Attitudes towards surgical safety checklists among American College of Veterinary Surgeons diplomates.

OBJECTIVE: To examine attitudes towards surgical safety checklists (SSCs) among American College of Veterinary Surgeons (ACVS) diplomates and to identify barriers to implementation. STUDY DESIGN: Qualitative online research survey. SAMPLE POPULATION: A total of 1282 current ACVS diplomates. METHODS: An anonymous online survey was distributed to current ACVS diplomates via email. ACVS diplomates were identified using publicly available data through the ACVS website. A total of 1282 surveys were electronically distributed, and respondents were given 4 weeks to respond. The survey consisted of 34 questions examining (1) demographic information, (2) current use of SSCs, (3) knowledge and attitudes towards SSCs, (4) perceived advantages and disadvantages to use of SSCs, (5) implementation strategies, and (6) potential reasons for noncompletion of SSCs. RESULTS: Survey response rate was 20% (257/1282). A total of 169 of 249 (67.9%) respondents indicated using SSCs. Respondents generally agreed that SSCs were proven to reduce surgical complications (196/249 [8.7%]) and did not perceive any disadvantages to use (100/138 [75.2%]). Respondents not using SSCs were more likely to perceive them as a waste of time (p < .001). The most common reasons for noncompletion of SSCs were forgetfulness (21/52 [39.6%]) and time constraints (19/52 [36.5%]). Improved training (72/138 [52.2%]) and modifying the SSC based on staff feedback (69/138 [50%]) were suggested as methods to improve SSC uptake. CONCLUSION: Respondents currently using SSCs were generally satisfied. Time constraints and memory related issues were common causes for noncompletion of SSCs. CLINICAL SIGNIFICANCE: Efforts to expand the implementation of SSCs in veterinary surgery should focus on improved engagement of relevant stakeholders and modification of the SSC to suit local conditions.

Presentation, diagnosis, and outcomes of cats undergoing surgical treatment of ectopic ureters.

OBJECTIVE: To describe the signalment, treatment, complications, and outcomes of cats treated surgically for ectopic ureters. STUDY DESIGN: Retrospective, multi-institutional study. ANIMALS: Twelve client-owned cats. METHODS: Medical records of cats diagnosed with unilateral or bilateral ectopic ureters were reviewed and analyzed. Data reported included signalment, clinical signs, diagnostics, open celiotomy, or cystoscopic surgical interventions, and outcomes. RESULTS: Seven of the 12 cats in the study population were female or female spayed and the median age at time of presentation was 4 years, with an interquartile range (IQR) of 6 months-14 years. Presurgical diagnostic imaging diagnosed ectopic ureters by abdominal ultrasound (8/10), contrast enhanced computed tomography (3/3), fluoroscopic urography (3/4), or cystoscopy (6/7). Eight of 12 cats had extramural ectopic ureters and six cats were affected bilaterally. Eight affected cats underwent ureteroneocystostomy, one cat underwent neoureterostomy, two cats underwent cystoscopic laser ablation, and one cat underwent nephroureterostomy. Immediate postoperative complications occurred in three cats; one cat required additional surgical intervention. Short-term complications occurred in three cats, and long-term complications in two cats. All cats that underwent surgical or cystoscopic intervention had improvement of their urinary incontinence scores, with complete resolution in 11 cats. CONCLUSION: Surgical correction of ectopic ureters in cats is associated with good long-term outcomes. Ectopic ureters in cats are commonly extramural and bilateral. Postoperative outcomes were acceptable and there were few postoperative complications, with varying forms of surgical correction. CLINICAL SIGNIFICANCE: Ectopic ureters in cats are rare but urinary incontinence can be corrected or improved successfully with surgery.

Outcome of video-assisted thoracoscopic treatment of idiopathic chylothorax in 15 cats.

