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- Author or Editor: Eric Monnet x
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Abstract
Objective—To evaluate the outcome of dogs with perineal hernia treated with transposition of the internal obturator muscle.
Design—Retrospective case series.
Animals—34 dogs.
Procedures—Medical records of dogs with perineal hernia surgically treated from 1998 to 2012 were reviewed. Diagnostic methods and surgical techniques were recorded. Dogs were assigned preoperative and postoperative clinical sign scores. Complication and recurrence rates were evaluated over time. Risk factors were determined.
Results—Median follow-up time was 345 days (range, 22 to 1,423 days). Complications were observed in 10 dogs. Tenesmus (n = 9), dyschezia (7), fecal impaction (3), stranguria (4), hematochezia (2), urinary incontinence (2), diarrhea (1), urinary tract infection (1), and megacolon (1) occurred following surgery. Bladder retroflexion at the time of initial evaluation or surgery was not a risk factor for complication (hazard ratio, 1.72). One year after surgery, 51.2% dogs were free of complications. Three dogs developed a perineal hernia on the contralateral side between 35 and 95 days after surgery. The 1-year recurrence rate was 27.4%. Median time for recurrence was 28 days after surgery (range, 2 to 364 days). Postoperative tenesmus was a risk factor for the development of recurrence (hazard ratio, 2.29).
Conclusions and Clinical Relevance—Internal obturator muscle transposition was used for primary repair of perineal hernia in dogs. Recurrence was recorded as long as 1 year after surgery. Tenesmus was a risk factor for the development of recurrence after treatment of perineal hernia with internal obturator muscle transposition.
Abstract
OBJECTIVE To identify risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis.
DESIGN Retrospective case series.
ANIMALS 232 client-owned dogs with a diagnosis of laryngeal paralysis treated with lef-tsided unilateral arytenoid lateralization.
PROCEDURES Medical records were reviewed. Signalment, medical history, surgical complications, and outcome data were collected. Follow-up was performed via review of medical records and by telephone interview with the owner, referring veterinarian, or both.
RESULTS At the 1-, 3-, and 4-year follow-up periods, aspiration pneumonia occurred in 18.6%, 31.8%, and 31.8% of dogs, respectively. The 1-, 3-, and 4-year survival rates for dogs with postoperative aspiration pneumonia were 83.1%, 51.5%, and 25.8%, respectively. None of the dogs with aspiration pneumonia before surgery developed clinical signs of aspiration pneumonia after surgery. Postoperative megaesophagus (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.56 to 3.93) and postoperative administration of opioid analgesics prior to discharge (HR, 1.69; 95% CI, 1.12 to 2.80) were significant risk factors for the long-term development of aspiration pneumonia in this study. Perioperative metoclopramide administration did not significantly decrease the risk for development of aspiration pneumonia (HR, 0.94; 95% CI, 0.67 to 1.37).
CONCLUSIONS AND CLINICAL RELEVANCE In the present study, aspiration pneumonia was the most commonly reported postoperative complication of unilateral lateralization in dogs treated for laryngeal paralysis; however, preexisting aspiration pneumonia was not associated with an increased risk for development of aspiration pneumonia after surgery. Megaesophagus was identified as an important risk factor for eventual development of aspiration pneumonia. Administration of an opioid analgesic may increase the risk of aspiration pneumonia in dogs treated surgically for laryngeal paralysis.
Abstract
Objective—To compare the bursting strength of a vessel sealant device (VSD) with that of an encircling suture on uterine horns and bodies from dogs.
Sample—Uteri from 24 shelter dogs with unknown reproductive histories.
Procedures—Uterine horns and bodies were allocated to groups to be sealed with suture or a VSD. Uteri were then infused with saline (0.9% NaCl) solution until the seals burst or the uteri reached a maximal pressure of 300 mm Hg. Variables recorded included dog age, uterine body and horn diameter, and maximal pressure.
Results—The median (range) bursting pressure reached in sealed uterine horns was 300 (0 to 300) mm Hg for the VSD group and 300 (200 to 300) mm Hg for the suture group. Within the VSD group, seals of 2 of 3 uterine horns with a diameter ≥ 9 mm burst before intraluminal pressure reached 100 mm Hg, compared with 1 of 21 uterine horns with a diameter < 9 mm. The median bursting pressure for uterine bodies was 237 (0 to 300) mm Hg for the VSD group versus 300 (175 to 300) mm Hg for the suture group. Within the VSD group, seals in uterine bodies with a diameter ≥ 9 mm failed at a significantly lower pressure (125 [0 to 125]) mm Hg than those with a diameter < 9 mm (275 [125 to 300]) mm Hg.
Conclusions and Clinical Relevance—The failure pressure for both sealing techniques was high, which indicated that the VSD may be a safe instrument for sealing the uterine horn in dogs. Given the low mean bursting pressure for seals in uterine bodies with large diameters, the VSD cannot be recommended for sealing uterine bodies ≥ 9 mm in diameter.
