Ch. 95: Liver & Biliary

Question 1

Rogers JVECC 2020

Prevalence and impact of cholecystitis on outcome in dogs with gallbladder mucocele

% with cholecystitis?
Association between cholecystitis and survival? Cholecystitis and intra-op culture?
% in hospital mortality?

Answer 1

29% had cholecystitis

No association between cholecystitis or subtypes & survival

No association between cholecystitis and intraop bacterial culture positivity

17% dogs (38) died or euthanized during hospitalization

Question 2

Piegols VSURG 2020

Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: a multi-institutional retrospective study

3 significant findings associated with catheterized dogs?

Difference in incidence of intra-op comps between groups? Post-op complications?

What post-op complication was associated with CBD catheterization? Did normograde vs retro matter?

Answer 2

Catheterized dogs: higher ASA scores, higher total bilirubin, and were more likely to have dilated CBD at the time of surgery

No difference for either; incidence of intra- and post-op complications similar between groups

Post-op pancreatitis associated with performing CBD catheterization (OR 8) - but not different bw norm or retrograde cath

Question 3

Putterman VSURG 2021

Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele

Post-op complications more common with what group?

% survival to discharge? What was difference between groups?

% decrease in TBili after NG flush? RG flush?
% increase in in TBili after NG flush? RG flush?

Significance of diplomate surgeon presence?

Answer 3

Dogs catheterized RG were more likely to experience post-op complications, esp. persistence of GI signs

86% survived to d/c - no difference between groups with survival to discharge or long-term survival

TBILI:
Decreased in - 70% NG, 39% RG
Increased in - 15% NG, 38% RG

Incidence of any periop or postop complications were decreased when a diplomate was present (good thing we will be boarded soon :) )

Question 4

Pavlick JVIM 2021

Evaluation of coagulation parameters in dogs with gallbladder mucoceles

% dogs with hypercoagulability based on TEG parameters?

Did this match plasma-based coag testing results?

Answer 4

83% dogs had results consistent with hypercoagulability based on TEG parameters, maximal amplitude, and G

No - plasma-based coagulation testing suggested that a complex state of hemostasis exists

Question 5

Griffin JVIM 2021

Choledochal stenting for treatment of extrahepatic biliary obstruction in cats

MC presenting clinical sign?
CS improved post-op in what %?

Post-op TBILI decreased in what %?

% survival to dc?
% recurrence of EHBO?

Answer 5

MC CS - vomiting, 91%

Post-op CS improved in 75%

TBILI decreased post-op in 68% cats

78% cats survived

Recurrence in 39%

Question 6

Allan JVIM 2021

Clinical features and outcomes in 38 dogs with cholelithiasis receiving conservative or surgical management

% of symptomatic dogs with choledocholithiasis?
% incidental dogs with choledocholithiasis?

Cholethiasis resolution % in med tx? sx tx? non tx groups?

Answer 6

44% of symptomatic cases vs 0% of incidental had choledocholithiasis

cholelithiasis completely resolved:
50% (4/8) medically treated (Ursodiol)
71% (5/7) of surgically treated
50% (1/2) non-treated dogs

(resolution in 50% (5/10) in non-sx treatment group - but these dogs had way less # of choledocholiths) .. dumb paper

Question 7

Brand VRU 2020

Computed tomographic features of confirmed gallbladder pathology in 34 dogs

MC abnormal CT findings? Pathognomonic for any pathology?

Answer 7

most common abnormalities detected: intraluminal nodules, gallbladder wall thickening, hyperattenuating material (35-100 HU), and mineral attenuating material (>100 HU)

Not pathognomonic for any pathologies detected

Question 8

Simpson VSURG 2021

Cholecystectomy in 23 cats (2005-2021)

MC presenting CS?
MC indication for cholecystectomy?

% cats that required post-op blood transfusion?

% survival to dc?

MC short and long term post-op comp?

