Anal furunculosis preventing anal glands draining

RE: Anal furunculosis preventing anal glands draining

Thomas Johnson — Sat, 15 May 2021 13:51:15 GMT

An update on this case. He has had no further flare-ups of his anal gland problem so for the moment we are leaving well alone. In discussion with the owner we are going to wait and see what happens, if he is getting regular recurrence we will consider surgery, if there is only very occasional problems we will manage medically as we have before.

RE: Anal furunculosis preventing anal glands draining

Lindsey Edwards — Mon, 26 Apr 2021 20:40:18 GMT

I haven't removed glands but have had success with marsupialising duct from edge of gland to opening

RE: Anal furunculosis preventing anal glands draining

Thomas Johnson — Fri, 23 Apr 2021 08:19:39 GMT

Thank you all for your thoughts. I've done a few anal sacculectomies and not had any serious complications, no incontinence so far! I've always used a closed technique, and in my first practice we used to fill the anal sacs with car body filler first (I guess it was cheaper than the resin sold for the purpose). I'm thinking that I will do the surgery, and do it when the sac is moderately full so I can dissect carefully around it.

RE: Anal furunculosis preventing anal glands draining

Joyce Whitehead — Thu, 22 Apr 2021 20:54:59 GMT

I’ve removed a fair few anal sacs over the years, although always with the help of the gel (which I think is discontinued now). I’ve so far (touch wood) never had a permanent incontinence, although I mention it to owners as a rare side effect. I’ve had some dogs so much happier after the surgery as they obviously had chronic irritation.

I did remove the sacs from one of my own dogs, due to persistent recurring infections, despite packing etc. She, of course, had small episodes of incontinence for about 2 weeks, especially when she barked, much to her surprise. Fortunately it stopped in time.

RE: Anal furunculosis preventing anal glands draining

Jill Butterworth — Thu, 22 Apr 2021 17:03:33 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29785/anal-furunculosis-preventing-anal-glands-draining/230021#230021"]I find that previously happy docile dogs can rapidly become nervous and unhappy at vet visits because of this approach.[/quote]

I've got quite small hands

RE: Anal furunculosis preventing anal glands draining

Gillian Mostyn — Thu, 22 Apr 2021 10:36:12 GMT

[quote userid="6297" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29785/anal-furunculosis-preventing-anal-glands-draining"]I'm wondering if the best option is to surgically remove the left anal sac. Has anyone seen this before and does this sound like a sensible approach?[/quote]

I haven't seen this exact situation, but I did once attempt removal in an English bulldog where the open draining fistulas from the sacs never healed, so I assumed the ducts were scarred closed. Indeed, I couldn't pass a small cannula into either of them under GA or instil the gel into them to aid removal. I chopped out what I could identify as sac wall (I wouldn't go as far as to call it dissection - it felt pretty brutal as the area was so scarred and inflamed) and, miraculously, they healed well and never caused any more issues. To be fair, as the dog already had permanent draining fistulas I was unlikely to make it worse - which helped to give me the confidence to go for it.

If it were my dog, I'd rather go for surgery rather than cope with chronic bursting anal sac issues.

RE: Anal furunculosis preventing anal glands draining

Gillian Mostyn — Thu, 22 Apr 2021 10:29:59 GMT

The idea is that you don't cut into the sac at all but remove it like it is a mass. I do find it helps with identification and manipulation in most cases.

RE: Anal furunculosis preventing anal glands draining

Gillian Mostyn — Thu, 22 Apr 2021 10:27:36 GMT

[quote userid="8858" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29785/anal-furunculosis-preventing-anal-glands-draining/230013#230013"]was to suggest very frequent emptying for a cheap fee ( weekly initially, then monthly)[/quote]

I find that previously happy docile dogs can rapidly become nervous and unhappy at vet visits because of this approach. If profibre doesn't help (it usually does, but obv wouldn't in this case) I'd much rather remove them.

But, so far, I've never had anything but minor complications so I guess experiences differ. I did my first AG excision on a GSD within a few months of graduation - using just a surgical text on the end of the table for guidance! Those were the days!

RE: Anal furunculosis preventing anal glands draining

Thomas Johnson — Thu, 22 Apr 2021 10:08:33 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29785/anal-furunculosis-preventing-anal-glands-draining/230007#230007"]What happens when you instill saline, water, or you favourite more solid ear prep??into the anal duct? Might pay to try both sides as it may be some congenital defect??[/quote]

Perhaps I wasn’t completely clear. The opening of the left duct is scarred over, it is impossible to cannulate the duct so I can’t flush or pack it.