OBJECTIVE: To evaluate the outcomes and complications of video-assisted thoracoscopic (VATS) treatment of chylothorax in cats. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Fifteen client-owned cats. METHODS: The medical records of cats undergoing thoracoscopic thoracic duct ligation (TDL) for treatment of idiopathic chylothorax were reviewed. Cats undergoing additional procedures including thoracoscopic pericardectomy and/or laparoscopic cisterna chyli ablation (CCA)_were included. Follow up was obtained through communication with the referring veterinarian or owner. RESULTS: All cats underwent thoracoscopic TDL. Thirteen cats underwent simultaneous pericardectomy and two cats underwent laparoscopic CCA without pericardectomy. Conversion from a thoracoscopic to open approach was necessary in 2/15 (13%) of thoracic duct ligations and 1/11 (9%) of pericardectomies. The most common postoperative complication was persistent pleural effusion in five cats (33%). Four of 15 cats (27%) died or were euthanized prior to hospital discharge following surgery. Recurrence of effusion occurred in 1/7 (14%) of cats that sustained resolution of the effusion at the time of surgery with a median follow up of 8 months. The overall mortality attributed to chylothorax was 47%. CONCLUSION: Thoracoscopic treatment of idiopathic chylothorax resulted in a low incidence of intraoperative complications or conversion in the study population; however, mortality related to feline idiopathic chylothorax remained high. CLINICAL SIGNIFICANCE: While VATS treatment of idiopathic chylothorax is technically feasible, further consideration of the underlying pathology and current treatment algorithm is needed to improve outcomes as this remains a frustrating disease to treat in the feline population.

Use of a haired angularis oris axial pattern flap in a dog to correct a large oronasal fistula secondary to resection of a hard palate multilobular osteochondrosarcoma.

A 6-year-old neutered male mixed-breed dog underwent curative-intent surgical resection of a hard palatal multilobular osteochondrosarcoma and closure of the defect using bilateral buccal mucosal flaps. However, failure of the flaps resulted in a massive hard palatal defect that was subsequently repaired using a haired skin angularis oris axial pattern flap. This report describes the clinical outcome using this surgical approach and novel complications encountered. Key clinical message: The haired skin angularis oris axial pattern flap appears to be a suitable and robust option for reconstruction of large palatal defects.

Utilisation d'un lambeau cutanée poilus avec rotation axiale au niveau de l'artère angularis oris chez un chien pour corriger une fistule oronasale volumineuse secondaire à la résection d'un ostéochondrosarcome multilobulaire du palais dur. Un chien croisé mâle castré de 6 ans a subi une résection chirurgicale à visée curative d'un ostéochondrosarcome multilobulaire du palais dur et une fermeture de l'anomalie par des lambeaux de la muqueuse buccale. Cependant, la défaillance des lambeaux a entraîné un défaut important du palais dur qui a ensuite été réparé à l'aide d'un lambeau de peau avec poils avec rotation axiale au niveau de l'artère angularis oris. Ce rapport décrit les résultats cliniques de cette approche chirurgicale et les nouvelles complications rencontrées.Message clinique clé :L'utilisation d'un lambeau de peau avec poils avec rotation axiale au niveau de l'artère angularis oris semble être une option appropriée et robuste pour la reconstruction des défauts importants du palais.(Traduit par Dr Serge Messier).

Near-infrared fluorescence cholangiography in dogs: A pilot study.

OBJECTIVE: To determine the effect of indocyanine green (ICG) dose and timing of administration on near-infrared fluorescence (NIRF) imaging of the normal canine biliary tree. STUDY DESIGN: Preclinical prospective study. ANIMALS: Eight purpose-bred beagles. METHODS: The dogs were randomized to receive two of four intravenous ICG dose (low [L]:0.05 mg/kg or high [H]:0.25 mg/kg)/time (0 and 3 h prior to NIRF) combinations. NIRF images were collected every 10 min for 120 min. Target (cystic duct)-to-background (liver) ratios were calculated for all timepoints and compared. RESULTS: ICG cholangiography was successful in all dogs. The contrast ratio was above 1 in the L0 group by 20 min and reached its peak at 100 min. In the H0 group, the ratio was above 1 by 60 min and reached its peak at 90 min. Contrast ratios above 2 (fluorescence twice as bright in the cystic duct compared to the liver) were maintained from 180 to 300 min for L3 and H3 and was achieved after 80 min for L0. CONCLUSION: Low dose ICG provided better ratios early after injection compared to the high dose which remained highly concentrated in the liver tissue after injection. Both doses provided excellent visualization of the biliary tree at 3 h post injection, low dose ICG provided better ratios from 3 to 5 h post injection. Based on these results, 0.05 mg/kg of ICG administered at anesthetic premedication, or as early as 3 h prior to laparoscopic surgery should yield optimal fluorescence images. CLINICAL SIGNIFICANCE: This study provides guidelines for NIRF cholangiography in clinically normal dogs.

Outcome in 38 dogs surgically treated for hepatic abscessation.

