastomosis was patent in four of six dogs. In two dogs, flow through the anastomosis was obstructed due to kinking of the ICV just cranial to the MAC.

Conclusion: Anastomosis of the TD and ICV using a MAC was feasible and was shown to maintain patency up to 30 days. When performing the anastomosis, care should be taken to ensure the ICV is not kinked by the MAC.

Clinical significance: Direct anastomosis of the TD and ICV may have application for treatment of idiopathic chylothorax in dogs by maintaining flow from the abdominal lymphatics to the central venous circulation and thereby preventing the stimulus for collateral circulation and persistent chylous effusion. Further investigation is warranted to assess the efficacy of this technique in dogs affected with idiopathic chylothorax.

Objective: To compare strength of left paramedian colopexies using various techniques in equine ex vivo models.

Study design: Experimental study.

Sample population: Equine cadavers euthanized for nongastrointestinal pathology (36 specimens derived from 9 horses).

Methods: Colopexies were performed after euthanasia. Suture pattern (horizontal mattress vs. cruciate) and incorporation of dorsal sheath of the rectus abdominis (partial-thickness) versus incorporation of dorsal and ventral sheath of the rectus abdominis (full-thickness) were evaluated. Single cycle load to failure, work to peak load, stiffness, and mode of failure of colopexy tissue constructs were assessed.

Results: Mean load to failure of all constructs ranged from 102.26 to 166.38 N. Partial-thickness bites demonstrated a mean load to failure and standard deviation (SD) of 111.91 (35.88) N and 102.26 (30.06) N (p < .05) which was significantly lower than the mean and SD of full-thickness bites (166.3 [72.42] N and 163.21 [51.40 N]), respectively. All full-thickness bites regardless of suture pattern and over half of partial-thickness bites failed at the colonic wall. There was no significant difference in load to failure compared to mode of failure.

Conclusion: A stronger colopexy was achieved with a full-thickness bite regardless of the suture pattern. The most common mode of failure was the colon wall.

Clinical significance: Incorporating ventral and dorsal fascia of the rectus abdominus provided a stronger colopexy structure, which may necessitate a second incision or subcutaneous palpation of the needle when performing a colopexy. The lateral band of the colon failed in most constructs (77%) regardless of technique, which could weaken the colonic wall and risk colonic rupture.

Objective: To compare survival and report perioperative complications in cats undergoing surgery for small intestinal (SI) linear (LFBO) and discrete (DFBO) foreign body obstructions (FBO). To report success of a red rubber catheter technique (RRCT) to remove LFBOs.

Study design: Retrospective study.

Animals: Client-owned cats (n = 169).

Methods: Medical records of cats undergoing surgery for SI FBO from a veterinary teaching hospital between February 2012 and January 2023 were classified as LFBO, DFBO, or both linear and discrete FBO (BFBO). Signalment and perioperative data were collected.

Results: Preoperative hypoalbuminemia (LFBO: n = 1/6; DFBO: n = 5/6) and septic peritonitis (LFBO: n = 2/4; DFBO: n = 0/4; BFBO: n = 2/4) were rare. Intraoperative hypotension did not differ between LFBOs and DFBOs (p = .4756). RRCT was successful in 20/24 attempts of LFBO removal. Three cats were euthanized intraoperatively (LFBO: 1; DFBO: 1; BFBO: 1). Postoperatively, two cats (DFBO) experienced intestinal dehiscence and two cats (DFBO) died or were euthanized. Survival to discharge (p = 1.0000) and postoperative complications (p = .1386) did not differ between LFBOs and DFBOs.

Conclusions: Postoperative complications and survival did not differ between cats with LFBOs and DFBOs. Intestinal dehiscence secondary to FBO in cats is rare. A RRCT can be successful in many cats with LFBOs.

Clinical significance: Cats with LFBOs and DFBOs have similar postoperative complication rates and survival to discharge when preoperative septic peritonitis is not present. Intestinal dehiscence is rare, which is important when discussing surgical prognosis with owners. A RRCT can be considered to remove LFBOs when there is concern for multiple enterotomies.

Objective: To identify which aspiration technique increased plasma platelet concentration and which technique minimized plasma leukocyte and erythrocyte concentrations using a gravitational double-syringe platelet rich plasma (PRP) system.

Study design: Controlled laboratory study.

Animals: Thirty adult dogs.

Methods: Whole blood was collected into two autologous conditioned plasma (ACP) syringes and an ethylenediaminetetraacetic acid (EDTA tube) (control samples). The ACP syringes were centrifuged for 5 min at 1500 rpm. The proximal 2 mL of plasma from one ACP syringe was deposited in an EDTA tube (preflash samples). Plasma from the second ACP syringe was withdrawn until the buffy coat was pierced, producing a "flash" of red blood cells, agitated and deposited into an EDTA tube (flash samples). Complete blood counts were performed.

Results: Mean plasma platelet concentrations of the control, preflash, and flash samples were 2.4 × 10⁵/dL, 3.3 × 10⁵/dL and 4.1 × 10⁵/dL, respectively. The mean platelet concentration of the flash samples was 7.9 × 10⁴/dL higher than the preflash samples (p = .005). The mean platelet concentration was lower in the control samples than the preflash (p = .002) and flash (p < .0001) samples. The median plasma leukocyte concentration of the preflash samples (0/dL) was lower than in the flash samples (2.4 × 10³/dL) (p = .001). The median plasma hematocrit value of the preflash samples (0%) was lower than in the flash samples (1.0%) (p = .002).

Conclusion: The flash method is not necessary to produce a PRP sample.

Clinical significance: Both methods produced PRP. However, clinicians should avoid aspirating the buffy coat when processing PRP for therapies where leukocytes and erythrocytes are contraindicated.