Answer 8

MC CS: Vomiting, jaundice, abdominal pain

Cholelithiasis - major indication for cholecystectomy

39% (9/23 cats) required a postop blood transfusion
(Intra-op hypotension & post-op anemia were common)

78.3% (18/23) survived to discharge

MC short-term and long-term postop complication: vomiting

Question 9

Center JAVMA 2022

Clinical features, concurrent disorders and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome

Diagnostic imaging correctly found choleliths in what %?

% of cases with “idiopathic pancreatitis” actually found to have transiting choleliths?

2 survival advantages?
3 survival disadvantages?

Answer 9

Diagnostic imaging identified only 58% of surgically confirmed choleliths

51% (28/55) cats with “idiopathic pancreatitis” were documented to have transiting choleliths

Survival advantages: Cholelithiasis (with or without bile duct obstruction) and cholecystectomy

Survival disadvantages: leukocytosis, ≥ 2-fold increased ALP, hyperbilirubinemia

Question 10

Hattersley JSAP 2020

Impact of intra-operative hypotension on mortality rates and post-operative complications in dogs undergoing cholecystectomy

which 4 factors associated with mortality (in hospital & 28 day) on univariable?
which 2 still significant on multivariable?

Answer 10

ASA grade, postop hypoproteinemia, ileus, and pancreatitis were associated w/ both in hospital and 28 day mortality on univariate analysis

Ileus and pancreatitis were the only factors that remained significant for mortality on multivariate analysis

Question 11

Barker JSAP 2020

Serological markers of gluten sensitivity in Border terriers with gall bladder mucoceles

what 2 markers detected in Border Terriers with GBM? (decreased or increased for either?)

Answer 11

reduced cholecystokinin

increased transglutaminase-2-IgA autoantibodies

Question 12

Viljoen JSAP 2021

Clinical characteristics and histology of cholecystectomised dogs with non gravity-dependent biliary sludge: 16 cases (2014-2019)

Majority of dogs had what GB diagnosis?

How many dogs had enteritis? Majority what kind?

Answer 12

12/16 (75%) dogs had cholecystitis
(11 lymphoplasmacytic, 1 neutrophilic)

13 dogs (81%) had enteritis
(12 lymphoplasmacytic, 1 eosinophilic)

Question 13

Bandara JSAP 2021

Histopathological frequency of canine hepatobiliary disease in the United Kingdom

Top 3 histological diagnoses?

Answer 13

Most frequent histological diagnoses (4584 cases):

Reactive hepatitis (n=770);
Chronic hepatitis (n=735); (note: Labs & Spaniels predisposed)
Reversible hepatocellular injury (n=589); (note: Schnauzer)

Question 14

Wilkinson JVIM 2020

Bile duct obstruction associated with pancreatitis in 46 dogs

% survival?
% of survivors treated with medical mgmt alone?
Were BD dilation or bilirubin different between survival or non survivors?

Answer 14

80% survival

94% of survivors had medical mgmt. alone

No - median bile duct dilation at time of dx and peak bilirubin were not different b/w survivors and non-survivors

Question 15

Lindaberry JVIM 2021

Proteinuria in dogs with gallbladder mucocele formation: a retrospective case control study

What ratio of urine dipstick protein concentration to USG was found to be significantly higher in dogs with GBM formation compared to controls?

Is GBM formation significantly associated with proteinuria?

Answer 15

≥ 1.5
- Median urine dipstick protein conc to USG ratio was significantly higher in GBM than controls
- Number of dogs w/ ratio ≥ 1.5 was significantly higher in GBM than controls

Yes - Gallbladder mucocele formation is significantly associated with proteinuria in dogs

Question 16

Jaffey JVIM 2022

Ultrasonographic patterns, clinical findings, and prognostic variables in dogs from Asia with gallbladder mucocele

2 independent predictors of death after cholecystectomy?

What variable & with what ORs, affected odds of death with GB rupture vs not ruptured?

Answer 16

Independent predictors of death after cholecystectomy:
- age (OR 2.81)
- intraoperative systolic blood pressure (SBP) nadir.

