Spay and Castration

Complications - All Preventable!

Daniel D. Smeak, DVM, Diplomate ACVS
Professor, Chief of Surgery
Colorado State University

Seminar Plan
Specific major complications related to canine and
feline spay and neuter operations- how to prevent them
Dan Smeak, Chief of Surgery, CSU
Minor common postoperative complications, how to
manage them, how to document them
Laura Helmueller, Chief Medical Officer, Emancipet

OHE Complications
Retained ovarian tissue (remnants)
Uterine stump pyometra

Ovarian Remnant Syndrome

Differential Diagnoses
Inflammation or infection of GU tract
Vaginal hemorrhage due to FB, trauma
Uterine stump pyometra
Neoplasia of GU tract
Exogenous estrogen administation*

Diagnosis: Ovarian Remnant

Suspect- any dog or cat with signs of estrus after
OHE or vaginal hyperplasia, prolapse occurs after
surgery
Vaginal cytology: cornified epithelial cells
predominate
Ultrasonography: sagittal plane caudolateral to
kidney; best if performed around estrus
Progesterone assays: >2 ng/mL (1-3 weeks after
estrus- dog; Queen induce ovulation, 2-3 weeks
later )

Rebecca L. Ball, JAVMA Mar 2010

Surgical error most common cause

21 cases (20002007) dogs and cats
Clinical signs- proestrus, estrus
Signs can be delayed- even up to 10 years!
Abdominal radiography suspicious in 11/12
All remnants in normal locations, NOT ectopic (usually entire ovary!) R > L
Surgical exposure, resection- long term resolution, no recurrences

Treatment
Key Point- perform complete exploratory laparotomy
while dog or cat is showing signs of heat
Eases identification of ovary and associated
vasculature
Prevention- adequate exposure, careful palpation of
ovary BEFORE clamp placement; open ovarian bursa
after OHE to assure ovary removal

Cant identify ovary?

Isolate ureter caudal to kidney
Resect all tissue caudal to
kidney including old ligation
site
Biopsy all tissue removed

Exploratory Laparotomy
Isolate and remove ovarian remnant!

Isol

Protect ureters, resect uterine stump en bloc

OHE Complications
Ovarian pedicle suture infection (draining sinus)

Castration Complications
Feline infected cord remnants

Explore inguinal area, resect infection nidus

Castration Complications
Canine
Fatal intra-abdominal bleeding
Scrotal hematoma
Combined closed-open technique- large, giant breeds

Open versus Closed Castration

Advantages/disadvantages
What do YOU do, why?

Avoid Fatal Hemorrhage

Closed technique
NO tension on cord during clamping or ligation

Avoid Scrotal Hematomas

Make sure all bleeding has been eliminated

Castration bleeders

Open Technique- Tunic bleeders

Modified Open Technique

Skin incision, spermatic

fascia broken down

Expose tunics, incise into parietal

tunic away from epididymis

Metzenbaum incision parallel

to cord contents

Divide between cremaster/

tunics, and vessels, ductus

Spermatic Cord

Division complete, resulting

in two bundles to ligate

Individual ligation, 1st tunics

and cremaster, leave ends long

Bring knot ears around

vessel/ductus bundle

Circumferential ligation
around both bundles

Routine Closure
Hypodermal closure, skin closure

Scrotal Hematomas
Treatments

Scrotal Hematomas
Treatments

How about drainage?

Scrotal Ablation

Urethral Laceration
Prescrotal castration incision
Misstaken caudal os penis for testicle
Longitudinal laceration
Complete transection

Urethral Laceration
Prevent by making skin is incised over testicle
Longitudinal laceration- catheterize, divert urine, 3-7
days
Complete transection- appositional reconstruction,
scrotal urethrostomy

Spay/Castration Complications
All are preventable!
Questions?