| Hi everyone, I hope you are enjoying some lovely weather. If you are looking for something to read by the pool, and you also happen to enjoy surgery, I may have found the perfect combination for you! This time, we explore several unusual and under-reported topics, for which it is particularly valuable to see new publications. We also consider some interesting alternatives to conventional surgery and return to BOAS procedures…but this time, not only in dogs: cats are joining the discussion too! I hope you enjoy the selection and my thoughts on the papers. As always, I would love to hear what you think. If there is a topic you are particularly interested in or would like to explore further, please let me know. Have a great day, enjoy the sunshine and happy reading! |
| A single-layer, full-thickness, simple continuous suture pattern is safe for hysterotomy closure in dogs undergoing cesarean section JAVMA. Open accesshttps://avmajournals.avma.org/view/journals/javma/aop/javma.26.03.0177/javma.26.03.0177.xml I have to confess: when it comes to suturing, I don’t use anything fancy! I tend to favour the simplest technique that gives me confidence and security. Hysterotomy closure following a Caesarean section (C-section) is one of the rare occasions when I routinely use a double-layer closure: a simple continuous appositional pattern for the inner layer, followed by an inverting outer layer. So this study sounded quite interesting to me. This study compared that technique with a single-layer, full-thickness simple continuous closure. It included 89 C-sections in 77 dogs, with French Bulldog being the most represented breed (what a surprise…) The study’s key finding was that a single-layer, full-thickness simple continuous pattern appears to be a safe option for hysterotomy closure. However, I would encourage you to read through the whole paper, as it contains several other findings that may be relevant to our day-to-day work. For example, anaesthetic complications were reported in 72% of procedures, with hypotension being the most common. Surgical complications occurred in 10%, mainly due to haemorrhage. The paper also offers an interesting overview of the different reasons for elective C-section and emergency procedures following dystocia. Of the dogs included, 24 went on to have a subsequent pregnancy. Nineteen required another Caesarean section, with no reported problems associated with the previous uterine closure technique. This was also interesting to me as I never had an opportunity to do a C-section after a previous C-section.Studies on this subject are relatively uncommon, so it is valuable to have data from an institution performing such a high number of these procedures. I hope you enjoy the read! I’d also love to hear which technique you use for hysterotomy closure. As for me, I think I may be switching to a single-layer, full-thickness simple continuous pattern from now on. Clinical outcomes of lateral ear canal resection performed in routine clinical practice for chronic otitis externa in dogs: a retrospective descriptive study of 58 ears (2016-2025) JSAP. Open accesshttps://onlinelibrary.wiley.com/doi/10.1111/jsap.70156 A look through the references in this paper highlights just how old much of the literature on ear disease and these procedures is. More recent studies have focused predominantly on total ear canal ablation and lateral bulla osteotomy (TECA-LBO), leaving a considerable gap in the evidence surrounding less invasive procedures. TECA-LBO is a salvage procedure for end-stage ear disease, and I have often struggled to identify a clear place for procedures such as lateral wall resection or vertical canal ablation in the population of dogs that I see. In fact, I have probably performed only a handful of them. As TECA-LBO is technically demanding and can be associated with significant complications, it is worth exploring whether it could be avoided in selected cases. The paper described 58 lateral wall resection procedures. During the follow-up period, none of the dogs required TECA-LBO, although some continued to need regular topical treatment, less frequently than before surgery.I found this interesting and quite applicable in practice. Lateral wall resection is a relatively straightforward procedure that aims to improve ventilation and drainage of the ear canal, it may help us avoid TECA-LBO or at least delay the need for it.One limitation of this study in my opinion was the absence of clearly defined exclusion criteria. In particular, more effort could have been made to define and exclude otitis media. I would be interested to know whether lateral wall resection is still commonly performed in general practice but is simply under-reported. One of