• odds of death associated with intraop SBP nadir were different for dogs with and without GB rupture
• SBP nadir in dogs with GB rupture (OR 0.92)
• SBP nadir in dogs without GB rupture (OR 0.88)

= Intraop SBP nadir was lower for dogs with gallbladder rupture that died compared to dogs with gallbladder rupture that survived
(but it was NOT different for dogs without gallbladder rupture that died compared to those that survived)

Question 17

Wilson VRU 2021

Dogs with biliary rupture based on ultrasound findings may have normal total serum bilirubin values

% of dogs with biliary rupture that had serum bilirubin WNL?

What was the difference in serum bili between rupture vs not?

What 2 CBC findings were significantly more common in dogs w/ biliary rupture?

Answer 17

40% of dogs w/ confirmed biliary rupture had serum bilirubin w/in ref intervals

No difference = no sig difference in serum bilirubin values of dogs w/ ruptured vs non-ruptured biliary tracts

leukocytosis and neutrophilia were sig more common in dogs w/ rupture

Question 18

Tamura VRU 2021

Extrahepatic biliary obstruction can interfere with hepatic fibrosis prediction using two-dimensional shear wave elastography in dogs

Pre-op shear wave velocity (SWVs) sig higher in which group (EHBO or not)?

Did surgery affect SWVs?

Histopath difference in hepatic fibrosis between EHBO vs no EHBO?

Answer 18

Pre-op shear wave velocity (SWVs) sig higher in dogs with EHBO compared to without

SWVs decreased significantly after surgery

No difference in histopathological hepatic fibrosis stages between dogs with and without EHBO

Question 19

** Hernon VSURG 2023 **

The effect of flushing of the common bile duct on hepatobiliary markers and short-term outcomes in dogs undergoing cholecystectomy for the management of gall bladder mucocele: Randomized controlled prospective study **

What breed over represented?

What chemistry values (5) reduced from pre-op to 3 days post-op?
Differences between groups (flush vs no flush) for which?

Survival to discharge?

Answer 19

Border terriers overrepresented (65%, 20/31)

Marked reductions from pre-op to 3 days postop in:
Serum bilirubin
ALP
ALT
GGT
Cholesterol

No difference in any marker between groups (flush vs no flush)!

Survival to discharge: 90% (28/31 dogs)

No short-term clinical or clin-path benefits were identified when flushing the CBD in dogs undergoing cholecystectomy for GBM!

Question 20

Jang VRU 2023

Increased radiographic opacity in the region of the gallbladder can be identified in dogs with large amounts of gallbladder sediment, sludge balls, and gallbladder mucocele

What % of dogs with GB sediment had increased opacity on at least one rad view?

Which view was most Sn to detect increased opacity?

What kind of sediment / sludge pathology had highest % of opacity?

Answer 20

22% (37/168) dogs with GB sediment had increased opacity on at least one radiographic projection

Sensitivity for detecting increased opacity was highest in the thoracic ventrodorsal view

Sludge balls (Group 4) was the highest percentage w/ increased radiographic GB opacity

Question 21

Villm VRU 2022

Prevalence of gallbladder sludge and associated abnormalities in cats undergoing abdominal ultrasound

What % cats had GB sludge found?

What GB finding significantly increased the odds of detecting GB sludge? OR?

Answer 21

GB sludge present in 44% of cats that underwent an AUS

GB wall thickening significantly increased the odds of detecting GB sludge (OR 3.7)

Question 22

MacLeod VRU 2023

Ultrasonographic Appearance of Gallbladder Neoplasia in 14 Dogs and 1 Cat

What was most commonly found final neoplasia diagnosis?

Answer 22

Neuroendocrine carcinoma (53%, 8/15)

Question 23

Lamb JSAP 2018

Determining the anatomical origin of canine hepatic masses by CT

% of correct CT compared to sx findings for masses on left of midline = left divisional?
Right of midline = right divisional?

Answer 23

All masses (100%) to the left of midline were left divisional
Only 60% (18/30) masses to the right of midline were right divisional

Question 24

Friesen JSAP 2021

Clinical findings for dogs undergoing elective and nonelective cholecystectomies for gallbladder mucoceles

Mortality rate for each group (elective vs non elective)?
Complication rate for each?
What type of complication (minor or major) most common for elective?

