Introduction

Spaying is a very common surgical procedure in small animal veterinary practice. Ovariohysterectomy is the typical procedure taught in U.S. veterinary medical schools. This involves an abdominal approach, suspensory ligament disruption, secure ligation of both ovarian pedicles, broad ligament division, secure ligation of the uterine body and associated vasculature, and excision of the reproductive tract.

Ovariectomy, removal of both ovaries while the uterine horns and body remain, has received increased attention because the procedure can often be accomplished with a smaller incision, less tissue dissection/disruption, and no increase in long‐term issues, such as pyometra and urinary incontinence.¹ However, one study did not show a difference in time to complete the surgery or pain scores between dogs undergoing ovariectomy and ovariohysterectomy.² Ultimately, the procedure chosen is the practitioner’s decision and should be discussed with the owner. The presence of uterine pathology influences this decision; however, in young, otherwise healthy dogs, ovariectomy is a reasonable choice. It is similarly a reasonable choice in older dogs without uterine pathology.

Indications/Preoperative Considerations

The primary indication for surgery is to eliminate the potential for unwanted pregnancy and/or to eliminate reproductive behavior. Mitigation of mammary tumor development is another factor cited in favor of ovariohysterectomy. The risk of mammary tumor development has been shown to be 0.5%, 8%, and 26% when dogs were spayed before the first heat cycle, after the first heat cycle, and after the second and subsequent heat cycles, respectively.³ Ovariohysterectomy may decrease mammary tumor recurrence under certain circumstances in dogs with mammary tumors.⁴ Other indications include uterine/ovarian trauma, neoplasia, or fluid accumulation in the uterine lumen.

Preoperative considerations vary depending on patient factors and preoperative screening tests should be tailored to patient and owner factors. For example, young otherwise healthy animals may need limited blood work prior to surgery (packed cell volume, total protein, lactate, and glucose measurement) compared to an older patient with various co‐morbidities. The latter might need more involved blood work (complete blood count, serum chemistry, urine analysis) and potentially imaging depending on the reasons for ovariohysterectomy. The breed of the patient may also determine the need for additional testing prior to any surgical procedure, such as buccal mucosal bleeding time (BMBT) as a screening test for von Willebrand’s disease in Doberman Pinschers.

Appropriate antiseptics, surgical consumables, such as drapes and suture material, as well as appropriate instrumentation (Figure 25.1) should be on hand. X‐ray detectable sponges should be used and counted before and after surgery prior to closure.

These procedures can usually be completed by a single surgeon; however, contingencies for emergent issues (e.g., loss of pedicle control) should be in place, and it is useful to have another veterinarian or a technician practiced in aseptic technique and tissue retraction if a situation occurs. Suspensory ligament disruption is a challenging aspect of the procedure because it often takes more force than believed necessary, and the ligament is ideally disrupted deeper in the abdomen often out of the surgeon’s direct sight. The ligament is broken a distance from the ovary because the physical distance from the pedicle is greater craniodorsally in the abdomen. Suspensory ligament disruption is usually needed to improve ovarian exteriorization and pedicle exposure in dogs, but not always so in cats.

Surgical Procedure

The surgical technique for ovariohysterectomy has many variations. A three‐clamp technique procedure is described here with potential variations noted. Relevant differences between cats and dogs are also noted.

The clipped area should be sufficiently large enough to allow for incision extension in either the cranial or caudal direction (Figure 25.2). Clipping from immediately cranial to the xiphoid process to immediately caudal to the pubis and lateral to the nipples will result in an adequate amount of exposure.

Draping with liquid impervious quarter drapes secured with an adequate number of towel clamps to similar dimensions as the clipped area is recommended. A large over‐drape is then placed and opened such that the patient is covered (Figure 25.3).

The caudal aspect of the over‐drape can be attached to the instrument table or draped over it, depending on surgeon preference. This is not necessary but does create a relatively large, continuous area covered by a sterile drape. The drape is opened with scissors and a rectangle of over‐drape that closely matches the quarter‐draped area is removed. The over‐drape can be secured to the quarter drapes with non‐penetrating clamps, such as Lorna‐Edna or Allis tissue forceps.

Incision length and exact location will vary depending on patient size, reproductive status, species, and exact procedure to be performed. In general, incision location and length for dogs is from immediately caudal to the umbilicus extending caudally approximately 2/3’s the distance to the pubis. The incision can begin somewhat more caudally in cats. If an ovariectomy is to be performed, the incision can be shifted cranially and does not need to extend to the same degree caudally. If any cranial abdominal procedures will also be performed (e.g., prophylactic gastropexy), the incision will need to be sufficiently large and extend cranially to accomplish the other procedure(s). Sterile saline lavage during surgery will help limit tissue desiccation.

Ovariohysterectomy

Stay updated, free articles. Join our Telegram channel

Join