Common surgical procedures

Question 1

Indication for vasectomy

Answer 1

Cattle: preparation of teaser animals for heat detection

Sheep: teasers to stimulate oestrus in ewes to advance and/or synchronise breeding

Question 2

Restraint and anaesthesia needed for vasectomy

Answer 2

sedation, local anaesthesia and low spinal epidural

Cattle: may be done standing or in lateral recumbency

Sheep: Usually in dorsal recumbency

Question 3

Surgical technique of vasectomy

Answer 3

clipping and scrubbing

3-8 cm incision made over the spermatic cord between the testicle and the inguinal ring

spermatic cord is isolated and exteriorised

1cm incision is made through the vaginal tunic

section of the vas deferens is isolated with haemostats. Two ligatures using fine absorbable suture is placed approximately 3cm apart on the exposed vas deferens

section of the vas deferens between the ligatures is removed

ends of the vas deferens can be folded over and sutured or can be cauterised

spermatic cord may be closed with one suture of absorbable material or may be replaced without suturing

skin incision is generally closed in two layers

Question 4

Post operative care of vasectomy

Answer 4

Allow 6 weeks or six ejaculates to evacuate viable semen

Skin sutures are removed in 14 to 21 days

ensure that the portion of tissue removed is vas deferens

Question 5

Indication of epididymectomy

Answer 5

Less commonly used method of preparing teaser animal and more likely to be performed in cattle

Question 6

Restraint and anaesthesia for epididymectomy

Answer 6

standing or in lateral recumbency under sedation for cattle

dorsal recumbency for sheep

Local anaesthetic is infused in the scrotal skin directly over the epididymis

Question 7

Surgical technique for epididymectomy

Answer 7

clipped and scrubbed

skin incision is made in the scrotum over the tail of the epididymis

tail of the epididymis is bluntly dissected from the testicle and ligated

tail of the epididymis is resected and removed

skin is sutured

Question 8

Indication for tracheotomy

Answer 8

Treatment of conditions that result in temporary or permanent obstruction of the larynx or nasal passage

Question 9

Restraint and anaesthesia for tracheotomy

Answer 9

Adult cattle: Standing restraint is recommended, with the head pulled up and extended dorsally using a halter and nose lead rope, using two halters and tying either side to straighten head.

Small ruminants and calves: animal in dorsal recumbency and restraining the head is appropriate.

Sedation and analgesia are useful but must be used with care due to respiratory stress in some cases. Local anaesthesia of site is used as cases are a poor risk for general anaesthesia.

Question 10

Surgical technique for tracheotomy

Answer 10

ventral cervical region (cranial one-third of the neck) is clipped and surgically scrubbed

head is extended upwards

trachea is stabilised with fingers

skin is incised midline over the tracheal rings

annular ring between 2 tracheal rings is punctured using a scalpel

one or two rings are cut with scissors to remove a section from 2 adjacent tracheal rings

Insert and stabilise tube in trachea

tube is inserted several centimetres into the trachea and sutured to anchor the tube

Question 11

Post operative care for tracheotomy

Answer 11

tube should be checked for patency and retained in place until the primary disease is alleviated

Antibiotics and NSAIDs

When the tube is removed the sutures are cut and the tube pulled out, any necrotic tissue of the incision edge is debrided

Question 12

Tracheostomy

Answer 12

a permanent opening in the trachea. This is considered a salvage procedure to get a severely dyspnoeic animal to slaughter

Question 13

Indication for tibial neurectomy

Answer 13

Treatment of spastic paresis in cattle

Question 14

Anaesthesia and restraint for tibial neurectomy

Answer 14

performed in lateral recumbency under sedation and epidural anaesthesia, or general anaesthesia may be used

Question 15

Surgical procedure of tibial neurectomy

Answer 15

surgical site is initially identified and marked- the groove between the two heads of the biceps femoris

the popliteal lymph node is a useful landmark adjacent to both tibial and peroneal nerves

wound retractor is useful to expose surgical site

About 2cm length of main truck of the tibial nerve is removed as precise identification of gastrocnemius branches is difficult or impossible

If the condition is bilateral there needs to be a gap of 8 weeks rest before correcting the condition in the other limb

Question 16

Post operative care for tibial neurectomy

Answer 16

Encourage limited exercise for 2 weeks

Question 17

Complications of tibial neurectomy

Answer 17

usually a good prognosis following neurectomy

Complications include continuing muscle atrophy, temporary or persistent peroneal paralysis, and wound breakdown

Gastrocnemius rupture may occur in heavy cattle 1-5 days after neurectomy

Question 18

Indication for gastrocnemius tenectomy

Answer 18

Alternative method for treatment of spastic paresis. Only temporary successful in young calves under 9 months

Question 19

Anaesthesia and restraint for gastrocnemius tenectomy

Answer 19

Performed on standing animal using local anaesthetic

Question 20

Surgical procedure of gastrocnemius tenectomy

Answer 20

area over the calcanean tendon 10cm proximal to the point of the hock is clipped and scrubbed

skin incision is made 6cm long vertically over the caudal aspect of the tendon

gastrocnemius tendon is located and cut transversely or a 2cm portion is removed

The adjacent superficial digital flexor tendon is also cut through half of the transverse diameter. The skin is sutured.