What post-op finding in 35% of dogs that underwent duodenotomy & retrograde flushing?

Answer 24

mortality rate: 6% for elective vs 23% for nonelective

complication rate: 52% for elective and 50% for nonelective
- most complications in elective category were grade 1 (mild)

postop hyperthermia in 35% of dogs w/ duodenotomy and retrograde catheterization

Question 25

Rogatko JVIM 2021

Drug-eluting bead chemoembolization for the treatment of nonresectable hepatic carcinoma in dogs: a prospective clinical trial

Tx resulted in stable disease or partial response in what %?

Major complication %?

Answer 25

Stable dz in 60%, partial response in 25% = 85%
(progressive disease in 15%)

10% major complications

Question 26

Shaker VRU 2021

Machine learning model development for quantitative analysis of CT heterogeneity in canine hepatic masses may predict histologic malignancy

Memorize this statement:
The best performing model utilized the CT features voxel volume and uniformity from postcontrast mass contour

Answer 26

The best performing model utilized the CT features voxel volume and uniformity from postcontrast mass contour

Question 27

Terai JAVMA 2022

Clinical, diagnostic, and pathologic features and surgical outcomes of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) in dogs: 14 cases (2009-2021)

Most masses looked like what?

MST of cHCC-CCA with sx?

cHCC-CCA may be more similar in prognosis to HCC or CCA?

Answer 27

Massive hepatic mass with inclusion of cyst like lesions

MST HCC-CCA = 700 days

More similar to HCC with sx (695-1460d) vs CCA (180d)

Question 28

Reist JAVMA 2023

Histopathologic findings and survival outcomes of dogs undergoing liver lobectomy as treatment for spontaneous hemoabdomen secondary to a ruptured liver mass: retrospective analysis of 200 cases (2012–2020)

MST for well-diff HCC? HSA? Benign?

Prognostic factors for survival (4)?

Increased __ improved the odds of diagnosing a WD-HCC by a factor of __?

Pre-op factors associated with shorter survival (3 BW, 1 other)?

Answer 28

Prognostic factors for survival:
diagnosis, increased ALT, anemia, & whether a transfusion was received.

Increased ALT improved the odds of diagnosing a WD-HCC by a factor of 10.7

Preoperative factors associated with a shorter survival:
decreased PCV, HCT, and albumin (blood loss)
& dogs that received a transfusion

Question 29

Locatelli JSAP 2022

Percutaneous ultrasound-guided microwave ablation for treatment of hepatocellular carcinomas in dogs: four cases (2019-2020)

(Small cases series - note that it exists)

Answer 29

HCC were successfully ablated, which in some cases resulted in an improvement in clinical signs and laboratory values.

No immediate complications.

Question 30

An VRU 2019

Evaluation of the radiographic liver length/11th thoracic vertebral length ratio as a method for quantifying liver size in cats

(Since we aren’t given the title) - What was the liver length compared to?

What was reference value of ratio?

Did it differ among signalment?

Answer 30

11th thoracic vertebral length

The reference value of the LL / T11 ratio was 4.22 +/- 0.54

LL/T11 ratio did not differ among signalment groups

Question 31

Cheney JSAP 2019

US and CT accuracy in localizing surgical- or necropsy-confirmed solitary hepatic masses in dogs

US predicted correct location in what %?

CT predicted correct location in what %?

Sn highest for what division?

Answer 31

Location was correctly predicted
US: 74% dogs
CT: 84% dogs

Sensitivity was highest for left division masses

Question 32

Rivas VSURG 2019

Ability of positive and negative contrast CT peritoneography to delineate canine liver lobe fissures

Which type of study improved delineation of hepatic interlobar fissures?

Answer 32

positive contrast CT peritoneography improved delineation of hepatic interlobar fissures in normal cadavers

Question 33

von Stade JSAP 2021

Prevalence of portal vein thrombosis detected by computed tomography angiography in dogs

What was overall prevalence of PVT?

What “category” of dogs had highest % of PVT?

Of the dogs with PVT that had an US, what % did US detect?

