Allegheny Veterinary Associates, PC

9450 Perry Highway Pittsburgh, PA 15237-5544 Phone:412-635-VETS(8387) Fax:412-635-0414

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CASE FILE 2

The “Routine” Spay (ovariohysterectomy)

Almost everyone that has owned a dog or has come in contact with someone else that owns a dog has heard of a spay. Yet, very few people including breeders, trainers, and life-long dog owners actually know what a spay is and how it is performed. As a veterinarian many pet owners have attempted to educate me with untrue theories and “facts” about this procedure.

It is true that spay and neuter procedures are the most common veterinary surgical procedures performed, but let me state that they are anything but “routine” or “minor surgical procedures”. The spay (known in medical terms as ovariohysterectomy) is major abdominal surgery. In this veterinarian’s opinion there are a minimal few other surgical procedures that even come close to the invasiveness of this procedure. Having said this, it is also my opinion that the ovariohysterectomy is a safe and effective procedure for controlling unwanted pregnancies and may also reduce the likelihood of some other serious diseases.

Fig 1. Patient is intubated and sleeping comfortably

Fig 2. Pulse Oximeter

Instead of focusing on the need for having your pet spayed or neutered in this feature I would like to detail the actual procedure, so that pet owners may more completely understand what it is a spay actually consists of.

When your pet is scheduled for a spay your veterinarian will go over their preferred protocol with you prior to hospital admission. Our protocol consists of withholding food and water the night before surgery. Your pet generally arrives at the clinic prior to 9am. Once at the clinic your pet receives a physical exam and blood work follows in most cases. Following this laboratory analysis and physical exam if your pet is deemed competent to undergo anesthesia an injection is given to sedate or relax the animal prior to anesthesia. This pre-anesthetic medication allows the actual anesthetic episode to go more smoothly and can also allow us to use less anesthetics during the procedure.

The skin is prepped with an antibacterial solution prior to entering the operating room. This scrub removes dirt, hair, and debris from the patient prior to surgery. This scrub lasts approximately 5 minutes.

Once sedated an intravenous catheter is placed. Anesthesia can then be induced with intravenous medications. At this point your pet is sleeping quite comfortably. The mouth is then opened and a tube is placed in the airway, inhalant or gas anesthesia is then administered along with oxygen. We now have access to the cardiovascular and respiratory systems via the catheter and breathing tube should anything go wrong and emergency measures be needed. Immediately following onset of anesthesia the patient is monitored. During surgical preparation we monitor pulse rate and oxygen saturation with a pulse oximeter. We also monitor depth of anesthesia by noting eyelid responses and heart and respiratory rates.

Fig 3.Pre-Operative Preparation

Fig 4. Abdomen Preparation

Fig. 5 Rough or Non-Sterile Skin Preparation	Once under anesthesia sterile eye ointment is applied to the eyes to maintain a moist environment for the eyes.The patient is then clipped.The entire abdomen is clipped of hair and a rough or non-sterile prep is completed.The surgical incision is made on the belly just behind the umbilicus or belly button. This area must be void of hair and debris so that abdominal contamination does not occur during the procedure. Once the patient is clipped and scrubbed they are then moved into the operating room. The patient is secured to the operating table and another set of monitors are attached. Once in the operating theater we monitor ekg, blood pressure, pulse oximetery, heart rate, respiratory rate, and reflexes. Multiple parameter monitoring allows us to deliver safe and effective anesthesia while keeping your pet at a good surgical plane of anesthesia. Intravenous fluids are also administered during surgery in order to maintain hydration and more importantly to maintain blood pressures. The patient is then once again scrubbed. The abdominal skin around the surgical site is prepped in sterile fashion. This prep removes bacteria from the surgical site and provides the surgeon with a sterile area in which to operate. Likewise, during the sterile prep the surgeon prepares the arms and hands for sterile surgery. Once the surgeon and patient are prepared the surgeon then dons a sterile surgical gown and gloves. The patient is then draped in a sterile cloth so that the surgical site is sterile. At this point surgery may safely begin. An incision is made at or behind the belly button. This incision is carried deeper through a fibrous band of tissue known as the linea alba. Once through the linea alba the abdomen is exposed. The surgeon then locates the uterus and extracts one of the paired uterine horns.
Fig. 6 Anesthesia delivery and monitoring equipment
Fig. 7 Pre-Surgical Sterile Scrub

Once the uterine horn is exteriorized a clamp is placed and a retractor is positioned to expose the ovarian vessels. Two ligatures are placed around the ovarian pedicle to prevent bleeding. Once ligated the uterine horn is removed from its pedicle and reflected out of the way. The other uterine horn is located, exposed, and ligated in the same manner. Once both horns and ovaries have been extracted the uterine body is exposed.

Fig. 8 Patient and Surgeon Ready for Sterile

Fig. 9 Skin Incision

Fig. 10 Abdominal Incision

Fig. 11 Uterine Horn Retraction

A clamp is then place around the uterine body and two additional ligatures are placed around the uterus. The uterus, uterine horns, and ovaries can then be removed from the patient. The patient is then inspected to make sure no bleeding is evident and closure can commence. The abdominal wall is closed first. This is completed with sutures that will be absorbed. This layer of sutures is not removed. The next layer commonly closed is the subcutaneous tissue layer. Again, this layer is closed with absorbable suture material that is not removed. The skin can then be closed. Skin closure can be completed in several different manners. Skin staples may be used which must be removed 10 to 14 days after surgery. Skin sutures may be used which also are removed 10 to 14 days after surgery. We typically use subcuticular sutures. These sutures are under the skin and do not require removal after surgery.
Fig. 12 Ligation of the ovarian vessels	Fig. 13 Both uterine horns and ovaries extracted exposing the uterine body	Fig. 14 Removed uterus, uterine horns, and ovaries

Pain medications may be given at this point or prior to surgery. Occasionally antibiotics may be given prior to or during surgery. Anesthesia is then ended and the patient is administered oxygen therapy prior to removing the breathing tube. Once the patient begins to have swallowing reflexes the tube is removed. The patient can usually stand and walk within 20 — 30 minutes post-operatively but are not discharged for several hours. The entire procedure from anesthesia induction to recovery takes between 45 minutes and 1.5 hours. The presence of heat or estrus is another issue to consider when having your pet spayed. When a dog is in heat the procedure can be more difficult. There is an increase in blood flow to the uterus making intra-operative and possibly post-operative bleeding more common. Although the procedure can be completed safely during heat cycles it takes more time to complete and may carry a slight added risk.
Fig. 15 Abdominal Closure	Fig. 16 Closed incision after surgery	Fig. 17 Skin closed and surgery complete

The thing to take home from this article is to understand that a spay is not “routine” or “minor surgery”. It takes a thoroughly trained staff and proper equipment to perform this procedure safely and effectively. Although we do this procedure on an outpatient basis it remains major abdominal surgery. It is imperative to follow your veterinarian’s recommendations for pre and post-surgical care. It is also highly recommended that you ask for pre-operative blood work analysis prior to having anesthesia performed on your pet — in fact I would demand it for my pet.

As you can see from this article a spay is a complicated procedure. If you are a concerned pet owner and discerning consumer you should request pre-anesthetic blood work, complete anesthetic monitoring, and even intravenous catheterization. This procedure although not cheap is generally performed at a significant value, and I’m a firm believer that the one thing you do not want for your pet when considering abdominal surgery is cheap surgery!! Do not allow anyone to cut corners and costs when its your pet on the operating table.

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