Digestive sys Flashcards
margins for tumors of maxilla / mandible?
○ at least 2 cm (preferably 3 cm) are recommended for malignant cancers (SCC, malignant melanoma, fibrosarcoma) in the dog.
○ If possible, mandibular SCC in the cat should be treated with surgical margins greater than 2 cm because of high local recurrence rates (Northrup et al. 2006).
○ If 3 cm margins are not possible without significant risk of morbidity, 1 cm margins of normal tissue beyond either the grossly visible tumor or the extent of the tumor as determined by imaging, whichever is greater, may be acceptable for malignant oral tumors and 0.5 cm margins for benign tumors (Syrcle et al. 2008).
sx considerations for maxi/mandibulectomy / sx planning
- minimum margins include:
○ 3 cm of bone rostral and caudal to the tumor, based on either gross palpation or preferably imaging findings
○ 1 cm of soft tissue (buccal, gingival, or palatine mucosa).- if there is no evidence of rostral mandibular tumors crossing the mandibular symphysis, then excision of the symphysis, including the contralateral middle incisor, should be sufficient
- Osteotomies bw teeth
- Closure: monofil abs, PDS recc
mm of mastication?
masseter, temporalis, pterygoids, digastricus
indications for rim mandibulecotmy? Murray 2010
Rim mandibulectomy is recommended for surgical excision of benign tumors confined to the alveolar margin of the mandible (Murray et al. 2010).
complications w mandibulecotmy?
mandibular drift
eating difficulties
incisional swelling /ranula
wound dehiscence
malloculsion
vessels encountered w maxillectomy?
○ major palatine and sphenopalatine arteries for rostral maxillectomies
○ infraorbital artery and maxillary artery for caudal maxillectomies
5 sx techs for maxillecotmy
incisivecctomy
rostral maxx - uni or bi
rostral max + nasal planecotmy
radical matxillectomy
caudal maxillecomty
bilateral caudal matxillectomy
revision options for maxillectomy dehiscence?
○ angularis oris axial pattern buccal flaps
○ advancement of skin flaps into the oral cavity
○ free microvascular grafts of the rectus abdominis muscle
○ free auricular cartilage autograft
insertion of a silicone nasal septal button
complications of glossectommy?
hemorrhage
dehiscennce
prehension difficultés
ptyalsim
tongue necrosis
heat stress
local recurrence
difficulty grooming (cats)
(Tuohy et al. 2014). found tumor size > X cm was associated with MST for MM?
tumor size > 3cm was prognostic with a median survival time of 874 days for melanomas < 3 cm 396 days for melanomas > 3 cm
diff in px for oral/gingival SCC vs tonsilar or tongue SCC?
- prognosis for dogs with oral SCC is good, particularly for rostral tumor locations. - mets in ~10%
- SCC of the tonsils and base of the tongue are highly metastatic, with metastasis reported in up to 73% of dogs, and local or regional recurrence is common
MST / survival rate for dogs w SCC untreated vs sx? Fulton 2013
○ MST for untreated dogs was 54 days with a 0% 1- year survival rate (Fulton et al. 2013). 2 MONTHS!!!
○ In comparison, the 1- year survival rate for dogs with surgically excised oral SCC was 94%
oral FSA px?
guarded
locally aggressive and local control more problematic than mets
mets inn <20% dogs
local recc in 59% w mandib & 40% w maxillectommy
RT resistant
poor px factors for dogs w/ mandibular/max or calvarial OSA?
○ ALP > 140 U/L
○ increased monocyte counts
○ telangiectatic histologic subtype
○ mitotic index
○ histologic grade
local tumor recurrence
layers of esophagus
○ Mucosa
○ Submucosa
○ Muscularis
○ adventitia (NOT serosa)
BS to esophagus? (cervical, thoracic, abdominal?)