Answer 33

13% prevalence of PVT

Pancreatitis category had highest % of PVT

Of 21 dogs with PVT that had ultrasound performed, ultrasound detected thrombosis in 19% (4/21)

Question 34

Israeliantz VRU 2022

A simplified CT-volumetry method for the canine liver

Is sagittal reformatting and hepatic contouring accurate? How many images did they use?

Answer 34

Using sagittally reformatted images and hepatic contouring in as few as nine images can be an accurate and simple method for CT-volumetry of the canine liver

Question 35

Spain JFMS 2022

Ultrasonographic prevalence and proposed morphologic classification of bilobed gallbladder in cats

Overall incidence of anomalous GB morphology?

Most common morphology? What are other types?

Answer 35

Overall incidence anomalous GB morph = 25%

Bilobed morphology MC - 14%

Others: Separated, Duplex, Complex

Question 36

Linden VSURG 2019

Outcomes and prognostic variables associated with central division hepatic lobectomies: 61 dogs

What type of resection associated with complications?

Rate of intra-op complications? What was most common (%)?

Rate of immediate post-op complications?

Peri-op mortality rates - immediate vs 14 days?

Answer 36

Hilar resection associated with increased intraop and postop complications.

Intraop complications occurred in 48% (29 dogs) – 69% had hemorrhage (20/29) with 19/20 requiring transfusions.

Immediate postoperative complications in 33% (20 dogs)

Perioperative mortality rate 11%
2-week mortality rate was 15%

Question 37

Sellier VSURG 2020 PQ

Use of a cavitron ultrasonic surgical aspirator for parenchyma-sparing and complex liver resections in dogs

How much blood loss (median) mL & % of BV?

Short term complication rate?

What device for parenchymal preservation PQ?

Answer 37

Lost median of 77mL blood = 4.3% BV

18%, 2/11 short term comp
1/11 died (9%) from complication

• cavitron ultrasonic surgical aspirator *

Question 38

Moore VSURG 2023

Association between divisional location and short-term outcome of liver mass resection in 124 dogs

Masses more common in which division?

Intra-op comp rate?
Odds increased with what by how much?
Less intra op comp with what side?

Post-op comp rate?
More likely if they did what in sx?
Less likely with what 3 factors?

Moratlity rate? What association bw location and mortality?

Answer 38

Liver masses MC in the left division (58%)

Intraop complication rate 11%

• Odds of intraop comps 19 x higher when surgery was performed without a TA stapler
• Intraop comps were less commonly associated with left divisional masses than right

Postoperative comp: 29%

• Postop comps more likely:
  if the incision extended to the thorax, which was more common during resection of right divisional masses
• Postop comps were less likely when surgery was performed with a TA stapler, by a specialist surgeon, and in heavier dogs

Mortality 7% (8/124)
No association was detected between mass location and mortality !

Question 39

Dean JSAP 2020

Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi-centre retrospective review of 31 dogs

Periop mortality rate?

Post-op complication rate?
How many attributed to diaphragmotomy?

Answer 39

Periop mortality 10%
None attributable to diaphragmotomy

Post-op comps 68% (of those that survived periop)
- 25% (7/28) attributed to diaphragmotomy (but resolved with non sx intervention)

Question 40

Reece JVIM 2020

Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs

% dogs with PCV decrease after biopsy?

Mean Δ in PCV?

Major hemorrhage in %?

Answer 40

85% dogs had a decrease in PCV after biopsy

Mean ΔPCV was -7.2%

Major hemorrhage occurred in 42% (but they considered clinically silent)

Question 41

Takagi VSURG 2022

Computed angiographic variations in hepatic venous vasculature in dogs

Conclusion? (was there variation, especially where?)

Answer 41

The draining pattern of hepatic veins varied widely in all liver lobes, especially the left lateral liver lobe.

Question 42

Sparago JSAP 2021

Investigation of the association between gall bladder wall thickness and hypoalbuminemia in dogs

Were albumin and GB wall thickness correlated in the study groups?

