Complications of Spay Neuter Surgery: Prevention and Management :Complications of Spay Neuter Surgery: Prevention and Management Phil Bushby, DVM, MS, ACVS Marcia Lane Endowed Professor of Humane Ethics and Animal Welfare College of Veterinary Medicine Mississippi State University


Introduction :Introduction Complications of spay and neuter Prevention Management Spay Neuter in the abnormal animal


We will look at: :We will look at: Hemorrhage Dehiscence Ovarian remnants Cryptorchidism Uterus unicornis Hermaphrodism Mammary Hyperplasia/Lactation Hypoglycemia Hypothermia


Hemorrhage :Hemorrhage Causes Bleeding from ovarian pedicle Bleeding from uterine stump Bleeding from broad ligament Inadvertent trauma to abdominal organ Bleeding disorders


Hemorrhage :Hemorrhage Prevention is the best cure Careful incisions Meticulous gentle handling of tissues Secure ligatures Ligatures that do not capture skin, subq, or body wall


Helpful hints – Linea incisions :Helpful hints – Linea incisions Good visualization Elevate linea Incise with upward motion Avoid downward motion Elevate to extend incision


Hemorrhage – Splenic trauma :Hemorrhage – Splenic trauma


Hemorrhage – Splenic trauma :Hemorrhage – Splenic trauma


Hemorrhage :Hemorrhage


Oops! – Other damaged tissue :Oops! – Other damaged tissue Bladder Mesentery Broad ligament Suture bladder wall, ligate damaged vessel Ligate torn/cut vessels Observe to ensure intestinal segment remains viable Ligate any bleeders


Oops! – Dropped / torn pedicles :Oops! – Dropped / torn pedicles Extend abdominal incision. Use biological retractors Descending duodenum Descending colon Visualize pedicle Pick up with fingers


Oops! – Dropped / torn pedicles :Oops! – Dropped / torn pedicles


Dropped / torn pedicles :Dropped / torn pedicles Gentle traction – no erratic motions Transect before you ligate Distance between hemostats Secure ligatures


Dehiscence :Dehiscence


Dehiscence – best defense is offense :Dehiscence – best defense is offense Secure knots – no slip knots Secure body wall closures Holding layer – external rectus sheath


Dehiscence – best defense is offense :Dehiscence – best defense is offense Secure knots – no slip knots Secure body wall closures Holding layer – external rectus sheath


Dehiscence :Dehiscence Clean tissues with isotonic fluids Replace in abdomen Lavage abdomen well Secure abdominal closure Broad spectrum antibiotics Prayer


Ovarian remnant :Ovarian remnant


Ovarian remnant - prevention :Ovarian remnant - prevention Proper exposure of ovaries Cutting suspensory ligaments Proper placement of incision Animal positioning Have thumb and index finger on ovary while placing hemostats


Ovarian remnant - management :Ovarian remnant - management Requires broad exposure Utilize biological retractors Explore just caudal to caudal pole of the kidneys Grasp, exteriorize, double clamp, excise ligate


Cryptorchidism :Cryptorchidism


Cryptorchidism :Cryptorchidism Caudal abdominal incision Enter abdomen on midline Reflect bladder caudally You will visualize the 2 vas deferens


Cryptorchidism :Cryptorchidism Caudal abdominal incision Enter abdomen on midline Reflect bladder caudally You will visualize the 2 vas deferens


Cryptorchidism :Cryptorchidism


Cryptorchidism :Cryptorchidism Gentle traction on the appropriate vas deferens Will exteriorize the abdominal testicle But what if…


Cryptorchidism – subcutaneous testicle :Cryptorchidism – subcutaneous testicle If the testicle is in the subcutaneous tissue But not palpable Your caudal skin incision is caudal enough to allow subcutaneous dissection and removal of the testicle without making another skin incision


Uterus unicornis :Uterus unicornis Congenital absence of one uterine horn 1 of every 5000 to 10,000 female cats Also occurs in dogs


Uterus unicornis :Uterus unicornis Complete absence of horn, uterine vessel, broad ligament Absence of horn and uterine vessel – broad ligament present Absence of horn, broad ligament and uterine vessel present OVARY ALWAYS PRESENT


Hermaphrodites :Hermaphrodites Presence of both ovarian and testicular tissue in the same gonad or the same individual


Hermaphrodites :Hermaphrodites


Hermaphrodites :Hermaphrodites Generally surgery is performed as a normal spay.


Hermaphrodites :Hermaphrodites But not always


Mammary hyperplasia / lactation :Mammary hyperplasia / lactation


Must prevent hypothermia :Must prevent hypothermia


Thermoregulation :Avoid: Wide surg clip areas Moistening of hair coat Cold fluids Alcohol Aggressive scrubbing Thermoregulation Think ahead! From time of premed onward Reduce contact with cold environments Paper or cloth bedding Circulating warm water blankets Stand off/protected warm water containers Rice mamas, water bottles Convective warm air systems Limited body cavity exposure


Slide 38:Preventing Hypothermia: Warmth


Must prevent hypoglycemia :Must prevent hypoglycemia


Provide food for pediatric patients :Provide food for pediatric patients


Hypoglycemia - Management :Hypoglycemia - Management


Questions :Questions