○ Segmental BS
○ Cervical esophagus – cranial /caudal thyroid aa
○ Thoracic esophagus – bronchoesophageal and dorsal intercostal aa+ esophageal br of aorta
○ Abdominal esophagus – L gastric aa
structures to avoid near cervical esophagus?
carotid sheath, recurrent laryngeal nerves, thyroid glands, and parathyroid gland
ICS for caudal esophagus vis cranial esophagus?
cranial esophagus – Left 3-4 or right 3-5
caudal esophagus– left 7-9
2 options for esophageal support (help w healing)
esophageal myotomy
esophageal patching
factors contributing to complications w esophageal healing
lack of sserosa
tension
segmental BS
lack of omentum
constant peristalssis
continual bathing of incision w food/water
o In a study of 245 cases of salivary gland disease, cats were shown to have a higher prevalence of XXX salivary gland tumors than dogs (Spangler 1991)
what was the prevalence
1.6times greater
approaches for zygomatic sialoadenecotmy?
intraoral approach
lateral approach w zygomatic osteotomy
lateral approach w/o osteotomy (dorsal or ventral)
- Bush et al, vet surg 2023. Outcomes and clinical features associated with surgically excised canine salivary gland carcinoma: A mulit-institutional, retrospective, VSSO study.
most common glands affected?
MST in this study vs Hammer 2001 study?
o Most common glands = mandibular/sublingual 54.2%; Parotid 38.9%
o overall MST associated with salivary carcinoma was 1886 days. /5y
previously reported 550 days (Hammer 2001)
- Manzoni et al, JSAP 2023. Preoperative computed tomography, surgical treatment and long term outcomes of dogs with abscesses on migrating vegetal foreign bodies and orophayngeal stick injuries: 39 cases (2010-2021)
most freq isolated bacteria?
o Pasteurella multocida
- Castejon-Gonzalez, JAVMA 2023. Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review
recc age for sx? if defect is large then which age recc?
recc age is 4mo
if defect too large or std tech / larger flaps needed then delay until 7-8mo
- Treggiari et al, JVIM 2023. Tonsillar carcinoma in dogs: treatment outcome and potential prognostic factors in 123 cases
positive prognostic factors?
overall survival time ?
o positive prognostic factors –absence of clinicals signs at presentation, surgery (tonsillectomy), use of adjuvant chemotherapy and use of NSAIDs.
o OST was 126 days (4mo) – Significantly longer survival was seen in dogs without evidence of metastatic disease (MST 381 days)
- Bobis-Villagra, JFMS 2022. Feline sialocoele: clinical presentation, treatment and outcome in 19 cases
most common gland affected and resolution rate w/ sx?
mandibular–sublingual salivary gland–duct complex was the most frequently involved.
o Surgical excision=complete resolution of CS
- Cinti et al. Vet surg 2021. Complications between ventral and lateral approach for mandibular and sublingual sialoadenectomy in dogs with sialocele
recurrence rates bw lateral approach vs ventral? which had more complications?
o Recurrences were more likely after LAT approach (7%) vs ventral (0%) but wound-related complications were more likely after VPM approach (28%)
- Arzi et al, JAVMA 2023. Contemporary management of temporomandibular joint fractures in dogs and cats: review and expert insights on diagnostic imaging, treatment strategies and long term outcomes
indications for open tx?
severe / displaced fx of mandibular fossa+/-condylar process preventing closure / opening of the mouth OR displacement of the condylar process into the auditory system
- Cray et al, JAVMA 2022. Analysis of risk factors associated with complications following mandibulectomy and maxillectomy in dogs
what 3 factors were associated with inc complications?
sx time, preop RT or chemo, & matxillectomy
tx options for lower esophageal sphincter achalasia-like syndrome (3)
mechanical dilation, functional dilation with botulinum toxin A (BTA) injections, and modified Heller myotomy with Dor fundoplication
- Beer et al, JAVMA 2022. Complications associated with and outcomes of surgical intervention for treatment of esophageal foreign bodies in dogs
% of dogs w/ esophageal perf on presentation?
survival to discharge rate?
factors associated with w non survival?