What correlation was found? relates to immune mediated disease

Answer 42

Serum/plasma albumin concentration and gallbladder wall thickness were not significantly correlated in groups 1&2

A moderate negative correlation (-0.64) between gallbladder wall thickness and albumin concentration in dogs with immune-mediated diseases

Question 43

Mattolini VRU 2023

CT features of divisional bile ducts in healthy Labrador Retrievers

How many dogs could at least 1 division of bile duct be seen?

Answer 43

At least 1 of the divisional bile ducts could be visualized using contrast-enhanced CT in the majority of sampled dogs (75%)

Question 44

Dickerson VSURG 2023

Outcome in 38 dogs surgically treated for hepatic abscessation

Pre-op peritoneal effusion in %?
Which org most common cultured?
Rate of neoplasia?
Complication rate?
Periop mortality rate?
Recurrence rate?
Overall long term px considered?

Answer 44

Peritoneal effusion in 84% (32/38) preop

Escherichia coli most common

Hepatic neoplasia in 31% (11/36)

of dogs that survived sx, complications in 58% (21/36)

Periop mortality 21% (8/38) =
2 dogs died intraop, 6/36 dogs died prior to discharge.

Recurrence rate 0%
Long term px is good

Question 45

Ambrosini JVIM 2022

Serum 25-hydroxyvitamin D and C-reactive protein and plasma von Willebrand concentrations in 23 dogs with chronic hepatopathies

Correlations bw Vitamin D, C-reactive protein, and vWF with chronic hepatopathies?

Answer 45

• Vitamin D concentration was negatively correlated with disease activity
• CRP was positively correlated with histopath necroinflammatory activity and fibrosis score;
• vWF concentration was positively correlated with fibrosis score

Basic: In dogs with CH, serum 25(OH)VD concentration was negatively correlated with disease activity, whereas serum CRP concentration and plasma vWF concentration were positively correlated with histopathologic grade and stage

Question 46

Butler JVIM 2022

A multicenter retrospective study assessing progression of biliary sludge in dogs using ultrasonography

Which breeds were independent risk factors for development of GB mucocele? OR?

How did biliary sludge scores affect GBM formation?

Answer 46

• Shetland Sheepdogs OR 41 and Border Terriers OR 12, more likely to develop GBM
• Odds for GBM formation increased with biliary sludge scores

Question 47

O’Kell JVIM 2022

Gastroduodenal ulceration (GDU) in dogs with liver disease

Rates of GDU and erosions?

Answer 47

10% (4/40 dogs) had Gastroduodenal ulceration
15% (6/40) had erosions

Question 48

Oramas VSURG 2019

Laparoscopic access to the liver and application of laparoscopic microwave ablation in 2 dogs with liver neoplasia

What lobes accessible?
MWA feasible?
Complications in 2 case dogs?

Answer 48

All lobes of canine liver accessible via laparoscopy ; used 17 g MWA probe
15 reverse Trendelenburg; 5 mm port caudal to umbilicus; then 2nd port 1/3 distance between umbilicus and xiphoid
Inserted probe for ablation as proximal on hilus as possible ; cycle for 30 watts for 10 sec

Histopath diagnosis tx by LMWA included met HSA and primary hepatocellular carcinoma

Laparoscopic microwave ablation feasible, and no complications occurred

Conclusion: laparoscopic access to hilus of each liver lobe possible via VD approach provided reverse Trendelenburg & lateral rotation is used, especially for right lateral lobe;

Question 49

Simon VSURG 2020

Laparoscopic cholecystectomy with single port access system in 15 dogs

What did they need to do in 12 cases?
Risk of conversion decreased with what?
Complications?

Answer 49

SPAS placed 1 cm caudal to umbilicus; completed with SPAS alone in 2 cases
Additional cannula added in 12 cases
Last 10 cases additional cannula placed at beginning of procedure

Dissection began at the cystic duct in 11 dogs (73%); in 3 cases (20%) SPAS converted to laparotomy; 2 of these conversions were elective, and one was emergent

Risk of conversion was affected by experience of the surgeon & rate of conversion reduced when cannula added at beginning of procedure

Intraop complications in 4 cases – 3 minor with bleeding of liver parenchyma; 1 major leakage of bile from dissection

14 dogs discharged from hospital
1 dog died after being discharged due to severe cholangiohepatitis & another dog died due to leakage of gastrostomy tube

Conclusions: use of SPAS has acceptable outcome; experience and extra cannula reduced risk of conversion

Question 50

Michael (hehe) VSURG 2021

Feasibility of laparoscopic liver lobectomy in dogs

LLL feasible for what lobes?
LLL not possible in what lobes?
Large cadavers what issues?
Clinical cases - what indications determined?