OBJECTIVE: To report outcomes following surgical treatment of hepatic abscessation in dogs. STUDY DESIGN: Retrospective. ANIMALS: Thirty-eight dogs. METHODS: Records from 6 institutions were evaluated for dogs undergoing surgical treatment for hepatic abscessation between 2010 and 2020. Signalment, clinical signs, medical therapy, surgical treatment, and postoperative outcome was obtained from medical records. Long-term outcome was recorded when possible. Median survival time was assessed using the Kaplan-Meier product-limit method. RESULTS: Peritoneal effusion was documented in 32/38 dogs preoperatively, with septic peritonitis confirmed in 21/23 samples. Liver lobectomy was the most common surgery (27 dogs). A single organism was cultured in 24/35 dogs, most commonly Escherichia coli. Hepatic neoplasia was identified in 11/36 dogs. Dogs were hospitalized for a median of 5 days (range, 3-17) with complications recorded in 21 dogs (regurgitation, aspiration pneumonia, and pancreatitis most commonly). Two dogs died intraoperatively, and 6 dogs died prior to discharge. Median survival time for dogs surviving to discharge was 638 days. Of these, 19 were lost to follow up a median of 301 (range, 3-1418) days postoperatively and 11 died a median of 291 (range, 7-1292) days postoperatively. No abscess recurrence was noted. CONCLUSION: Septic peritonitis was a common sequela to hepatic abscessation. Perioperative complications were recorded in approximately one-third of dogs. In dogs surviving the postoperative period, long-term prognosis was good. CLINICAL SIGNIFICANCE: Dogs treated surgically for hepatic abscessation have a high risk of perioperative complications but favorable long-term prognosis and apparent low risk of recurrence.

Complications and outcomes of thoracoscopic-assisted lung lobectomy in dogs.

OBJECTIVE: To describe complications and outcomes of dogs undergoing thoracoscopic-assisted (TA) lung lobectomy. STUDY DESIGN: Multi-institutional, retrospective study. ANIMALS: Client-owned dogs (n = 30). METHODS: Medical records of dogs that underwent TA lung lobectomy were reviewed. Signalment, bodyweight, clinical signs, imaging findings, surgical variables, complications, and short-term/long-term outcome were assessed. Thoracoscopic-assisted lung lobectomy was performed with a mini-thoracotomy. RESULTS: Twelve intraoperative complications were recorded in 11 dogs, 6 requiring conversion to open thoracotomy. Reasons for conversion were reported in 5/6 dogs and included adhesions (2), difficultly manipulating the lesion through the mini-thoracotomy (2), and acute oxygen desaturation (1). One lung ventilation was successful in 4 of the 7 dogs in which this was attempted. A linear stapling device (DST series Medtronic, Minneapolis, Minnesota) was used for lung lobe ligation in 14 dogs. Twenty-three dogs underwent surgery for a neoplastic lesion, with 19 of these being carcinoma. The median lesion size was 4.3 cm (range 1-10 cm); margins were clean, except in 1 dog. Complications were documented in 8 dogs prior to discharge, 5 of these being classified as mild. Twenty-nine dogs were discharged at a median of 47 h postoperatively (range 24-120 h). Death was reported in 9 dogs, with a median survival time of 168 days (range 70-868 days). CONCLUSION: Thoracoscopic-assisted lung lobectomy was achieved with few major complications in the population reported here. Dogs were able to be discharged from hospital quickly, with most surviving beyond the follow-up period. CLINICAL SIGNIFICANCE: Thoracoscopic-assisted lung lobectomy may be considered to facilitate the excision of larger pulmonary lesions or to treat smaller dogs, in which a thoracoscopic excision may be technically more challenging.

Perioperative characteristics and long-term outcomes following prophylactic total laparoscopic gastropexy using a novel knotless tissue control device in 44 dogs.

Objective: To report on operative technique and outcomes following prophylactic total laparoscopic gastropexy (PTLG) using a novel knotless tissue control device (KTCD) in dogs. Animals: This study included 44 dogs. Procedure: Medical records were reviewed, and perioperative data were collected. Right-sided incisional gastropexy was performed using 2 strands of KTCD introduced through a 12-millimeter cannula in a single-incision multi-channeled port. Dog owners were contacted to obtain outcome data. Results: Median age and weight of dogs were 17 mo (6 to 60 mo) and 48.5 kg (14 to 73.3 kg). Median surgical and anesthesia times were 90 min (60 to 150 min) and 195 min (135 to 270 min). Major intraoperative complications were not reported. Follow-up data were available for 40/44 (91%) dogs. Median follow-up time was 522 d (43 to 983 d). Gastric dilatation volvulus (GDV) was not reported in any dog. One dog developed suspected colonic entrapment around the gastropexy that required surgical revision. All owners were satisfied with the procedure and indicated they would repeat the procedure with future pets. Conclusion: The PTLG procedure using novel KTCD in this cohort of dogs was effective at preventing GDV for the duration of follow-up and was associated with low perioperative complication rate and high owner satisfaction. Clinical relevance: This retrospective study reports on operative technique and outcomes associated with KTCD use in PTLG. Our findings warrant prospective evaluation of KTCD use in PTLG.