Following surgery there is a mark dropping of hock on weight bearing.

Question 21

Complication of gastrocnemius tenectomy

Answer 21

Some calves may develop fibrous union of operated area, leading to recurrence 2-3 months later

Question 22

Indication for teat surgery

Answer 22

Teat lacerations are an emergency and should be cleaned, sutured or bandaged as soon as possible (within 6 hours) to reduce contamination and inflammation.

Some obstructions will require immediate treatment, whilst others may be left and not corrected until the dry period

Question 23

Restrain and anaesthesia for teat surgery

Answer 23

Usually standing sedation.

Roll-over crushes are useful.

For anaesthesia of the teat methods include local anaesthetic into teat canal and ring block at the base of teat.

Question 24

Basal teat obstructions

Answer 24

Congenital in heifers or from adhesions due to chronic inflammation from infection in dry period.

Use Hudson’s teat probe and spiral to clear obstruction.

Question 25

Mid teat obstructions

Answer 25

Chronic inflammation, milk calculi (teat peas), neoplasia (bovine papillomatosis).

Break into fragments and remove lesions via the streak canal using Barrett’s papillotome.

Larger lesions may require open surgery.

Question 26

Apical teat obstructions

Answer 26

Fibrosis and stenosis of streak canal due to chronic inflammation that may be associated with subclinical mastitis.

Use McLean’s knife to open teat end using cruciate incisions. Risk of stenosis.

Question 27

Teat lacerations

Answer 27

Initial assessment to determine whether there is involvement of the teat canal is vital.

Deep wounds into teat canal can result in sinus formation and their repair is essential.

Superficial lacerations and deeper lacerations not involving the teat canal should be cleaned, debrided and skin sutures placed where necessary using fine metric suture material in a vertical mattress pattern.

Between milkings, the lesions should be protected by a teat bandage.

Lacerations into the teat canal should be repaired in 3 layers:
- mucosal lining,
- submucosal layer
- skin,
using a round bodied needle and fine suture material in a simple interrupted or continuous pattern.

Question 28

Teat fistula

Answer 28

These are usually congenital flaps or secondary to trauma.

Determine whether there is an effect on normal teat drainage and leave alone, or trim and suture as necessary during the dry period.

Question 29

Teat amputation

Answer 29

Sometimes indicated in cases of severe trauma or gangrenous mastitis.

Ligate above teat with rubber tourniquet, trim out milk sinus with scissors, close with three suture layers (mucosa, muscle, skin) using simple interrupted pattern with fine suture material.

If damage is severe the devitalised tissue can just be trimmed or crushed with a Burdizzo and then removed with scissors.

In cases of mastitis, particularly summer mastitis, the teat cistern should be left open to allow drainage.

Question 30

Post operative care of teat surgery

Answer 30

Intra-mammary antibiotics (milking cow), teat cannula to allow milk let-down (self-retaining) for about 1 week.

Suture removal if indicated.

Question 31

Indications for supernumary teat removal

Answer 31

Supernumary teats can interfere with milking and are associated with mastitis

Ideally removed in first month of life

Question 32

Restrain and anaesthesia for supernumery teat removal

Answer 32

Young animals in dorsal recumbency

Standing in older animals

Anaesthetic must be used in cattle over 3 months

Question 33

Surgical technique for supernumery teat removal

Answer 33

Isolated teats removed with burdizzo and sharp scissors

Attached teats may share common teat cistern so will need to be sutured

Question 34

Amputation of the udder or parts of the udder

Answer 34

Amputation is not recommended because of the tendency for marked haemorrhage,
shock, and death, especially in lactating animals.

Question 35

Indications for tail amputation

Answer 35

Injury to the tail, usually traumatic in origin. More commonly occurs in cattle, due to widespread tail docking of sheep

Question 36

Restraint and anaesthesia for tail amputation

Answer 36

Standing using caudal epidural.

Question 37

Surgical technique of tail amputation

Answer 37

The site is clipped and scrubbed.

On the healthy skin margin, cranial to the injury a V-shape full thickness skin incision is made on dorsal and ventral aspect of tail with tip pointing caudally.

The skin and soft tissue is undermined down to bone, trying to preserve as much of the soft tissue as possible with the skin.

Continue this proximally to the top of the V in the skin.

Cut through the bone (using suitable instrument to prevent fragmentation) or disarticulate bones at the level of the top of the V (cranially).

Close the soft tissue over the exposed bone margin using absorbable suture material.

Close the skin symmetrically.

There is no need to apply any form of dressing over the site.

To prevent haemorrhage an assistant holding the tail should put pressure on the tail vein until the skin incision is closed. Alternatively, a tourniquet can be used until the procedure is completed.

Question 38

Indication for amputation of urethral appendage

Answer 38

In small ruminants where urolithiasis is suspected or diagnosed, the urethral (vermiform) appendage should be surgical removed in all cases.

This is often the site of blockage in these species as it is a narrow part of the male urinary tubular system.

