Complications of surgical neutering Flashcards
What are possible complications during surgical neutering
Anaesthesia related:
- inadequate monitoring
- anaesthesia deepened due to a response to pulling on an ovary
Bleeding:
- bitch - ovarian pedicle, cervico-uterine stump, broad ligament
- stallion - testicular artery
Damage to other organs:
- e.g., queen or bitch during opening the abdomen
- e.g. inclusion of ureters within cervical ligatures in bitch
What is the cause of most bleeds during surgical neutering?
inadequate exposure or poor ligation techniques
How can bleeding be managed in the bitch or queen during surgical neutering?
Increase exposure
Use suction
Convert flank to midline approach (cat)
Ask for assistance
Use mesenteric dam maneuvers to look at ovarian pedicles
Retract bladder caudally to look at cervical stump
Re-ligate, consider fluid therapy
How can bleeding be managed in the stallion during surgical neutering?
Grasp spermatic cord stump with artery forceps
Re-ligate
How can damage to organs be managed during surgical neutering?
Identify organ damaged
effect a repair
What are the common post-operative anaesthesia related complications?
Hypothermia
Abnormal heart rate (arrhythmias)
Hypoventilation
Hypotension
Difficult recovery
What are the common post-op bleeds seen in the bitch and the signs of this?
Bleeding into the abdomen:
- poor recovery
- pale m.membs
- rapid HR
- swollen abdomen
- blood seepage through wound
What are the common post-op bleeds seen in the stallion and the signs of this?
Bleeding from open incision
- steady blood drip = skin bleeder
- anything more is likely to be major vessels (e.g. testicular artery) & requires intervention
How is post-op bleeding in the bitch prevented and managed?
Always check the 3 sites before you close the abdomen it is much easier to re-ligate now rather after recovery
After recovery - make a decision on whether to re-open the abdomen (this is best made early)
How is post-operative major vessel bleeding managed in stallions?
Try to identify the spermatic cord, clamp and re-ligate
You may need to blindly try clamping with long artery forceps
This may not be possible so you can pack the scrotum with sterile gauze
Consider further surgery if bleeding cannot be stopped
What are some common complications during recovery in the stallion and what should you do if these happen?
Herniation of omentum
- Don’t pull out any more material
- Resect protruding tissue
- Pack wound / close skin
- Box rest, antimicrobials
Eventration (prolapse of intestine through scrotal incision)
- Prevent further damage using sheet to hold viscera & prevent any further protruding
- Refer for surgery
What are common post-surgical complications in the short term?
Wound inflammation (seroma)
Scrotal haematoma (firm swelling)
Wound infection & breakdown
Scrotal dermatitis (caused by licking)
- Dogs lick scrotum if clipped or scrub solution not washed away (so don’t clip)
What should you do if wound inflammation (seroma) occurs post surgery?
Consider exercise regimes to prevent before this occurs (e.g. hand walking stallions)
Ensure swelling is simple fluid (not infection / herniation)
Consider removing the fluid
For stallion walking exercise for 30mins twice daily
What should you do if scrotal haematoma occurs post surgery?
Provide appropriate antimicrobial cover
What should you do if wound infection occurs post surgery?
Provide appropriate antimicrobial cover
Prevent self-trauma
Remove any infected material (e.g. skin sutures)
What should you do if wound breakdown occurs post surgery?
Provide appropriate antimicrobial cover
Remove devitalized tissue, debride
Suture if only healthy tissue remains or consider treating as open wound
What long-term issues may arise after surgical neutering?
Surgical materials left behind (e.g. swabs, sutures).
Bitch:
- flank fistula from ovarian pedicle
- inguinal fistula from uterine stump
- pyogranuloma => infected or enlarged stump + red/brown vulval discharge
Stallion:
- chronic infection of cord (scirrhous cord)
Incomplete removal of the gonads
What should you do if a long term issue (e.g. surgical material left behind, fistula, chronic infection, pyogranuloma) arises?
Establish nature of the problem (fistulography, vaginal endoscopy etc)
Re-operate & remove devitalized tissue, surgical instrument, swabs, suture material
Provide appropriate antimicrobial cover
What are the signs of incomplete gonad removal in males and females?
Females - signs of repeated oestrus
Males - persistent male-like behaviour
What are the possible causes of incomplete removal of the gonads in males?
Usually this is a cryptorchid animal which has had a unilateral castration
Sometimes in the stallion a portion of the testis is left behind
What do you need to do if there are signs of repeated oestrus post neutering in bitch/queen?
Establish this is oestrus by observing behavior, vaginal cytology
Establish there is ovarian tissue by hormone testing
What do you need to do if there are signs of persistent male-like behaviour post neutering in dog/tom/stallion?
Establish there is androgenisation by clinical exam (e.g. penile spine in cats, musculature in stallions)
Establish there is testicular tissue by hormone testing
What are the consequences of removing the gonads?
Increased risk of:
- Urinary incontinence
- Certain neoplasias
- Joint diseases (hip/elbow dysplasia)
- Growth plate fractures (if neutered early)
Physical Changes:
- Body conformation changes
- Loss of secondary male characteristics (muscle mass, mane)
- Taller growth if neutered early (delayed growth plate closure)