Caractéristiques peropératoires et résultats à long terme après une gastropexie laparoscopique totale prophylactique à l'aide d'un nouveau dispositif de contrôle des tissus sans nœuds chez 44 chiens. Objectif: Rendre compte de la technique opératoire et des résultats après une gastropexie laparoscopique totale prophylactique (PTLG) à l'aide d'un nouveau dispositif de contrôle des tissus sans nœuds (KTCD) chez le chien. Animaux: Cette étude a inclus 44 chiens. Procédure: Les dossiers médicaux ont été examinés et les données peropératoires ont été recueillies. La gastropexie incisionnelle du côté droit a été réalisée à l'aide de 2 brins de KTCD introduits par une canule de 12 millimètres dans un orifice multicanal à incision unique. Les propriétaires de chiens ont été contactés pour obtenir des données sur les résultats. Résultats: L'âge et le poids médians des chiens étaient de 17 mois (6 à 60 mois) et 48,5 kg (14 à 73,3 kg). Les temps chirurgicaux et anesthésiques médians étaient de 90 min (60 à 150 min) et 195 min (135 à 270 min). Des complications peropératoires majeures n'ont pas été rapportées. Des données de suivi étaient disponibles pour 40/44 (91 %) chiens. La durée médiane de suivi était de 522 jours (43 à 983 jours). Le volvulus de dilatation gastrique (GDV) n'a été signalé chez aucun chien. Un chien a développé une suspicion de piégeage du côlon autour de la gastropexie qui a nécessité une reprise chirurgicale. Tous les propriétaires étaient satisfaits de la procédure et ont indiqué qu'ils répéteraient la procédure avec de futurs animaux de compagnie. Conclusion: La procédure PTLG utilisant le nouveau KTCD dans cette cohorte de chiens a été efficace pour prévenir le GDV pendant la durée du suivi et a été associée à un faible taux de complications peropératoires et à une satisfaction élevée des propriétaires. Pertinence clinique: Cette étude rétrospective rend compte de la technique opératoire et des résultats associés à l'utilisation de KTCD dans le PTLG. Nos résultats justifient une évaluation prospective de l'utilisation de KTCD dans le PTLG.(Traduit par Dr Serge Messier).

Application of a distant, direct, single-pedicle hinge flap for reconstruction of a circumferential cutaneous defect of the thoracic limb in a dog.

A 4-year-old, neutered male, mixed-breed dog initially presented to a tertiary referral center for suspected mushroom intoxication and subsequent necrotizing fasciitis of the right thoracic limb. One day after presentation, a fasciotomy was carried out to remove necrotic tissue, leaving an extensive cutaneous defect spanning from axilla to carpus and occupying 75 to 100% of the circumference of the limb. Following establishment of a bed of granulation tissue, a distant, direct, single-pedicle flap was performed using the lateral thoracoabdominal skin. The limb was flexed at the shoulder and secured to the body wall during flap healing. Staged division of the flap was initiated 20 d after flap harvesting and completed 3 d later. Complete reconstruction of the large circumferential cutaneous defect was obtained 56 d after initial presentation. No major complications were encountered. At 387 d postoperatively, the dog had clinically normal limb function and was free of lameness. Key clinical message: This case report demonstrates the successful use of a distant, direct, single-pedicle hinge flap for reconstruction of a large thoracic limb wound spanning from axilla to carpus in a dog. This technique should be considered a viable limb-sparing, surgical option for resolution of extensive cutaneous thoracic limb wounds.