the key questions raised by this paper is how many of these dogs will eventually progress to TECA-LBO. If none, or only a small proportion, require salvage surgery in the longer term, perhaps we should consider lateral wall resection much earlier in the course of the disease. I would love to know your opinions on this! Use of phenylephrine-soaked gauze following staphylectomy does not reduce the need for reintubation or temporary tracheostomy in brachycephalic dogs JAVMA. Open accesshttps://avmajournals.avma.org/view/journals/javma/aop/javma.26.04.0283/javma.26.04.0283.xml This is a quick read involving brachycephalic dogs undergoing cut-and-sew staphylectomy for BOAS over a two-year period. In an attempt to reduce postoperative inflammation, phenylephrine-soaked gauze was applied to the surgical site at the anaesthetist’s discretion. The study retrospectively investigated whether this intervention was associated with the need for reintubation or temporary tracheostomy. The short message is that there were no significant differences between dogs treated with phenylephrine-soaked gauze and those that were not in terms of reintubation, temporary tracheostomy placement or survival to discharge.I don’t use anything specific to reduce the swelling over the surgical site, but I like to have a look at the end of the surgery or when ready to recover the dog and if I see some inflammation or swollen larynx, I give them a dexamethasone injection (0.1-0.2mg/kg). I leave you here the link for a nice study:https://onlinelibrary.wiley.com/doi/10.1111/vsu.14039; This intervention was not intended to reduce inflammation, but rather to reduce haemorrhage by adding adrenaline to bilateral maxillary nerve blocks, useful to keep in mind. Ala vestibuloplasty for treatment of feline brachycephalic syndrome: a description of the procedure and long-term outcomes in 27 cats JFMS. Open accesshttps://journals.sagepub.com/doi/10.1177/1098612X261465216 Another study on brachycephalic patients, but this time in cats! These cats are primarily affected by stenotic nares, and ala vestibuloplasty has previously been described in both cats and dogs. This technique can take some time to “master”, but it becomes much easier to understand when demonstrated by someone with experience. I wanted to highlight this paper because one of its aims was to provide a detailed description of the technique, supported by clear photographs, to make it easier for others to reproduce. The reported outcomes were very encouraging, based on owner-completed quality-of-life questionnaires. One particularly interesting aspect of the study was the inclusion of some cats from a previous study that had used a very similar questionnaire. The owners were asked to complete the new questionnaire, allowing the researchers to assess recall bias. There was a tendency for owners to remember their cats’ preoperative clinical signs as being slightly more severe than they had originally reported. This highlights an important limitation that can affect retrospective studies relying on owners’ recollections. I have included two interesting techniques for treating stenotic nares in cats below: Single pedible advancement flap:https://journals.sagepub.com/doi/10.1177/1098612X20910539 Alar fold lift-up and sulcus pull-down:https://avmajournals.avma.org/view/journals/javma/261/9/javma.23.01.0054.xml Bedinvetmab (Librela/Beransa) in dogs raises safety concerns, including rapidly progressive osteoarthritis, and warrants vigilant adverse event reporting JAVMA. Open accesshttps://avmajournals.avma.org/view/journals/javma/aop/javma.26.03.0170/javma.26.03.0170.xml This is an important and potentially provocative paper discussing emerging safety concerns about bedinvetmab (Librela/Beransa), particularly its possible association with rapidly progressive osteoarthritis. Similar cases have already been reported. Bedinvetmab can provide very effective analgesia for many dogs with osteoarthritis, my own dog received it a few years ago, with an obvious improvement in her quality of life, and clinician satisfaction remains high. However, the authors describe a small but concerning group of dogs that developed unusually rapid and destructive joint changes following treatment. The proposed association is biologically plausible: nerve growth factor is involved not only in pain signalling but also in bone and cartilage homeostasis. Rapidly progressive osteoarthritis was a significant concern during human trials of anti-NGF monoclonal antibodies and contributed to these products not receiving regulatory approval for use in people. I was unaware of this and found it both worrying and scientifically fascinating. This is currently a very “hot” subject that deserves a more