Complications of Surgical Contraception

Question 1

Complications of Surgical Neutering

Answer 1

• Complications during surgery
• Complications during recovery
• Complications shortly after surgery
• Longer term complications
• Consequences of removing the gonads

Question 2

Complications during surgery

Answer 2

Anaesthesia related
○ Inadequate monitoring
○ When anaesthesia is deepened because of response to pulling on ovary
Bleeding (often due to poor ligation)
○ Ovarian pedicle
○ Cervico-uterine tump
○ Broad ligament
Often minor
○ Testicular artery in stallion
Damage to other organs
○ E.g. queen or bitch during opening the abdomen
○E.g. inclusion of ureters within cervical ligatures in bitch

Question 3

Counter measure for bleeding in spays

Answer 3

○ Increase exposure
○ Use suction
○ Convert flank to midline approach (cat)
○ Stay calm, try not to panic
○ Ask for assistance
○ Use mesenteric dam maneuvers to look at ovarian pedicles
○ Retract bladder caudally to look at cervical stump
○ Re-ligate, consider fluid therapy

Question 4

Counter measure for bleeding in stallion

Answer 4

○ Grasp spermatic cord stump with artery forceps
○ Re-ligate

Question 5

Complications during recovery

Answer 5

Anaesthesia related
Bleeding
Herniation of omentum in stallion (open castration)
Eventration in stallion at time of standing

Question 6

Anaesthesia related complications in recovery

Answer 6

○ Hypothermia
○ Abnormal heart rate (arrhythmias)
○ Hypoventilation
○ Hypotension
○ Difficult recovery

Question 7

Bleeding complications during recovery

Answer 7

○ Bitch: Bleeding into the abdomen = poor recovery
Pale mms
Rapid HR
Swollen abdomen
Blood seepage through wound
○ Stallion: Bleeding from open incision = A skin bleeder will be a steady drip of blood
Anything more is likely to be a major vessel and requires intervention
□ Inguinal or testicular artery

Question 8

Counter measures for bleeding in bitches on recovery

Answer 8

○ Check 3 sites before closing abdomen
Easier to re-ligate now than have to re-open abdomen
○ After recovery make early decision on whether to re-open

Question 9

Counter measures for bleeding in bitches on recovery

Answer 9

○ Check 3 sites before closing abdomen
Easier to re-ligate now than have to re-open abdomen
○ After recovery make early decision on whether to re-open

Question 10

Counter measures for bleeding in stallions on recovery

Answer 10

○ Try to identify the spermatic cord, clamp and re-ligate
○ You may need to blindly try clamping with long artery forceps
○ This may not be possible so you can pack the scrotum with sterile gauze
○ Consider further surgery if bleeding cannot be stopped

Question 11

Counter measures for herniation of omentum

Answer 11

○ Don’t pull out any more material
○ Resect protruding tissue
○ Pack wound / close skin
○ Box rest, antimicrobials

Question 12

Counter measures for eventration

Answer 12

○ Prevent further damage using a sheet to hold viscera and prevent any further protruding
○ Refer for surgery

Question 13

Complications Shortly After Surgery

Answer 13

Wound inflammation - seroma
Scrotal haematoma
Wound infection
Wound breakdown

Question 14

Counter measures for wound inflammation (seroma)

Answer 14

DON’T CLIP SCROTUM
Clean of surgical scrub
Walk stallions for 30 mins twice daily
Ensure swelling is simple fluid - not herniation
Consider removing fluid

Question 15

Counter measures for scrotal haematoma

Answer 15

○ Provide appropriate antimicrobial cover
○ Wait for organization and resorption

Question 16

Counter measures for wound infection

Answer 16

○ Provide appropriate antimicrobial cover
○ Prevent self-trauma
○ Remove any infected material (e.g. skin sutures)

Question 17

Counter measures for wound breakdown

Answer 17

○ Provide appropriate antimicrobial cover
○ Remove devitalized tissue, debride
○ Suture if only healthy tissue remains or consider treating as open wound

Question 18

Longer term complications

Answer 18

Surgical instruments being left behind
* swabs
* instruments
* suture material
Flank fistula from ovarian pedicle in bitches
Inguinal fistula from uterine stump in bitches
Chronic infection of cord
Pyogranuloma in bitch - red/brown vulval discharge
Incomplete removal of gonads - repeated signs of oestrus/male-like behaviour

Question 19

Counter measures for longer term complications

Answer 19

• Establish nature of the problem
  ○ Fistulography
  ○ Vaginal endoscopy
• Re-operate and remove devitalized tissue, surgical instrument, swabs, suture material
• Provide appropriate antimicrobial cover