Surgical Complications, An Issue of Veterinary Clinics: Small Animal Practice

Christopher A. Adin

Description

A comprehensive review of small animal surgical complications for the general veterinary practitioner! Topics on complications will include: upper urinary tract surgery, lower urinary tract surgery, GI surgery, hepato-biliary surgery, spay/neuter surgery, reconstructive surgery, thoracic surgery, airway surgery, minimally invasive surgery, metabolic complications of endocrine surgery, ear surgery, surgical site infections, and more!

Sujets

• Smal Animal
• Veterinary Medicine
• Medical
• Médecine

Informations

• Publié par: Saunders
• Date de parution: 28 septembre 2011
• Nombre de lectures: 0
• EAN13: 9781455712113
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Veterinary Clinics of North America: Small Animal Practice , Vol. 41, No. 5, September 2011
ISSN: 0195-5616
doi: 10.1016/S0195-5616(11)00127-6

Contributors
Veterinary Clinics of North America: Small Animal Practice
Surgical Complications
Christopher A. Adin, DVM
ISSN  0195-5616
Volume 41 • Number 5 • September 2011

Contents
Cover
Contributors
Forthcoming/Recent Issues
Preface: Surgical Complications
Metabolic Complications of Endocrine Surgery in Companion Animals
Complications of Upper Urinary Tract Surgery in Companion Animals
Complications of Lower Urinary Tract Surgery in Small Animals
Complications of Gastrointestinal Surgery in Companion Animals
Complications of Hepatic Surgery in Companion Animals
Complications of the Extrahepatic Biliary Surgery in Companion Animals
Complications of Upper Airway Surgery in Companion Animals
Management of Complications Associated with Total Ear Canal Ablation and Bulla Osteotomy in Dogs and Cats
Complications of Reconstructive Surgery in Companion Animals
Complications of Minimally Invasive Surgery in Companion Animals
Complications of Ovariohysterectomy and Orchiectomy in Companion Animals
Surgical Site Infections in Small Animal Surgery
Index
Veterinary Clinics of North America: Small Animal Practice , Vol. 41, No. 5, September 2011
ISSN: 0195-5616
doi: 10.1016/S0195-5616(11)00129-X

Forthcoming/Recent Issues
Veterinary Clinics of North America: Small Animal Practice , Vol. 41, No. 5, September 2011
ISSN: 0195-5616
doi: 10.1016/j.cvsm.2011.07.002

Preface: Surgical Complications

Christopher A. Adin, DVM
Guest Editor, Email: [e-mail]
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 610 Vernon Tharp Street, Columbus, OH 43210, USA


Christopher A. Adin, DVM Guest Editor

“Although today we are spared the horror of operations without anesthesia and the misery of mortality from uncontrolled hospital gangrene, we still find there are other problems that we have to face with steadfastness, self-control and intensity of purpose if we are to achieve that very great contentment and happiness in successful treatment of our patients …. I remember at an early stage of our development of the surgery of mitral valve stenosis, about 1948 or 1949, we had four successive deaths in one ward. Despair stalked before us and everyone's morale was low. I recall saying to my team that we could only do one of two things, give up or go on; that it was impossible to give up as we were certainly in the right; the only thing therefore, that we should do was go on. This we did and had 30 consecutive successful cases. Tenacity of purpose must be accompanied by serenity of purpose and a surgeon requires this serenity in addition to technical dexterity.”
— Sir Russel Brock, MS, FRCS (Eng), FRACS (Hon.), FACS (Hon.), from “Philosophy of Surgery,” an address given upon his receipt of the Gairdner Foundation International Award in 1961 and published in the Canad Med Assoc J 1962;86:370-2.
This quotation, from a pioneer in open heart surgery, reflects an ongoing trend in veterinary surgery. As we continue to achieve technological advancements in both diagnosis and treatment of surgical disease, surgeons will continually be challenged with new and more complicated procedures that will, initially, have a steep learning curve. As an introduction to this excellent series of articles concerning surgical complications in veterinary surgery, I think that it is appropriate to point out that, although complications must give us pause and compel us to improve, they must not be allowed to create a feeling of self-doubt that prevents us from achieving our ultimate goal: successful care for our patients. I would like to thank the authors for their own “tenacity of purpose” in continuing to improve our approach to veterinary surgery.
Veterinary Clinics of North America: Small Animal Practice , Vol. 41, No. 5, September 2011
ISSN: 0195-5616
doi: 10.1016/j.cvsm.2011.05.012