Abstract
Objective—To evaluate the effect of protein concentration on rate of closure of ameroid constrictors in vitro.
Sample Population—Twenty-four 3.5-mm ameroid constrictors.
Procedure—Ameroid constrictors were equally allocated into 4 treatment groups; constrictors were placed in saline (0.9% NaCl) solution (control) or plasma diluted with saline solution to obtain protein concentrations of 1.5, 3, or 6 g/dL. Ameroid constrictors were incubated for 27 days. A digital camera was used to image ameroid constrictors in culture at 1, 6, 11, 16, 21, and 27 days, and the lumen diameter of each constrictor was measured.
Results—None of the rings were completely closed at 27 days. Mean final lumen diameter was 0.205 ± 0.22 mm. Mean final lumen diameter of constrictors in the control group was significantly larger than that of constrictors in the 1.5, 3, and 6 g/dL groups. Constrictors in the 1.5 g/dL group closed to a larger diameter than that of constrictors in the 6 g/dL group. Constrictors in the control group had the smallest overall change in lumen diameter, compared with constrictors in the 3 and 6 g/dL groups. Constrictors in the 1.5 g/dL group had a significant decrease in overall lumen diameter, compared with constrictors in the 3 and 6 g/dL groups. The diameter of the ameroid lumen was a function of time and protein concentration.
Conclusions and Clinical Relevance—High plasma protein concentrations resulted in rapid closure of the ameroid constrictor lumen. Complete closure of ameroid constrictors may not be attributable to imbibition of casein. (Am J Vet Res 2005;66:1337–1340)
Abstract
OBJECTIVE
To determine ideal insufflation pressures during transanal minimally invasive surgery (TAMIS) in canine cadavers for rectal submucosal transection and incisional closure.
ANIMALS
16 canine cadavers.
PROCEDURES
Cadavers were placed in lateral recumbency. Urinary catheters were placed to measure intra-abdominal pressure (IAP). A single access port was placed to establish a pneumorectum. Cadavers were placed in insufflation groups of 6 mmHg to 8 mmHg (group 1), 10 mmHg to 12 mmHg (group 2), or 14 mmHg to 16 mmHg (group 3). Defects in the rectal submucosa were created and closed with a unidirectional barbed suture. Duration for each procedure and subjective ease of identifying the transection plane and performing incisional closure were assessed.
RESULTS
The single access port was successfully placed in dogs weighing 22.7 kg to 48 kg. The ease of each step of the procedure was not influenced by the insufflation pressure. The median surgical duration for group 1 was 740 seconds (range = 564 to 951 seconds), 879 seconds (range = 678 to 991 seconds) for group 2, and 749 seconds (range = 630 to 1,244 seconds) for group 3 (P = .650). The insufflation pressure increased the IAP (P = .007). Perforation of the rectum happened in 2 cadavers in group 3.
CLINICAL RELEVANCE
The duration of each step of the procedure was not significantly influenced by insufflation pressure. Defining the dissection plane and performing resection was more challenging in the highest-pressure group. Rectal perforation occurred only with the 14 mmHg to 16 mmHg insufflation pressure. Single access port usage with TAMIS may provide a readily available, minimally invasive approach for the resection of rectal tumors in dogs.
Abstract
Objective—To compare leakage and maximum intraluminal pressures for a novel suture material with pressures for comparable suture material when used in closure of intestinal anastomoses in canine cadavers.
Sample—Healthy intestines from cadavers of dogs euthanized for reasons unrelated to the study.
Procedures—18 anastomoses were performed on intestinal sections within 72 hours after dogs were euthanized and intestinal samples collected. Anastomoses were performed with a simple continuous suture pattern. Leakage and maximum intraluminal pressures were measured and recorded for 6 control segments and 18 anastomosed sections. A barbed glycomer 631 suture (size 4–0 United States Pharmacopeia [USP]) was compared with glycomer 631 sutures (sizes 3–0 and 4–0 USP). Results for leakage and maximum intraluminal pressures were compared via an ANOVA.
Results—The barbed glycomer 631 suture material leaked at a significantly higher pressure than did the comparable glycomer 631 suture materials. Maximum intraluminal pressures were not significantly different among the suture materials.
Conclusions and Clinical Relevance—Barbed glycomer 631 4–0 USP suture material was as effective as glycomer 631 suture materials and may be a safe alternative for use in closure of enterectomies in dogs.
Abstract
Objective—To evaluate fluid pressures generated via common wound-flushing techniques.
Sample Population—24 combinations of bottles, needles, a syringe, and a bag.
Procedures—12 medically trained individuals used the following devices to forcefully expel fluid as for wound flushing: full and half-full 1-L and 500-mL bottles with holes in the cap made with 16-, 18-, 20-, and 22-gauge needles; a 35-mL syringe with the same needle sizes; and a 1-L bag placed in a cuff pressurized to 300 mm Hg, with the same needle sizes. Fluid expulsion pressures were measured and compared.
