OHE

Question 1

Indications for OHE?

Answer 1

Elective sterilization
Treatment of ovarian neoplasia
Treatment/prevention of uterine disese (pyometra/torsion)
Prevention/treatment of vaginal hyperplasia/prolapse
Prevention of mammary neoplasia

Question 2

What additional advantages can OHE have for a pet, in addition to preventing the babies?

Answer 2

Prevention of mammary tumors

Possibly prevent

• idiopathic epilespy (estrogens)
• diabetes mellitus (progesterone inhibits insulin receptors)

Question 3

What are disadvantages of OHE?

Answer 3

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

Question 4

What approach do you use for OHE?

Answer 4

Ventral midline

From umbilicus to pubis

Question 5

After you incise the skin and SQ, you want to remove SQ from fascia, how much do you remove and how?

Answer 5

Blunt dissection with metzenbaum scissors

Lift 5mm (too much dead space can lead to seroma)

Question 6

How do you make your incision into the linea alba?

Answer 6

Tent abdomen

Reverse stab incision
45degree angle

Carinal if using scalpel
Caudal if using scissors

Question 7

Where are the ovaries and the uterine horns located?

Answer 7

Ovaries at caudal pole of kidney
Uterine horse run in dorsolateral abdomen

Uterine body is between bladder and colon

Question 8

What spans between the ovary and uterine horns and is should be clamped to manipulate ovary

Answer 8

Proper ligament

Question 9

What runs betwee the cranial pole of the ovary to the body wall/last rib and must be broken to exteriorize the ovary ?

Answer 9

Suspensory ligament

Question 10

How is he suspensory ligament broken?

Answer 10

Hold clap, ovary and uterine horse

Apply gentle traction

Isolate suspensory ligament
Rupture towards insertion

Question 11

What vessels supply the ovary?

Answer 11

Ovarian arteries branch off aorta
Anastomosis with uterine artery’s

Right ovarian vein —> vena cava
Left ovarian vein —> left renal vein

Question 12

You need to make a window in the broad ligament before placing your ligatures.. where will you make this window?

Answer 12

Avascular area of mesovarium (window make with Rochester-carmalts)

Question 13

What technique is this?

Clamp on the proper ligament and two on the pedicle

Answer 13

Modified 3 clap technique

Question 14

What type of ligature do you place in the modified 3 clap technique and where should it be placed?

Answer 14

Millers knot in the crush of the most proximal clamp

Question 15

What size suture do you use for ovarian pedicle ligation?

Answer 15

2/0 for most

3/0 - for toy breeds and cats

0- for giant breeds

Question 16

How is the uterine body ligated?

Answer 16

3 clap technique
-millers in crush of most proximal clamp

Transfixing ligature proximal to middle clamp

Question 17

How can you check your ovarian pedicle for hemorrhage?

Answer 17

Left — move mesocolon medially

Right — medoduodenum medially

Question 18

How can you check the uterine stump for hemorrhage?

Answer 18

Located between colon and bladder

Exteriorize bladder can help

Question 19

Common complications to OHE?

Answer 19

Hemorrhage

• tearing of pedicle while strumming
• incomplete ligation
• loose ligatures
• increased risk in dogs >25kg

Infection
Dehiscence
Ligation or clamping of ureter

Question 20

How do you recognize hemorrhage post op?

Answer 20

Signs of shock

• slow recovery
• pale membrane
• distended abdomen
• decreased BP

this should NEVER happen

Question 21

What do you do if you see hemorrhage during your OHE?

Answer 21

Extend the incision

Laparotomy sponges to tamponade area

Identify source of bleeding

Exteriorize vessel before clamping
Clap and re-ligate

Question 22

What post op care is required for OHE patients?

Answer 22

Exercise restriction

Elizabethan collar

Dogs in estrus
— males may still try to mate early post op (make sure to separate) —> can cause terrine tearing

Question 23

How does the approach to feline OHE differ from dog?

Answer 23

Feline: Middle 1/3 of caudal abdomen and usually a shorter incision (3-4cm)

Dog: cranial 1/3 of caudal abdomen , incision 4-6cm

Question 24

T/F: the suspensory ligament must be broken to exteriorize the ovary in cats

Answer 24

False

Question 25

How is our uterine body ligation different in cats compared to dogs?

Answer 25

Dogs: 3 clamp technique

Cat: double ligate before clamping (2 clamps distal to ligature then transection )