Application d'un lambeau distant, direct, à pédicule unique pour la reconstruction d'un défaut cutané circonférentiel du membre thoracique chez un chien. Un chien de race mixte mâle castré de 4 ans a été initialement présenté à un centre de référence tertiaire pour suspicion d'intoxication aux champignons et de fasciite nécrosante subséquente du membre thoracique droit. Un jour après la présentation, une fasciotomie a été réalisée pour enlever le tissu nécrotique, laissant un vaste défaut cutané s'étendant de l'aisselle au carpe et occupant 75 à 100 % de la circonférence du membre. Après la mise en place d'un lit de tissu de granulation, un lambeau distant, direct, à pédicule unique a été réalisé en utilisant la peau thoraco-abdominale latérale. Le membre était fléchi au niveau de l'épaule et fixé à la paroi corporelle pendant la cicatrisation du lambeau. La division par étapes du lambeau a été initiée 20 jours après la récolte des lambeaux et terminée 3 jours plus tard. La reconstruction complète du grand défaut cutané circonférentiel a été obtenue 56 jours après la présentation initiale. Aucune complication majeure n'a été rencontrée. À 387 jours après l'opération, le chien avait une fonction cliniquement normale du membre et n'avait pas de boiterie.Message clinique clé :Ce rapport de cas démontre l'utilisation réussie d'un lambeau distant, direct et à pédicule unique pour la reconstruction d'une grande plaie d'un membre thoracique s'étendant de l'aisselle au carpe chez un chien. Cette technique doit être considérée comme une option chirurgicale viable épargnant les membres pour la résolution des plaies cutanées étendues des membres thoraciques.(Traduit par Dr Serge Messier).

Outcomes following combined median sternotomy and ventral midline laparotomy for bicavitary penetrating wooden foreign bodies.

Combined abdominal and thoracic pathology caused by extra-gastrointestinal migration of an ingested wooden foreign body (WFB) is an uncommon but serious injury. Presenting clinical signs are typically nonspecific and, in the absence of observed WFB ingestion, diagnosis is challenging. Treatment requires concurrent abdominal and thoracic surgical exploration to remove the WFB and address injuries caused by its migration. This case series describes perioperative characteristics and outcomes in 4 dogs following combined median sternotomy and ventral midline laparotomy (CMSVML) for bicavitary penetrating WFBs. Key clinical message: Treatment of bicavitary penetrating WFBs with CMSVML provided postoperative outcomes similar to those in previous reports; however, high-grade complications and prolonged hospitalization were commonly encountered.

Résultats après sternotomie médiane et laparotomie médiane ventrale combinées pour des corps étrangers en bois pénétrant bicavitaires. La pathologie combinée abdominale et thoracique causée par la migration extra-gastro-intestinale d'un corps étranger en bois (WFB) ingéré est une blessure rare mais grave. Les signes cliniques présentés sont généralement non spécifiques et, en l'absence d'ingestion observée de WFB, le diagnostic est difficile. Le traitement nécessite une exploration chirurgicale abdominale et thoracique simultanée pour retirer le WFB et traiter les blessures causées par sa migration. Cette série de cas décrit les caractéristiques peropératoires et les résultats chez 4 chiens après une sternotomie médiane et une laparotomie médiane ventrale combinées (CMSVML) pour des WFB pénétrantes bicavitaires.Message clinique clé:Le traitement des WFB pénétrants bicavitaires avec CMSVML a fourni des résultats postopératoires similaires à ceux des rapports précédents; cependant, des complications de haut grade et une hospitalisation prolongée ont été fréquemment rencontrées.(Traduit par Dr Serge Messier).

Perioperative characteristics, histologic diagnosis, complications, and outcomes of dogs undergoing percutaneous drainage, sclerotherapy or surgical management of intrarenal cystic lesions: 18 dogs (2004-2021).

