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Evaluation of cellophane banding with and without intraoperative attenuation for treatment of congenital extrahepatic portosystemic shunts in dogs

Daniel Frankel DVM, MS, DACVS1, Howard Seim DVM, DACVS2, Catriona MacPhail DVM, DACVS3, and Eric Monnet DVM, PhD, DACVS4
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  • 1 Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft Collins, CO 80525.
  • | 2 Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft Collins, CO 80525.
  • | 3 Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft Collins, CO 80525.
  • | 4 Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft Collins, CO 80525.

Abstract

Objective—To evaluate the effect of intraoperative attenuation of congenital extrahepatic portosystemic shunts (CEPSSs) during cellophane banding procedures in dogs.

Study Design—Retrospective case series and prospective study.

Animals—18 cases evaluated retrospectively and 14 dogs evaluated prospectively.

Procedures—Gradual occlusion of CEPSSs was performed via cellophane banding. Shunts were occluded to a diameter < 3.0 mm during surgery in dogs prospectively enrolled in the partial attenuation group, whereas the shunt was not attenuated during surgery in dogs prospectively enrolled in the no-attenuation group or in dogs that had previously undergone surgery and were retrospectively evaluated. Postprandial serum bile acids (PPSBA) concentrations were measured before surgery and at various time points after surgery.

Results—Mean ± SD PPSBA concentrations were 26.8 ± 24.5 μmol/L at < 2.25 months after surgery (n = 16 dogs), 22.1 ± 14.0 μmol/L from 2.25 to 6 months after surgery (12 dogs), and 34.9 ± 32.5 μmol/L at > 6 months after surgery (22 dogs). In the prospectively enrolled dogs, mean PPSBA concentrations increased over time in dogs in the partial attenuation group, but not in dogs in the no-attenuation group.

Conclusions and Clinical Relevance—Cellophane banding may be used to occlude larger CEPSSs and may decrease the need for intraoperative monitoring of portal vein blood pressure. The technique may facilitate minimally invasive treatment of CEPSSs in dogs. Intraoperative attenuation of CEPSSs to a diameter < 3.0 mm is not necessary and may result in a less favorable outcome.

Abstract

Objective—To evaluate the effect of intraoperative attenuation of congenital extrahepatic portosystemic shunts (CEPSSs) during cellophane banding procedures in dogs.

Study Design—Retrospective case series and prospective study.

Animals—18 cases evaluated retrospectively and 14 dogs evaluated prospectively.

Procedures—Gradual occlusion of CEPSSs was performed via cellophane banding. Shunts were occluded to a diameter < 3.0 mm during surgery in dogs prospectively enrolled in the partial attenuation group, whereas the shunt was not attenuated during surgery in dogs prospectively enrolled in the no-attenuation group or in dogs that had previously undergone surgery and were retrospectively evaluated. Postprandial serum bile acids (PPSBA) concentrations were measured before surgery and at various time points after surgery.

Results—Mean ± SD PPSBA concentrations were 26.8 ± 24.5 μmol/L at < 2.25 months after surgery (n = 16 dogs), 22.1 ± 14.0 μmol/L from 2.25 to 6 months after surgery (12 dogs), and 34.9 ± 32.5 μmol/L at > 6 months after surgery (22 dogs). In the prospectively enrolled dogs, mean PPSBA concentrations increased over time in dogs in the partial attenuation group, but not in dogs in the no-attenuation group.

Conclusions and Clinical Relevance—Cellophane banding may be used to occlude larger CEPSSs and may decrease the need for intraoperative monitoring of portal vein blood pressure. The technique may facilitate minimally invasive treatment of CEPSSs in dogs. Intraoperative attenuation of CEPSSs to a diameter < 3.0 mm is not necessary and may result in a less favorable outcome.

Contributor Notes

Address correspondence to Dr. Frankel.