Dogs with a brachycephalic conformation often experience a collection of abnormalities related to their craniofacial conformation, which can lead to a variety of clinical signs such as stertor, exercise intolerance, respiratory distress, and gastrointestinal signs such as regurgitation, among others. This collection of abnormalities is termed brachycephalic obstructive airway syndrome (BOAS). With the rise in popularity of several brachycephalic breeds, veterinarians and veterinary surgery specialists are seeing these dogs with increasing frequency for surgical and medical treatment of these clinical signs, leading to an increased interest in developing surgical techniques for dogs with BOAS and evaluating objective methods of determining outcome after surgery. Advances in anesthetic management including standardized protocols and use of local nerve blocks to decrease opiate use may decrease postoperative complications. A variety of new or modified surgical techniques to manage hyperplastic soft palate and stenotic nares, among other BOAS components, have been developed and studied in recent years. Newer studies have also focused on risk factors for development of major complications in the postoperative period and on objective measurements that may help determine which patients will receive the most benefit from BOAS surgery. In this review, the newest studies focused on updates in anesthetic management, surgical techniques, and postoperative care will be discussed. Additionally, updated information on complication rates and outcomes for dogs undergoing surgical management of BOAS will be included.

Objective: To identify small animal surgery (SAS) residency program factors associated with board examination pass rates for the American College of Veterinary Surgeons (ACVS) board certification examinations.

Study design: Online survey.

Sample population: Program directors of ACVS-registered SAS residency programs.

Methods: An online survey was distributed to eligible 2021 ACVS SAS residency program directors. Respondents provided program information and Phase I and Phase II board examination pass rate data from 2017 to 2021. Programs were grouped based on overall combined board examination pass rates as "excellent" (≥90%) versus "adequate" (<90%). Data were analyzed using recursive partitioning.

Results: Responses from 36 ACVS SAS residency programs (18 private practice [PP], 18 academic programs [AP]) were included. Pass rates were considered "excellent" for 17/36 programs (11/17 AP, 6/17 PP). The strongest indicator of "excellent" programs was most mentors participating in rounds >75% of the time. Of those, the second indicator of "excellent" programs was a soft tissue caseload of <7 surgeries/resident/week. If the soft tissue caseload was >7 surgeries/resident/week, a high orthopedic caseload (>9 surgeries/resident/week) was indicative of "excellent" programs. If most mentors were not participating in rounds >75% of the time, APs were more likely to be "excellent."

Conclusion: SAS APs may have higher ACVS board examination pass rates. Mentor involvement, caseload, and residency practice type may influence board examination pass rates.

Clinical impact: ACVS SAS residency programs' board examination pass rates may improve by optimizing mentor involvement and caseload regardless of practice type.

Objective: To report the technique and the outcome for the repair of pelvic fractures in cats using external skeletal fixation (ESF).

Study design: Retrospective case series.

Animals: Client-owned cats (n = 125).

Methods: Medical records of cats with pelvic fractures, treated with an ESF between June 2001 and June 2009, were reviewed. Preoperative, immediate postoperative, and more than 4 weeks' postoperative radiographs were compared. Clinical examination was performed 4 to 9 weeks following surgery. Longer term follow up (4 to 80 months) was conducted by client questionnaire.

Results: No intraoperative complications occurred. There was no change in the pelvic canal width observed on follow-up radiographs (p = .16). Implant loosening was noted on follow-up radiographs in 16/125 (13%) of cases, and 67/803 (8%) pins were palpably loose at the time of frame removal. The mean time to frame removal was 37 ± 9 days. No long-term complications were reported. Long-term mean mobility score was 95 ± 5 and median lameness was 0 (range: 0-2).

Conclusion: An ESF may be successfully applied for the stabilization of various pelvic fractures in cats.

Clinical significance: The application of an ESF for the management of pelvic fractures in cats provides good outcomes.

Objective: To report gross anatomical gastrointestinal measurements and compare enterotomy leak pressures between fresh and cooled feline cadavers.

Study design: Ex vivo, randomized study.

Animals: Fresh feline cadavers (n = 20).

Methods: Jejunal segments (8 cm) were harvested on the same day as euthanasia. From each cadaver, one segment was randomly assigned to control (C), fresh enterotomy (FE), and cooled enterotomy (CE) groups. Enterotomy construction and leak testing were performed within 12 h of euthanasia for the C and FE groups and after 17-29 h of cooling for the CE group. Initial leak pressure (ILP) and maximum intraluminal pressure (MIP) were compared. Gastrointestinal wall thickness and intraluminal diameter were measured on harvested applicable gastrointestinal divisions at up to three time points: day 1 fresh, day 2 cooled, and day 3 cooled.

Results: The mean (± SD) ILPs for the C, FE, and CE constructs were 600 (± 0.0), 200.3 (± 114.7), and 131.3 (± 92.6) mmHg, respectively. The C ILP was higher (p < .001) than the FE and CE ILP. The ILP (p = .11) and the MIP (p = .21) did not differ between the FE and CE constructs. Wall thickness (measured in mm) did not differ between duodenum day 1 fresh and day 2 cooled groups (p = .18) or between any jejunum day groups (p = .86). The intraluminal diameters (mean ± SD) for the duodenum, jejunum, and ileum were 5.7 (± 0.7), 5.8 (± 0.8), and 7.2 (± 2.2) mm, respectively.

Conclusion: No difference was appreciated between FE and CE ILP and MIP. Wall thickness measurements did not differ between days for duodenum or jejunum.

Clinical relevance: Cadaveric feline intestine cooled for up to 29 h may be used for determining intestinal leak pressures.