An overview of pediatric spay and neuter benefits and techniques - Veterinary Medicine
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An overview of pediatric spay and neuter benefits and techniques
Many veterinarians now perform these procedures in dogs and cats at an earlier age. The surgery is faster, the perioperative complication rate is lower—even the healing time is shorter than in adult animals.


VETERINARY MEDICINE


OVARIOHYSTERECTOMY IN PEDIATRIC CATS

Feline pediatric ovariohysterectomy is performed essentially the same as ovariohysterectomy in adult cats is; however, the structures are smaller and the exposure can be markedly less.

Place the anesthetized patient in dorsal recumbency, perform an abdominal surgical clip and scrub, and make an incision at the midpoint between the umbilicus and cranial brim of the pubis on the ventral abdominal midline. The incision can be as small as 1 to 2 cm in length. Excise any subcutaneous fat (there is usually none) in the surgical field, exposing the linea alba.

Make an incision in the linea alba. The linea alba is narrow in the pediatric cat, and it may be difficult to make the incision completely on the linea. There are, however, no adverse consequences if the incision is slightly paramedian. With the abdominal incision this far caudal, the urinary bladder can generally be easily visualized. Elevation of the bladder allows direct visualization of the uterine body and uterine horns. If the bladder is not visible, the uterine horn can be exteriorized with a spay hook.

Deliver one uterine horn through the incision. Apply enough caudal traction to the uterine body to expose the proper ligament and ovary. Clamp the proper ligament with a mosquito hemostat, and apply slight upward traction, exposing the suspensory ligament. Transect the suspensory ligament with scissors or a scalpel, and tear a hole in the broad ligament just caudal to the ovarian vessels. The ovarian vessels can be tied off and transected by using the same hemostat tie technique as in a feline orchiectomy.23

Gentle caudal traction on the first uterine horn will expose the uterine body and the second uterine horn. Expose the second ovary, and tie off and transect the second ovarian pedicle in a manner identical to that of the first.

Incise the broad ligaments to the uterine vessel on both sides to allow exposure of the uterine body. It is not necessary to remove the entire uterine body to the level of the cervix. One ligature placed with a Miller's knot without clamping the uterus is sufficient for hemostasis in pediatric patients. The suture type and size depends on the surgeon's preference; we prefer using 3-0 monofilament synthetic absorbable suture.

Create the Miller's knot by passing a length of suture material around the uterine body twice, creating a loop. Then pass the needle holders through the loop and create a standard square knot throw. Secure the knot, and tighten both loops evenly by elevating the loops as they are tightened, ensuring that the tissue is thoroughly compressed. Finish the Miller's knot with a series of square knots to prevent loosening. Then transect the uterine body distal to the ligature.

Closure consists of a simple continuous pattern in the body wall followed by simple interrupted subcuticular sutures to close the skin.10

OVARIOHYSTERECTOMY IN PEDIATRIC DOGS

Canine pediatric ovariohysterectomy is performed similar to ovariohysterectomy in a pediatric cat with only a few differences. The structures in the pediatric dog are smaller than in the adult dog. The ovaries are more easily exteriorized, and it is more difficult to exteriorize the uterine body. For these reasons, the abdominal incision in the pediatric dog is slightly caudal to that in the adult dog.

To perform this procedure, place the anesthetized patient in dorsal recumbency, perform a surgical clip and scrub, and make an incision just cranial to the midpoint between the umbilicus and cranial brim of the pubis on the ventral abdominal midline. Subcutaneous dissection on the midline exposes the linea alba, which is nicked with a scalpel blade. Extend the linea incision with scissors, exposing the abdominal contents. The urinary bladder may be visible, and if so, elevate it to allow direct visualization of the uterine body or uterine horns. If the bladder is not visible, exteriorize the uterine horn with a spay hook.

Deliver one uterine horn through the incision. Apply enough caudal traction to the uterine body to expose the proper ligament and ovary. Clamp the proper ligament with a mosquito hemostat, and apply slight upward traction, exposing the suspensory ligament. Transect the suspensory ligament with scissors or a scalpel, and tear a hole in the broad ligament just caudal to the ovarian vessels. Use a standard three-clamp technique on the ovarian pedicle, and transect and ligate the pedicle. The suture type and size depend on the surgeon's preference; we prefer using 2-0 monofilment synthetic absorbable suture. Generally, only one ligature is necessary on each pedicle in a pediatric canine spay.

Gentle caudal traction on the first uterine horn will expose the uterine body and the second uterine horn. Expose the second ovary and transect and ligate the second ovarian pedicle in a manner identical to that of the first.

Incise the broad ligaments to the uterine vessel on both sides, allowing exposure of the uterine body. One ligature placed with a Miller's knot without clamping the uterus is sufficient for hemostasis in pediatric patients. Transect the uterine body distal to the ligature.

Closure consists of a simple continuous pattern in the body wall followed by interrupted or continuous subcuticular sutures to close the skin.10

POSTOPERATIVE CARE

Even though puppies and kittens recover rapidly from sterilization surgery, it is still important to attempt to minimize activity for three to five days after surgery. Advise owners to keep surgical areas clean and dry and to seek veterinary care if bleeding, swelling, or separation of wound edges occurs.

CONCLUSION

Recognizing the shorter anesthetic and surgical times and lower complication rates for younger patients, many practitioners have begun performing spays and neuters at an earlier age in pets. Historically, practitioners have routinely seen kittens and puppies for a series of vaccinations and wellness visits between 6 and 16 weeks of age, and then advised owners to return a few months later for neutering. This gap in care may have contributed to many pets being spayed or neutered after puberty and after the birth of unintentional litters. By spaying and neutering pets at 4 or 5 months of age, two to three weeks after standard vaccinations, practitioners can allow time for the animals to develop immunity through vaccination while ensuring that they are neutered before sexual maturity. Since owners generally establish a routine of veterinary appointments for their pet during the wellness visits, there is no gap in veterinary care between the vaccine series and the surgical appointment and compliance may be improved.23

By performing spay or neuter surgery at this age, veterinarians are also able to ensure numerous health benefits for their patients, including a dramatic reduction in the risk of mammary tumors and the elimination or reduction of highly objectionable behaviors, including scent marking, spraying, fighting, and roaming. Additional benefits include avoiding the stresses and costs associated with spaying while in heat, with pregnancy, or with pyometra. Furthermore, spaying and neutering young puppies and kittens is technically easier for surgeons and more cost effective than neutering these pets once they are mature.

Philip A. Bushby, DVM, DACVS
Department of Clinical Sciences
College of Veterinary Medicine
Mississippi State University
Mississippi State, MS 39762

Brenda Griffin, DVM, DACVIM
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
University of Florida
Gainesville, FL 32608


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Source: VETERINARY MEDICINE,
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