o Esophageal perforation=66% dogs
75% =survived to discharge
o nonsurvival =esophageal perforation, undergoing a thoracotomy, and whether a gastrostomy tube was placed
- Vangrinsven et al, JSAP 2021. Diagnosis and treatment of gastroesophageal junction abnormalities in dogs with brachycephalic syndrome
main conclusion?
beneficial effect of antacid treatment on the improvement of digestive clinical signs and lesions
- Conte, VS 2020. Computed tomographic comparison of esophageal hiatal size in brachycephalic and non‐brachycephalic breed dogs
main conclusion?
o Esophageal hiatus cross‐sectional surface area in brachycephalic dogs was considerably larger
support the existence of a specific anatomical factor that could likely correlate to functional GE alterations (eg, regurgitation, gastroesophageal reflux, and sliding hiatal hernia) commonly seen in brachycephalic dogs.
- Basscunan, VS 2020. Vascular ring anomalies in cats: 20 cases (2000‐2018)
most common VRA in cats?
survival rate?
peristent CS?
o Persistent right aortic arch was the most commonly diagnosed
o 90% survival
persistent CS in 69% cats; ME in 31%
- Mayhew et al. Vet surg 2023. Effect of conventional multilevel brachycephalic obstructive airway syndrome surgery on clinical and videofluoroscopic evidence of hiatal herniation and gastroesophageal reflux in dogs
did conventional multilevel sx improve SHH or GER?
o Conventional multilevel surgery in dogs with BOAS does not appear to consistently resolve SHH and GER, although CS may improve.
- Luciani et al, JVIM 2022. Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs
brachy dogs were more likely to have which 3 factors?
younger, in resp distress, or have asp pneumonia on presentation
- Lhuillery et al. Vet surg 2022. Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization
conclusion? what was associated with w inc mortality ?
did not provide evidence of benefits in delaying surgery beyond the initial 90 min stabilization
o Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk
- Dobberstein et al. Vet surg 2022. Primary repair of nonsteroidal anti‐inflammatory drug‐associated full thickness gastrointestinal ulcers in 11 dogs
conclusion? / survival rate
o Primary closure = high success rate w/ 73% survival to discharge
- Duffy et al. Vet surg 2021. Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model
recc? which closure method biomechnically superior?
o Double-layer suture closure = superior biomechanical properties vs stapling
o Reinforcing single-layer closure of partial gastrectomies with an inverting Cushing pattern is recommended
- Grimes et al, JAVMA 2020. Characteristics and long term outcomes of dogs with gastroesophageal intussusception
most common breed? survival rate? most common postop CS?
o most common= young males, GSDs = 33%
o 88% survival to discharge (w/ sx) – consider sx tx
o persistent regurg was common (esp if ME or acute CS)
- Abrams et al. Vet surg 2019. Perioperative complications and outcome after surgery for treatment of gastric carcinoma in dogs: A Veterinary Society of Surgical Oncology retrospective study of 40 cases (2004–2018)
MST? what was associated with inc survival?
o Major complications =20%
o MST = 178 d (6mo)– Prev studies – MST of 72 days
administration of adjuvant chemotherapy was associated with improved survival
- Mullen et al, Vet surg 2023. A quantitative evaluation of the effect of foreign body obstruction and enterectomy technique on canine small intestinal microvascular health
conclusion?
Stapled enterectomies do not lead to greater vascular compromise than handsewn enterectomies
- Williams et al, Vet surg 2023. Clinical outcomes of the use of unidirectional barbed sutures in gastrointestinal surgery for dogs and cats: A retrospective study
what was a major adverse event /complicaiton w/ barbed suture?
intestinal obstruction due to strictures
- Sanders et al, vet surg 2023. Gastrointestinal thickness, duration, and leak pressure of five intestinal anastomosis techniques in cats
thickness of stomach vs dogs?
what did they recc for staple size for stomach vs rest of GIT?
thickness of the stomach in cats is almost half that of the stomach in dogs (1.6mm cats vs 3.2 dogs)
potentially use green TA for SI and blue TA for stomach (transverse line?)