in-depth discussion than I can provide here. However, I think it is important for clinicians to be aware of these emerging concerns, and this article is certainly worth reading. In my opinion a very well written article. Surgical closure of labial and alveolar cleft defects with a modified Millard technique: A prospective study of ten dogs Vet Surgeryhttps://onlinelibrary.wiley.com/doi/10.1111/vsu.70120 This is a very interesting study describing a modified Millard technique for repairing labial and alveolar clefts in ten puppies. I was not familiar with this technique, and this is one of those papers worth keeping to hand, as sooner or later, it is likely to be helpful. These are uncommon and challenging defects, and the veterinary literature offers relatively little practical guidance on their surgical management. One of the greatest strengths of this paper is its detailed, step-by-step description of the procedure, supported by incredible images, drawings and reconstructions that make the technique “easier” (relatively) to understand and reproduce.Adapted from human paediatric cleft surgery, the procedure involved separate reconstruction of the nasal and oral layers, followed by repair of the lip and nostril. After surgery, all the dogs were able to eat and drink normally, and their preoperative clinical signs resolved. I found this to be a particularly useful surgical paper. It does not establish that this is the best technique, but it provides a well-described approach to a difficult condition for which treatment options remain limited. Definitely worth reading! Ethanol ablation guided by sonographic appearance of the nodule is effective for treatment of primary hyperparathyroidism in dogs JAVMA. Open accesshttps://avmajournals.avma.org/view/journals/javma/aop/javma.26.02.0157/javma.26.02.0157.xml This paper caught my eye because I remember reading some of the earlier studies a few years ago, and our institution is now developing a protocol that will allow us to offer this treatment. I have to say that I enjoy performing parathyroidectomies – they are generally quick and neat procedures. I am rather less enthusiastic about the postoperative management, as normalising calcium concentrations can be challenging in some dogs.This paper describes a minimally invasive procedure involving the injection of 95% ethanol into the parathyroid nodule under ultrasound guidance. Unlike previous protocols, which used a predetermined volume calculated from the size of the nodule, ethanol was administered incrementally until the entire nodule appeared diffusely hyperechoic on ultrasound.The results were encouraging, with hypercalcaemia resolving in approximately 89% of dogs. This approaches the reported success rate of surgical parathyroidectomy. I found this to be an interesting and relevant paper. Ultrasound-guided ethanol ablation can offer a useful alternative to parathyroidectomy, particularly for older dogs, patients with comorbidities or owners wishing to avoid surgery. However, it is important to remember the anatomical location of the parathyroid glands and their proximity to several vital structures in the neck. This is a technically demanding procedure that should not be undertaken lightly. Large-bore thoracostomy tube placement in small animals JAVMA. Open accesshttps://avmajournals.avma.org/view/journals/javma/aop/javma.26.01.0046/javma.26.01.0046.xml This video provides a practical tutorial on placing large-bore thoracostomy tubes, both with and without a trocar. A handy and informative resource to watch! Author’s special Vessel-sealing devices may be safely used for hepatic surgery in dogs with a low rate of severe complications AJVRhttps://avmajournals.avma.org/view/journals/ajvr/87/7/ajvr.26.01.0008.xml In this multicentre study led by Colorado State University, we investigated the use of vessel-sealing devices in canine hepatic surgery. Our aim was to assess their feasibility and safety when used for liver biopsy and lobectomy.These devices performed well for obtaining liver biopsies, with diagnostic-quality samples obtained in every case. They were also successfully used for liver lobectomies. However, when discussing hepatic surgery, I would always recommend that surgeons become familiar with several techniques. Having different options available is particularly important when dealing with challenging liver masses that require dissection or vascular control at the hepatic hilus.One question that remains unanswered is whether these devices seal bile ducts as reliably as blood vessels, as biliary leakage was reported in few cases. Further investigation is therefore needed, and the hepatic stump should be carefully assessed for bile leakage before abdominal closure. |