Lateral Ovariectomy in the Bitch

Re: Lateral Ovariectomy in the Bitch

Mark Hedberg — Mon, 30 Sep 2013 08:55:01 GMT

[quote user="Tom Yarrow"]

The Journal of the Rejected Manuscript.

This article is four pages and any if any body wants it email me <tomyarrow@gmail.com>

[/quote]

Do you know, I'd probably subscribe to a magazine like that just on general principles?

Re: Lateral Ovariectomy in the Bitch

Anthony Todd — Sun, 29 Sep 2013 19:39:28 GMT

[quote user="Tom Yarrow"]This article is four pages and any if any body wants it email me <tomyarrow@gmail.com>[/quote]

If you give it to me I'll scan it and put it here, mate.

Re: Lateral Ovariectomy in the Bitch

Tom Yarrow — Sun, 29 Sep 2013 19:33:15 GMT

Hi,

I am Tom Yarrow - since Tony Todd told me that you needed some advice - since my reply to Tony I have found an article I wrote on flank spaying of bitches which I wrote many many years ago and never submitted for publication - probably worried that it would have to go in The Journal of the Rejected Manuscript.

This article is four pages and any if any body wants it email me <tomyarrow@gmail.com>

Re: Lateral Ovariectomy in the Bitch

Anthony Todd — Sat, 28 Sep 2013 21:49:30 GMT

[quote user="Iain McAllister"]

I am going to Central America where they neuter bitches using this technique

1. Does anyone know on an online resource describing/illustrating the technique

2. If anyone has done the procedure - can they advise on top tips and possible pitfalls that I may encounter

thanks

[/quote]

Tom Yarrow, who some of your may remember and of whom I have the greatest regard as a surgeon was persuaded to write this which may be of interest.

Flank Spay

There is a French article where they opened the abdomen on both sides.

There was one in Modern Veterinary Practice ( now defunct ) where this guy from Fort Worth made a tiny incision in the muscular flank. He made a very small incision in the skin and then punctured the abdomen with a very thin artery forceps and opened them and then placed a larger artery forceps through the same incision withdrew the thin ones and stretched the wound with the bigger forceps - used a hook to get up the left horn remove the ovary from it's attachment and then dealt with the bifurcation area - having secured this he then pulled up the right horn.

One suture in the skin and a photo with a dime by the incision site!!

Said this method was good advertising.

I first saw flank spaying doing a locum at Stevenage and Letchworth.

They went through lots of muscle which I thought was daft

Try to operate on the left flank as the left ovary is very difficult to exteriorise with a Right Flank incision. The right ovary can easily be exteriorised through the left incision.

So these people need to look at an anatomy book which is what I did (Millers of the Dog). They will see the flank muscles external & internal oblique ventrally decide to become the Rectus Sheath.

The skin incision should be just above the mammary glands then external and internal oblique are transected in the tendon just below the muscle fibres = blood free.

The transversalis muscle is very thin and it is attached to the rectus sheath more medially so don't bother looking for this attachment just cut the transversals at right angles = minimal or no bleeding. You can split it in the fibre direction but I never did.

Use a tissue forcep on the muscles in upper part of the incision and lift up all three muscles. Insert Rochester Pean forceps (preferably curved ) upwards and grab some tissue; withdrawing the forcep will exteriorise the left uterine horn.

The fatty tissue you grab will have the left uterine horn under it so it needs flipping over in an upward direction to expose the horn.

Exteriorise the left ovary and detach it - ligate the left mesentery ( meso metrium ?) - pull the left horn posteriorly and the right horn will become exposed then slowly exteriorise the right ovary and detach it.

(not sure detach is a good word here but I know what I mean)

Ligate the right mesentery and ligate at the uterus vagina area.

As long as you have the ovaries out leaving a bit of uterus is not a problem.

Close all muscle layers with the same sutures.

Close the skin.

[Tell the owner to "Take it to the Park for Good Advertising". Advice from Eamon McAlister on bone repair with external fixation. ]

What to avoid:

- do not do this on very round abdomen dogs - TEST If the anaesthetised bitch is on the table lying say on its right side and see it you can push the incision area down and feel the table - if you cannot feel the table my advice would be do it mid line.

We reckoned to be able to do one dog about every 15 - 20 minutes including GA, clipping, wound prep ( spray with povidone iodine ).

Average incision would be between 1 and 2 inches.

