OHE Flashcards
Indications for OHE?
Elective sterilization
Treatment of ovarian neoplasia
Treatment/prevention of uterine disese (pyometra/torsion)
Prevention/treatment of vaginal hyperplasia/prolapse
Prevention of mammary neoplasia
What additional advantages can OHE have for a pet, in addition to preventing the babies?
Prevention of mammary tumors
Possibly prevent
- idiopathic epilespy (estrogens)
- diabetes mellitus (progesterone inhibits insulin receptors)
What are disadvantages of OHE?
Obesity
-increased appetite and decreased metabolic rate
Orthopedic problems
-hip dysplasia/CCL rupture
Urinary incontinece
- 20% of spayed females
- estrogen plays a role in sphincter
Neoplasia
- HSA
- lymphoma
What approach do you use for OHE?
Ventral midline
From umbilicus to pubis
After you incise the skin and SQ, you want to remove SQ from fascia, how much do you remove and how?
Blunt dissection with metzenbaum scissors
Lift 5mm (too much dead space can lead to seroma)
How do you make your incision into the linea alba?
Tent abdomen
Reverse stab incision
45degree angle
Carinal if using scalpel
Caudal if using scissors
Where are the ovaries and the uterine horns located?
Ovaries at caudal pole of kidney
Uterine horse run in dorsolateral abdomen
Uterine body is between bladder and colon
What spans between the ovary and uterine horns and is should be clamped to manipulate ovary
Proper ligament
What runs betwee the cranial pole of the ovary to the body wall/last rib and must be broken to exteriorize the ovary ?
Suspensory ligament
How is he suspensory ligament broken?
Hold clap, ovary and uterine horse
Apply gentle traction
Isolate suspensory ligament
Rupture towards insertion
What vessels supply the ovary?
Ovarian arteries branch off aorta
Anastomosis with uterine artery’s
Right ovarian vein —> vena cava
Left ovarian vein —> left renal vein
You need to make a window in the broad ligament before placing your ligatures.. where will you make this window?
Avascular area of mesovarium (window make with Rochester-carmalts)
What technique is this?
Clamp on the proper ligament and two on the pedicle
Modified 3 clap technique
What type of ligature do you place in the modified 3 clap technique and where should it be placed?
Millers knot in the crush of the most proximal clamp
What size suture do you use for ovarian pedicle ligation?
2/0 for most
3/0 - for toy breeds and cats
0- for giant breeds
How is the uterine body ligated?
3 clap technique
-millers in crush of most proximal clamp
Transfixing ligature proximal to middle clamp
How can you check your ovarian pedicle for hemorrhage?
Left — move mesocolon medially
Right — medoduodenum medially
How can you check the uterine stump for hemorrhage?
Located between colon and bladder
Exteriorize bladder can help
Common complications to OHE?
Hemorrhage
- tearing of pedicle while strumming
- incomplete ligation
- loose ligatures
- increased risk in dogs >25kg
Infection
Dehiscence
Ligation or clamping of ureter
How do you recognize hemorrhage post op?
Signs of shock
- slow recovery
- pale membrane
- distended abdomen
- decreased BP
this should NEVER happen
What do you do if you see hemorrhage during your OHE?
Extend the incision
Laparotomy sponges to tamponade area
Identify source of bleeding
Exteriorize vessel before clamping
Clap and re-ligate
What post op care is required for OHE patients?
Exercise restriction
Elizabethan collar
Dogs in estrus
— males may still try to mate early post op (make sure to separate) —> can cause terrine tearing
How does the approach to feline OHE differ from dog?
Feline: Middle 1/3 of caudal abdomen and usually a shorter incision (3-4cm)
Dog: cranial 1/3 of caudal abdomen , incision 4-6cm
T/F: the suspensory ligament must be broken to exteriorize the ovary in cats
False
How is our uterine body ligation different in cats compared to dogs?
Dogs: 3 clamp technique
Cat: double ligate before clamping (2 clamps distal to ligature then transection )