Answer 50

LLL was feasible for left and central division in small cadavers.

LLL of right division was not possible because of inability to articulate the stapler anvil across the hilus.

Stapler closure was complete and only one cartridge was used per lobe in small cadavers.

In large cadavers, resection was not successful because of incomplete closure of the stapler anvil and staples in any of the left and central division lobes and was not possible in right division lobes because of inability to articulate the stapler anvil across the hilus.

6 clinical cases – wts 8-38.5 kg, 4/6 quadrate partial LLL, 2/6 left lateral partial LLL. Resection 30, 60, 90%. Diagnoses HCC 3/6, chronic fibrosis 1/6, nodular hyperplasia 1/6, biliary cyst adenoma 1/6.
1/6 cases needed conversion, which was 38.5 kg dog with large mass in left lateral lobe.

LLL: similar indications to humans (peripherally located masses <5 cm)

Question 51

Poggi VSURG 2022

Laparoscopic portosystemic shunt attenuation in 20 dogs (2018-2021)

What did they attenuate with?
Conversion %? Why?
Outcomes? occlusion? BAs?

Answer 51

Shunt in epiploic foramen in 14 dogs
13/14 right paramedian approach, 1/14 left
Not located in epiploic foramen 6 dogs
left paramedian

Thin film band in all dogs

Conversion required in 5 dogs (25%)
- Failure to identify shunt 2 (10%)
- Moderate hemorrhage 2 (10%)
- Perforation of the diaphragm 1

Mild, self-limiting portal hypertension occurred in 3 dogs
- Severe requiring conversion in 1 dog

Second procedure needed for a dog with portal hypertension, replaced and did well after second procedure

All dogs had good outcome
All complete occlusion, 95% had normal bile acids within 3 months of surgery
95% of dogs (one dog follow up not needed) had no medications at long-term follow up
89% complete owner satisfaction

Question 52

Kanai VSURG 2022

Intraoperative cholangiography and bile duct flushing in 47 dogs receiving laparoscopic cholecystectomy for benign gallbladder disease: a retrospective analysis

Dissection method of GB?
Complications?
Conclusion?

Answer 52

LC used BDF method
Dissection within the subserosal layer of the gallbladder from the fundus to the cystic duct prior to transection

Procedure: Infundibulum ligated then incision made in cystic duct for IOC; catheter 4-7 Fr feeding tube inserted into cystic duct
Fed until the side hole was hidden inside lumen of cystic duct
If hard to place, used guidewire
Catheter and tissues clamped with atraumatic forceps
Flushed then contrast flushed with C-arm fluorscopy

Median procedure time for BDF and intraoperative cholangiography (IOC) was 4 min

No intraoperative or postoperative complications
4% died

During LC, BDF and IOC were performed safely and successfully. Intraoperative cholangiography identified obstructions and strictures in the common bile duct that were not detected using BDF alone.

Question 53

Kondo JSAP 2023

Laparoscopic cholecystectomy using the subserosal layer dissection technique in dogs: 34 cases (2015-2021)

Success in %?
Conversion rate?
Intraop bleeding and bile duct injury?

Answer 53

To describe a standardized subserosal layer dissection technique and evaluate its outcomes in canine laparoscopic cholecystectomy

34 dogs were included.
The most common preoperative diagnosis was cholecystolithiasis (n=29).

Operative time was 190 minutes (range: 110 to 330 minutes).

Subserosal layer dissection of more than 90% of the gallbladder bed was achieved in 27 (79%) dogs.
Conversion to open surgery was required in three (8.8%) dogs.
There were no cases of intraoperative bleeding, bile duct injury, or reoperation.