Results—The highest pressure generated with the bottle was 3.90 — 1.30 psi (mean — SD) with a 16-gauge needle and a full 1-L bottle. The highest pressure generated with the 35-mL syringe was 18.40 — 9.80 psi with a 16-gauge needle. The lowest pressure generated with the 35-mL syringe was 16.70 — 6.50 psi with an 18-gauge needle. The bag under pressure generated a pressure of 7.3 — 0.1 psi with a 16-gauge needle. Needle size did not have a significant effect.
Conclusions and Clinical Relevance—Solution bottles of any size and needle gauge do not meet the requirement for satisfactory flushing pressure of 7 to 8 psi. Use of a 35-mL syringe can produce pressure substantially > 7 to 8 psi, which could damage tissues. The most consistent delivery method to generate 7 to 8 psi was use of a 1-L plastic bag within a cuff pressurized to 300 mm Hg.
Abstract
Objective—To compare leakage and maximum intraluminal pressures of intestinal anastomoses with and without serosal patch supplementation in dogs.
Sample—Healthy small intestine segments from cadavers of 2 dogs euthanized for reasons unrelated to the study.
Procedures—12 enterectomy constructs were created by anastomosis of intestinal segments with a standard simple continuous suture pattern. Half of the constructs were randomly selected for additional serosal patch support. Leakage and maximum intraluminal pressures were measured in and compared between patch-supplemented and nonsupplemented constructs.
Results—Mean ± SD leakage pressure was significantly greater for the patch-supplemented anastomoses (81.8 ± 6.7 mm Hg) than for the nonsupplemented anastomoses (28.0 ± 6.7 mm Hg). Maximum intraluminal pressures were not significantly different between the groups.
Conclusions and Clinical Relevance—Serosal patch–supplemented anastomoses were able to sustain a significantly higher pressure before leakage than were nonsupplemented anastomoses in intestinal specimens from canine cadavers. The serosal patch supplementation may protect against leakage immediately after enterectomy in dogs.
Abstract
Objective—To determine long-term outcome of dogs treated surgically for idiopathic chylothorax.
Design—Retrospective case series.
Animals—11 client-owned dogs with idiopathic chylothorax that underwent surgery between November 1995 and April 2009 and had been followed up for at least 4 months after surgery.
Procedures—Medical records were reviewed for information on signalment, history, physical examination findings, results of clinicopathologic testing, radiographic findings, surgical procedures, postoperative complications, outcome, and cause of death.
Results—A median sternotomy was performed in 10 dogs, and a right intercostal thoracotomy (fifth and ninth intercostal spaces) was performed in 1. Thoracic duct ligation and subtotal pericardectomy were performed in all dogs. Thoracic omentalization was performed in 8 dogs at the time of surgery, passive pleuroperitoneal shunting was performed in 2 dogs, and pleurodesis was performed in 1 dog. Lung lobectomy was performed because of lung consolidation in 2 dogs and lung lobe torsion in another 2 dogs at the time of the initial surgery. Median disease-free interval did not differ significantly between dogs that did and did not undergo lung lobectomy. Postoperative complications occurred in 5 dogs. Median follow-up time was 46 months. Eight of 11 dogs were free from clinical signs 5 years after surgery. Two of the 3 dogs that did not undergo thoracic omentalization had a recurrence of clinical signs.
Conclusions and Clinical Relevance—Results suggested that the prognosis for dogs surgically treated for idiopathic chylothorax was fair and that lung lobectomy was not a negative prognostic indicator.
Abstract
Objective—To evaluate anatomic landmarks to define the ideal suture placement location to achieve appropriate and consistent arytenoid cartilage abduction via unilateral cricoarytenoid lateralization (UCL) in dogs.
Sample—6 cadaveric canine larynges.
Procedures—Laryngeal airway resistance (LAR) was determined for each specimen before (baseline) and after suture placements with the epiglottis open and closed. To achieve UCL, suture was placed through the cricoid cartilage just caudal to the cricoarytenoid articulation (suture placement position [SPP] 1), one-fourth of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 2), and three-fourths of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 3). The LAR was again calculated after tensioning of each suture separately.
Results—With a closed epiglottis, median LAR was 30.0, 20.4, 11.4, and 3.3 cm H2O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPP 1, LAR with the epiglottis closed was not significantly different from that at baseline. With an open epiglottis, median LAR was 2.0, 0.4, 0.2, and 0.0 cm H2O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPPs 1, 2, or 3, LAR with an open epiglottis was significantly lower than that at baseline.
Conclusions and Clinical Relevance—Results indicated that placement of suture through the cricoid cartilage at the caudal border of the cricoarytenoid articulation was appropriate to sufficiently reduce LAR without increasing the risk of aspiration pneumonia through overabduction of the arytenoid cartilage.