- Pfeifer et al, JVECC 2022. Gastric or duodenal perforation and secondary septic peritonitis following therapeutic nonsteroidal anti‐inflammatory drug administration
% of dogs on appropriate dose of nsaid dlvpt ulcer?
which nsaid at labeled dose had highest rate of perf?
o 60% of dogs perforated on labelled dose – meloxicam most common
- Duffy et al, vet surg 2022. Influence of crotch suture augmentation on leakage pressure and leakage location during functional end‐to‐end stapled anastomoses in dogs
conclusion?
o Placing 2 crotch sutures or use of a simple continuous pattern for anastomotic augmentation appeared to be superior to the placement of a single suture
- Lopez et al, JAVMA 2021. Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs
dehiscence rate for enterotomy vs R&A?
odds of dehiscence after R&A vs enterotomy?
Dehiscence: enterotomy = 4% and R&A =18%
o odds of intestinal dehiscence for R&A were 6x the odds for enterotomy
- Chang et al, vet surg 2021. Influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure
where should loop for barbed suture be placed relative to incision? end?
loop should be placed ≥ 5 mm from beginning of the incisional line for enterotomy closure
continue past incision for 3 bites
- Culbertson et al, VS 2021. Intraoperative surgeon probe inspection compared to leak testing for detecting gaps in canine jejunal continuous anastomoses: A cadaveric study
which was more sens?
o PT was highly sensitive at detecting gaps compared with LT
- Maxwell et al, Vet surg 2021. Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: A retrospective study by the Society of Veterinary Soft Tissue Surgery
did outcomes differ?
risk factors for perforation?
o Outcomes did not differ between dogs treated immediately or > 6hr after presentation – however more GI injury and R&A in delayed group
o Risk factors for perf: duration of CCS, inc lactate, linear FBO, timing of sx
- Larose et al, vet surg 2020. Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions
most common location for intuss?
recurrence?
ileocolic most common (43%)
3% recurrence
- Mullen et al, vet surg 2020. Gastrointestinal thickness, duration, and leak pressure of six intestinal anastomoses in dogs
recc for staple size ?
o Canine intestinal thickness may warrant use of a larger staple size If edematous tissues then green TA may be better d/t inc thickness of canine SI
o Recc use of TA blue or green staples for GIA/TA
- Duffy et al, vet surg 2020. Influence of oversewing the transverse staple line during functional end‐to‐end stapled intestinal anastomoses in dogs
conclusion?
o Leakage occurred at the level of the transverse staple line in non- oversewn constructs
o evidence to support oversewing
- Sumner et al, Vet surg 2019. Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008‐2018)
rate of dehiscence for oversew vs no oversew?
Dehiscence: 0% oversew vs 15% nonoversewn FEESA
- Strelchick et al, JAVMA 2019. Intestinal incisional dehiscence rate following enterotomy for foreign body removal in 247 dogs
reported rate of dehiscence?
o Enterotomy dehiscence rate = 2%
- Stecyk et al, JAVMA 2022. Gastrointestinal signs and a need for nutritional management may persist long term in dogs and cats undergoing resection of the ileocolic junction: 35 cases (2008–2020)
most common long term signs?
o long-term diarrhea, weight loss, and muscle loss were common
- Grossman et al, JAVMA 2022. Evaluation of outcomes following subtotal colectomy for the treatment of idiopathic megacolon in cats.
recurrence of constipation?
recc about ICJ?
o Constipation recurrence = 32% not associated with retention vs removal of the ICJ
o ICJ removal associated with long-term liquid feces recommend that veterinarians do not remove the ICJ
- Lux et al, JAVMA 2021. Evaluation of short-term risk factors associated with dehiscence and death following full-thickness incisions of the large intestine in cats: 84 cases (1993–2015)
dehiscence rate?
this rate vs other rates?
factors associated w dehiscence?
o dehiscence = 8% & survival = 94%
o factors assoc w/ dehiscence only — hypoalbuminemia, renal dysfxn, blood prod or >2 classes of ABX, intraabd fecal contam
- Sapora, VS 2021. Ex vivo comparison of hand‐sutured versus circular stapled anastomosis in canine large intestine
which stapler did they NOT recc?