Metabolic Complications of Endocrine Surgery in Companion Animals

Joao Felipe de Brito Galvao, MV, MS ∗ , Email: [e-mail] , Dennis J. Chew, DVM
Small Animal Internal Medicine, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH 43210, USA
∗ Corresponding author. Arboretum View Animal Hospital, 2551 Warrenville Road, Downers Grove, IL 60515

Keywords
• Hyperparathyroidism • Insulinoma • Adrenalectomy • Hypercalcemia • Thromboembolism • Hypertension
Metabolic complications of endocrine surgery occur commonly and precautions should be taken to avoid potentially life-threatening situations and to lessen expense associated with a more extended hospital stay. Common complications of endocrine surgery as well as prevention strategies will be reviewed for pancreatic, parathyroid, and adrenal surgery.

Pancreatic Surgery
Pancreatic surgery is indicated as the primary means of therapy for canine insulinoma. Unfortunately, surgical manipulation of the pancreas can result in a variety of complications, including vomiting, refractory pancreatitis, pancreatic exocrine insufficiency, and diabetes mellitus. The prevalence and consequences of metastasis, benefits and goals of surgery, and possible complications and mortality should be discussed with clients before surgery.
Approximately 45% (129 of 285) of dogs with insulinoma were reported to have metastasis detected at the time of surgery. 1 – 8 Additionally, 11.5% (7 of 61) of dogs had multiple pancreatic nodules. 2, 6 Whenever possible, partial pancreatectomy is recommended to achieve maximal local disease control in dogs with insulinoma. The only study that reported data on nodulectomy for insulinoma described a median survival time (345 days in 10 dogs) 2 that was shorter than the reported median survival times in dogs undergoing partial pancreatectomy (534 days in 60 dogs). 2, 6, 7 The goals of surgery are to achieve a definitive diagnosis of insulinoma and to potentially increase the overall median survival time by decreasing gross disease. Combining the results of previous retrospective studies, the median survival time for medical management as the only treatment was 124 days (22 dogs), 6, 7 and for surgical intervention with or without medical management, 436 days (102 dogs). 2, 6, 7 These results support the need for surgical intervention whenever possible.
Insulinomas are considered malignant in dogs. Location of the tumors is variable, with tumors located near the accessory pancreatic duct and biliary duct being considered less amenable to resection. Ideally, dogs with nonresectable tumors would not undergo surgery because fasting or manipulation of the pancreas can lead to refractory hypoglycemia and pancreatitis after surgery. Unfortunately, it can be extremely challenging to classify tumors as resectable or nonresectable based on standard methods of preoperative staging and surgical exploration is typically required.

Preoperative Considerations
The patient should not be fasted for longer than 8 to 10 hours, to minimize the risk for hypoglycemic seizures. Clinical signs should be closely monitored to avoid the development of seizures. Ideally, dextrose supplementation should be avoided unless the dog has clinical signs compatible with hypoglycemia (eg, tachycardia, muscle tremors, weakness, seizures). The use of anesthetic premedications that alter glycemic control such as dexmedetomidine is controversial. Alpha-2 agonists may exacerbate hyperglycemia due to decreased insulin secretion occasionally seen immediately after partial pancreatectomy.

Intraoperative Considerations
Inability to achieve complete resection of the primary tumor and the presence of gross metastasis at the time of surgery are important markers of postoperative complications and should be considered. Dogs with gross metastasis at the time of surgery or those with non-resected primary tumors are more prone to persistent hypoglycemia after surgery, which may be exacerbated by pancreatitis or stimulation of the neoplastic islet cells during surgical manipulation. Moreover, even though partial pancreatectomy may offer better disease control, this technique may be associated with a higher morbidity, especially when en bloc resection is performed at the central portion of the pancreas, necessitating biliary and intestinal reconstruction. These consequences should be addressed a priori when weighing the cost-benefit ratio for surgical intervention. Many surgeons will perform aggressive resection with partial pancreatectomy in dogs that have peripheral lesions near the tip of the left or right pancreatic lobes. In dogs with central lesions, nodulectomy can be considered in an attempt to minimize surgically induced morbidity while still achieving some degree of cytoreduction.

Postoperative Considerations
Postoperative complications of pancreatectomy include persistent hypoglycemia, seizures, pancreatitis, and transient hyperglycemia. These complications are discussed in detail next.
Hypoglycemia is the most common postoperative complication following insulinoma surgery ( Table 1 ). Based on the compilation of data available from previously published retrospective case series on insulinomas, hypoglycemia is estimated to occur in one third of dogs undergoing surgery and one third of those may die from complications associated with hypoglycemia.