Question 39

Surgical procedure of amputation of the urethral appendage

Answer 39

In entire male animals the penis can exteriorised, and the urethral appendage identified and incised at the tip of the penis at an angle to create the greatest possible opening.

In castrated males, especially those castrated before puberty the penis can be difficult to exteriorise due to preputial adhesions, so it may be necessary to make an incision into the prepuce to get access to the penis to remove the urethral appendage as described earlier.

The skin is then sutured following this.

Question 40

Indication for urethrostomy

Answer 40

Salvage procedure for the treatment of urolithiasis in fattening cattle and sheep.

Unsuitable procedure for retaining function in breeding animals.

Question 41

Restrain and anaesthesia for urethrostomy

Answer 41

Sedation and caudal epidural in the standing animal is recommended.

Question 42

High perineal urethrostomy technique

Answer 42

An incision is made high on the perineal midline.

The ventral commissure of this incision will be at the level of the sigmoid flexure.

An advantage of a high incision is that it allows the penis to be directed so that urine is expelled caudally and away from the inner aspects of the legs, which prevents urine scald of the rear limbs.

The subcutaneous tissue on the midline is bluntly dissected until the penis is identified.

The penis is isolated from the surrounding tissue, and a loop of the penis at the level of or just below the ischium is exposed.

The urethra starts to get wider at this point and is less likely to obstruct.

The loop of penis is anchored with heavy non-absorbable suture material, avoiding obstructing the urethra.

An incision is made into the urethra. A urethral catheter makes the urethra easier to identify. The incision should be at least two times the final opening as it is common to get 50% reduction in the size of the opening over time.

The mucosa of the urethra is sutured to the skin with absorbable suture material.

Haemorrhage from the corpus cavernosum is common and must be controlled.

Question 43

Technique for low perineal urethrostomy

Answer 43

An incision is made low in the perineal midline just ventral to the sigmoid flexure and caudal and dorsal to the base of the scrotum.

The advantage of the low incision is greater accessibility to the penis and urethra.

The subcutaneous tissue on the midline is bluntly dissected until the penis is identified, differentiating between the penis and the paired retractor penis muscles.

The penis is isolated from the surrounding tissue.

Traction is applied caudally to straighten the flexure and expose a loop of the penis through the skin incision.

After the loop of the penis is exposed there are three options.

1. Transection of the exposed penile loop, creating a 2-3cm stump with the proximal end of the penis. The dorsal artery and vein of the penis are ligated. The stump the penis is attached to the skin with 1-2 cm of penis exposed depending on size and species of animal. The urethra of the exposed penile stump may be split and its edges sutured in a flared position to enhance urine flow and to reduce the potential for urethral stricture.
2. Traction on the ventral (distal) part of the exposed penis until the preputial attachment is ruptured and the entire distal penis can be extended backward through the perineal skin incision. The exposed penis is incised to create a 2-3 cm stump with the proximal end. The penile stump is then handled as described above.
3. Urethostomy without penile transection as described in the high perineal urethostomy

Question 44

Post operative care of urethrostomy

Answer 44

Systemic antibiotics if necessary

Observe the patient for passage of urine.

Send the animal for slaughter at the earliest opportunity.

Urolithiasis sequelae such as chronic cystitis is common.

Question 45

Indication for tube cystostomy

Answer 45

A temporary procedure to establish urine flow while allowing a urethral obstruction and bladder rupture to be repaired and resolved.

The method allow urine to escape whilst uroliths can be passed or dissolved using dietary manipulation.

It is often used to maintain function of breeding animals and for companion farm animals, i.e., pet sheep and goats.

Likely to need hospital facilities due to the aftercare necessary after this procedure.

Question 46

Restraint and anaesthesia for tube cystostomy

Answer 46

Dorsal recumbency with hind quarters elevated slightly to force the intestines cranially and away from the urinary bladder.

General anaesthesia is preferred.

Sedation followed by local anaesthesia infiltration of surgical site is also acceptable.

Question 47

Surgical technique of tube cystostomy

Answer 47

The hair on the ventral abdominal wall from the pubis to the umbilicus is clipped.

The paramedian site is prepared for sterile surgery.

An 8-10cm paramedian incision is made on either the right or the left side.

The abdominal wall is incised, and the peritoneal cavity is opened carefully.

The urinary bladder is grasped and exposed through the abdominal incision and examined for tears and necrosis.

A stab incision is made into the ventrocranial urinary bladder.

A foley catheter is placed through the incision into the urinary bladder and the balloon is inflated.

If this does not feel secure, then a purse-string suture may be placed around the catheter and then anchored to the bladder.

The distal end of the catheter is passed through the abdominal wall lateral to the laparotomy incision.

Separate incisions are recommended so that the catheter will not delay healing of the laparotomy incision.

An adequate length of the catheter is left in the abdominal cavity to allow for dilatation, movement, and any other tension placed on the catheter and urinary bladder.

The catheter is anchored to the abdominal wall (at the point of exposure) with a simple suture of synthetic non-absorbable material.

The laparotomy wound is closed.