o use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses
- Latimer et al, JAVMA 2019. Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs
dehiscence rate?
factors associated with w dehisce?
intestinal dehiscence 10% and mortality rates 17%
o Factors assoc w/ dehiscence: preexisting colon trauma/dehiscence, preexisting peritonitis, blood products, admin of >2 abx, positive culture for sx sample, open abd mgmt of peritonitis
- Tidd, VS 2019. Outcomes in 40 cats with discrete intermediate- or large-cell gastrointestinal lymphoma masses treated with surgical mass resection (2005-2015).
which GI location had the best px?
o Cats with large intestinal masses (MST 675d) lived longer than those with small intestinal (65d) or gastric masses (96d)
- Franca et al, 2024. Histopathological diagnosis and surgical complications following bilateral anal sacculectomy for the treatment of unilateral canine apocrine gland anal sac adenocarcinoma: 35 cases (2019‐2023)
% of dogs w/ bilateral agasaca
sx recc?
o non-neoplastic anal sac disease was found in 66% dogs and bilateral AGASACA in 20% dogs
no dog w bilateral AGASACA was noted preop
o promote and encourage the use of bilateral anal sacculectomy in cases of suspected unilateral anal sac neoplasia
- Davey et al, Vet surg 2024. Outcomes of dogs with apocrine gland anal sac adenocarcinoma treated via modified closed anal sacculectomy (2015–2022)
recurrence rate?
complication rate?
recc from paper? which paper conflicts these results??
2% recurrence rate
postop comps ~30%
comparable postoperative complication rate but a lower local recurrence rate than prev reported
consider use
fontes 2023 found no diff w recc
- Rossello, JSAP 2023. Combined transposition of internal obturator and superficial gluteal muscles for perineal hernia treatment in dogs: 17 cases (2017-2020).
complication rate vs IOT only?
comp rate = 41%
IOT alone 5-16%
higher comps related to T shaped skin incision
Fontes, JAVMA 2023. Long-term outcomes associated with a modified versus traditional closed anal sacculectomy for treatment of canine anal sac neoplasia
complication rate bw techs? recc rate?
which paper conflicts sthis
o Complications: modified =15% vs traditional = 20%
o Tumor recurrence: modified = 23% vs traditional= 25%
o No benefits in complication rate or local recurrence were identified
davey 2024 - lower recc rate (2%)
- Griffin, JAVMA 2023. Short and long-term outcomes associated with anal sacculectomy in dogs with massive apocrine gland anal sac adenocarcinoma
local recurrence?
what was associated with dvlpt of new/progressive lnn mets?
MST?
o Local recurrence = 40%
o Dogs with lnn metastasis were more likely to develop new/progressive lymph node metastasis (~50%) vs those w/o lnn mets)
MST ~2yr
- Sutton, JSAP 2022. Computed tomographic staging of dogs with anal sac adenocarcinoma
relationship bw agasaca size and lnn?
o No association was found between anal sac mass size and presence or absence of iliosacral lymph node enlargement
local mets in 71%
- Hubers, JSAP 2022. Outcome of surgical treatment of perineal hernia in cats: 36 cases (2013‐2019)
what was most common p/o CS?
tenesumus – 75%
PU is hx risk factor
Tobias, vet surg 2022. Perineal hernia repair in dorsal recumbency in 23 dogs: Description of technique, complications, and outcome
prev abd hernias noted?
conclusion?
Concurrent or previous inguinal or umbilical hernias were noted in 21.7%
a single-stage abdominal and perineal approach without repositioning
complication rates similar to sternal
- Cantatore, vet surg 2022. Submucosal resection via a transanal approach for treatment of epithelial rectal tumors – a multicenter study
recur rate? when as recurrence more likely?