It is much easier and quicker to do this with a scrubbed assistant as they can hold the tissue forceps upwards when the surgeon puts in the Rochester Pean and get other things ready to hand to the surgeon.

For some reason the nurse looks after the anaesthesia; not really necessary these days and they would be much better employed learning what instruments the surgeon is going to use next - I reckon they like to get scrubbed and assist the surgeon as anaesthetics are so boring.

I saw a quadruple coronary artery bi-pass at Papworth many years ago and the anaesthetist once he had stopped the heart and put it on bypass

spent the whole time reading his journals.

The patient did recover.

Re: Lateral Ovariectomy in the Bitch

John Flynn — Sat, 28 Sep 2013 19:24:28 GMT

[quote user="bob lehner"]

I always thought it was the spikey ends of the blue mono-filament nylon linea alba sutures (single interrupted) which caused tissue reactions. One would often see a dog, months after the op, with a row of small 'blisters' down the incision line - and would then go in and remove the offending nylon sutures to resolve the problem. I suppose there might also have been an element of suture infection - although the practice in question was a VH, with a good level of surgical asepsis (by the standards of those days - we are talking 35-plus years ago).

(Haven't used nylon mid-line for donkeys' years now I hasten to add).

[/quote]

I use it regularly and can't remember a "suture reaction" in recent years (and I'd remember having to go and remove my midline sutures in a bitch spay I think).

I do them simple continuous, typically use 2M monofilament nylon and don't leave long spikey ends and close SC tissue over the knots.

Nylon's got to be one of the least reactive suture materials surely - also cheaper than catgut you know

If doing cheap neutering then I'd prefer nylon over catgut for all but ligatures.

Re: Lateral Ovariectomy in the Bitch

bob lehner — Sat, 28 Sep 2013 19:07:25 GMT

(Haven't used nylon mid-line for donkeys' years now I hasten to add).

Re: Lateral Ovariectomy in the Bitch

John Flynn — Sat, 28 Sep 2013 18:58:19 GMT

[quote user="bob lehner"]mono-filament nylon often produced nasty tissue reactions[/quote]

never noted a problem myself

Re: Lateral Ovariectomy in the Bitch

bob lehner — Sat, 28 Sep 2013 18:52:41 GMT

In my first job it was the practice policy to do all bitch spays via the flank - possibly because in those days we only had cat gut or nylon for suturing - and neither were ideal for mid-line abdomens - cat gut could break down and mono-filament nylon often produced nasty tissue reactions, even a long time post-op.

As I recall - we went in on the right side (probably to make for easier access to the more cranial R ovary). Relatively easy on a thin, flat-chested breed like a greyhound, but pretty tricky in a big, fat broad chested breed like a SBT - getting the deeper ovary up to the incision could make one sweat a bit...! (I do recall the bosses on occasion doing one side, then turning the dog over to go in again on the left for the second ovary).

Main other probs were bleeding in the muscle layers and post op seromas - obviously better to try and split the muscle layers rather than cutting.

Overall I was happy to move onto mid-line spays....particularly when vicryl arrived on the scene as the new wonder suture material !

Re: Lateral Ovariectomy in the Bitch

sharon rankin — Sat, 28 Sep 2013 14:13:30 GMT

In my first job as a new graduate, the senior vets always performed flank bitch spays/caesars. I think the advantages were: ability to spay without needing constant monitoring as the bitch is not lying on her back & that they used catgut in the muscle. I can see why it would be preferred in some overseas spay clinics.

I have performed one flank bitch spay & hated it (the nurse had already clipped the flank). They bleed more than a cat spay (muscle layers) and accessing both the ovaries and trying not to leave too much of a stump I found was trickier than midline (although less of a problem with ovariectomy) Also many of them come back with rather large seromas.

But like anything, practice makes perfect. Good luck!

Re: Lateral Ovariectomy in the Bitch

Anthony Dennison — Fri, 27 Sep 2013 10:17:17 GMT

This describes OVH, but I presume the approach would be the same.

http://veterinaryrecord.bmj.com/content/171/10/248.short

Re: Lateral Ovariectomy in the Bitch

Martin Atkinson — Fri, 27 Sep 2013 10:12:52 GMT

I have in the past in small/medium dogs, and for caesarians to avoid pups interfering with the sutures when suckling, it was just like flank spaying a large cat, no change in procedure from that.