RE: Anal furunculosis preventing anal glands draining

Anthony Todd — Thu, 22 Apr 2021 08:51:19 GMT

I remember there was some sort of white material in a kit which solidified when instilled into an AG supposed to make identification of AGs easier but,I suspect all it helped with was to identify the solid white stuff and extirpate that, probably leaving bits of the anal sac behind.....

RE: Anal furunculosis preventing anal glands draining

Jill Butterworth — Thu, 22 Apr 2021 08:26:51 GMT

Anecdotal, but practices I've worked at were never keen on anal sac surgery (presumably due to a few unsuccessful cases) and our management after infection was controlled, was to suggest very frequent emptying for a cheap fee ( weekly initially, then monthly), which seemed to be satisfactory and I followed this lead (Obviously I'm not referring to furunculosis or adenoma cases etc). Hence if you remain reluctant to operate on this dog, due to the furunculosis, and the contents seem normal, I guess you could sedate and aspirate with a sterile technique regularly as a simple solution for the longer or shorter term?

RE: Anal furunculosis preventing anal glands draining

Anthony Todd — Thu, 22 Apr 2021 01:05:33 GMT

I think i have posted this before but we used to pack the A/G with Panolog after draining and before scheduled booked!! extirpation but they all got better and [ I can't remember] but I don't think we ever removed an A/G again.

If I was still in practice I would try and import it myself somehow!

PS works just as well in cats too, and they get A/G impaction/irritation/infection.

PPS I/V cannulas with the tapered tip are so very good for entering A/G ducts, so keep your old ones!

RE: Anal furunculosis preventing anal glands draining

Craig Reilly — Wed, 21 Apr 2021 22:22:53 GMT

Dear Thomas - unusual! A cautionary tale for you - I have done hundreds of anal sac extirpation over 30+ years without issue - even those in horrible furunculosis cases missing large swathes of sphincter - both uni- and bi-lateral (latter more commonly) without incontinence complication - BUT - I had one case in a WHWT which was owned by a very fastidious family who owned a white shag carpet - it WAS a number of years ago.....! You guessed it - routine op as far as I was concerned - same technique I always use (and continue to use without issue - and she became permanently faecally incontinent.... I spoke to a well known Prof of Surgery at a Scottish Uni at the time and he said he never advised extirpation in Westies - no idea why, but it was his experience that they often become incontinent! Perhaps others may comment and say they have done Westies without issue - I have never tried another! Your case is unilateral so less risk than bilateral I guess - I might still be tempted to see if I could locate a duct and cannulate it and try conservative treatment for a while - with informed consent then extirpation should be curative I'd guess, just I'd be on tenterhooks for a few days post-op. Good luck!

RE: Anal furunculosis preventing anal glands draining

Beats — Wed, 21 Apr 2021 19:25:41 GMT

Not seen this with anal furunculosis, but interested in replies! I've never removed anal sacs from anal furunculosis case, but have sometimes thought about it.

My first anal sacculectomy was on a dog that had 2 x anal sacs that could not be expressed under GA (indeed there was not space to even rectal the patient properly).

Could not find the openings either.

I found it technically demanding, but then I'd never actually seen an anal sac removed before (and there was no youtube in those days, just textbook diescription and some line drawings in lecture notes...). I think I had moved jobs before I thought to remove another!

I would think in your case it would be a reasonable thing to do (esp. as unilateral), but I do personally dread the thought of removing an anal sac that cannot be expressed and cannot find an opening after that first experience!

I think if you have an anal sac that cannot be expressed at all (chronically) and is suspected of causing problems, then excision does seem the most logical thing to do (but I wouldn't look forward to actually doing it myself!)

PS - TEVA and Accord do generic tacrolimus ointments at a fraction of the price of Protopic (you probably already know this, but may be helpful to someone else reading and then googling protopic trade name and trying to order it!)

RE: Anal furunculosis preventing anal glands draining

Anthony Todd — Wed, 21 Apr 2021 16:51:14 GMT

What happens when you instill saline, water, or you favourite more solid ear prep??into the anal duct? Might pay to try both sides as it may be some congenital defect??