21% recurr
more likely w incomplete margins or complications
- Cinti, vet surg 2021. A novel technique to incorporate the sacrotuberous ligament in perineal herniorrhaphy in 47 dogs
where is best place to place sutures around?
o Recc placement of sutures around the proximal half of the sacrotuberous ligament Sciatic nn is closest to sacrotuberous lig @ two-thirds distance from the proximal attachment
- Schlag, JSAP 2020. Comparison of methods to determine primary tumour size in canine apocrine gland anal sac adenocarcinoma
dogs w tumors > XX were more likely to present w mets?
predictors of mets ? (3)
tumours >2.5 cm more likely to have mets
predictors: 1’ tumor size, tumor stage, vascular invasion
- Amsellem, JAVMA 2019. Apocrine gland anal sac adenocarcinoma in cats: 30 cases (1994–2015)
which CS assoc w/ cat agasaca
recurr rate & MST
perineal ulceration or discharge
recc = 36%
MST= 7mo
- Bernarde, JSAP 2018. Surgical findings and clinical outcome after bilateral repair of apparently unilateral perineal hernias in dogs
conclusion? recc rate?
o PH in dogs might be considered a bilateral disease
0% recc
- Singh et al, JAVMA 2023. Laparoscopic surgical treatment for sliding hiatal hernia is associated with an owner-perceived improvement in clinical outcome in dogs
main complication? %
o 55% pneumothorax w/ 22% conversion rate
- Mullen et al, Vet surg 2023. Use of real-time near-infrared fluorescence to assess gastric viability in dogs with gastric dilatation volvulus: A case-control study
conclusions?
o support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV
- Gollnick et al, JFMS 2023. Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009–2021
likelihood of postop septic peritonitis/mortality ?
< 5.2%
- Hiebert et al, JFMS 2022. Intestinal dehiscence and mortality in cats undergoing gastrointestinal surgery
mortality rate? odds of death w/ preop septic abd? dehiscence?
o 18% mortality rate – inc mortality d/t preop septic abdomen, hypothermia
o Cats w/ preop septic abd had 6.7x higher odds of mortality
o GI dehiscence = <1%
- Mullen et al, JAVMA 2021. Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008–2019)
dehiscence for feesa vs handsew?
relationship w leak testing?
o Dehiscence rate =9% – 10% FEESA vs 6% handsew
o Performing leak testing was not assoc w/ dec incidence of dehiscence
o No dehiscence in any R&As w/ positive leak test + augmentation vs 8.8% of R&As with neg leak test
- Anderson et al. JSAP 2021. Outcome following surgery to treat septic peritonitis in 95 cats in the UK.
survival rate? was px worse if pre-op peritonitis
o survival rate = 66%
o Cats with GI dehiscence did not have a worse px
o Intraop hypotension assoc w/ death
- Tidd, VS 2019. Outcomes in 40 cats with discrete intermediate- or large-cell gastrointestinal lymphoma masses treated with surgical mass resection (2005-2015).
MST for LI vs SI?
what was associated with w/ survival
MST: large intestine MST = 675d (~2y)»_space;> gastric MST = 96d (3mo) > SI MST = 65d (2mo)
o Complete margins assoc w/ survival: complete = 370d vs dirty = 83d
- DePompeo, JAVMA 2018. Intra-abdominal complications following intestinal anastomoses by suture or staple techniques in dogs
dehiscence rates for handsew vs stapled?
recc if preop septic peritonitis?
Dehiscence rates: handsew=13% vs stapled =5%
o dogs with preop septic peritonitis– subsequent dehiscence in 60% handsew vs 0% stapled
recc stapled anastomosis if preop septic peritonitis
- Grimes, JAVMA 2011. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs
risk factors for dehiscence? what was protective factor?
if preop peritonitis–> % w/ continued peritonitis postoperative?
Risk factors for dehiscence: preoperative septic peritonitis, low preop albumin & TP, and intraop hypotension
o Presence of a foreign body was a protective factor
o Dehiscence rates: 6% without preop peritonitis vs 20% with peritonitis –30% of dogs w/ peritonitis continued to have peritonitis