BACKGROUND: Canine intrarenal cystic lesions (ICLs) are infrequently reported in the veterinary literature. Several treatment options have been described including cyst fenestration (partial nephrectomy/deroofing) +/- omentalization, sclerotherapy using alcohol as a sclerosing agent, percutaneous cyst drainage (PCD), and ureteronephrectomy. Information regarding presenting clinical signs, physical examination findings, histologic diagnosis and outcomes of dogs with ICLs treated by different methods is limited. Medical records of 11 institutions were retrospectively reviewed to identify dogs that underwent PCD, sclerotherapy, surgical deroofing +/- omentalization, or ureteronephrectomy for management of ICLs from 2004 to 2021. Six weeks postoperative/post-procedural follow-up was required. Cases suspected to represent malignancy on preoperative imaging were excluded. The study objective was to provide information regarding perioperative characteristics, complications, and outcomes of dogs undergoing treatment of ICLs. RESULTS: Eighteen dogs were included, with 24 ICLs treated. Ten had bilateral. There were 15 males and 3 females, with crossbreeds predominating. PCD, sclerotherapy, deroofing and ureteronephrectomy were performed in 5 (5 ICLs treated), 7 (11 ICLs), 6 (6), and 7 (7) dogs, respectively, with 5 dogs undergoing > 1 treatment. Seven dogs experienced 8 complications, with requirement for additional intervention commonest. PCD, sclerotherapy and deroofing resulted in ICL resolution in 0/5, 3/11 and 3/6 treated ICLs, respectively. Histopathology identified renal cysts (RCs) in 7/13 dogs with histopathology available and neoplasia in 6/13 (4 malignant, 2 benign). Of 5 dogs diagnosed histopathologically with neoplasia, cytology of cystic fluid failed to identify neoplastic cells. Among 7 dogs with histologically confirmed RCs, 4 had concurrent ICLs in ipsilateral/contralateral kidney, compared with 2/6 dogs with histologically confirmed neoplasia. CONCLUSIONS: Benign and neoplastic ICLs were approximately equally common and cystic fluid cytology failed to differentiate the 2. Among renal-sparing treatments, deroofing most commonly resulted in ICL resolution. Presence of concurrent ICLs in ipsilateral/contralateral kidney does not appear reliable in differentiating benign from malignant ICLs.

Influence of staple line number and configuration on the leakage of small intestinal functional end-to-end stapled anastomosis: An ex vivo study.

OBJECTIVE: To determine the influence of the staple line configuration on the leakage of small intestinal functional end-to-end stapled anastomosis (FEESA). STUDY DESIGN: Experimental, ex vivo, randomized study. SAMPLE POPULATION: Jejunal segments (N = 72) from 10 mature, canine cadavers. METHODS: Jejunal segments (10 cm) were randomly assigned to a control group (8 segments) and 4 FEESA groups (16 segments/group (8 constructs/group)), according to the number of rows of staples used in the vertical (V) and transverse lines (T), respectively: Control, 2-row V/2-row T (2V/2T), 2-row V/3-row T (2V/3T), 3-row V/2-row T (3V/2T), 3-row V/3-row T (3V/3T). Initial leak pressure (ILP), maximum intraluminal pressure (MIP), and initial leakage location (ILL) were compared. RESULTS: The ILP (mean ± SD) for control segments, 2V/2T, 2V/3T, 3V/2T and 3V/3T were 321.38 ± 34.59, 32.88 ± 7.36, 50.13 ± 10.46, 34.38 ± 11.78, 69.88 ± 21.23 mmHg, respectively. All FEESAs initially leaked at lower pressures than intact segments. The only other differences detected between groups consisted of ILPs that were higher when FEESAs were closed with 3V/3T (69.88 ± 21.23 mmHg) than 2V/2T (32.88 ± 7.36, P < .001). Initial leakage occurred predominantly from the transverse staple line rather than the anastomotic crotch (P < .001). CONCLUSION: Placing 3 rows of staples in the transverse line (with or without a third row in the vertical staple line) improved resistance to leakage of FEESAs in normal cadaveric specimens. CLINICAL SIGNIFICANCE: The addition of a third row of staples in the transverse line (with or without a third row in the vertical staple line) in FEESAs should be further investigated as a strategy to reduce intestinal leakage clinically.

Primary repair of nonsteroidal anti-inflammatory drug-associated full thickness gastrointestinal ulcers in 11 dogs.

OBJECTIVE: To report the outcomes of dogs that underwent primary repair of gastroduodenal perforations associated with the administration of nonsteroidal anti-inflammatory drugs (NSAID). A secondary objective was to identify clinicopathological findings that predisposed dogs to postoperative death. STUDY DESIGN: Retrospective study. ANIMALS: Eleven dogs with complete gastric or duodenal perforation related to administration of an NSAID that underwent primary surgical repair. METHODS: Medical records were reviewed for dogs that presented with peritonitis due to a complete gastroduodenal perforation while receiving NSAIDs between November, 2011 and January, 2021. Data collected included patient characteristics, clinical signs, clinicopathological results, surgical details, and postoperative management and outcome. RESULTS: All dogs were large breeds (mean weight 42 kg; range 22-75 kg), with a mean age of 7.35 years. Nine dogs from a total of 11 (82 %) received a concurrent corticosteroid and NSAID, or a higher dose/frequency/length of NSAID administration than recommended by the manufacturer. All gastroduodenal perforations were found in the upper gastrointestinal tract. Eight of 11 (73%) dogs survived to discharge. The median postoperative duration of follow up was 444 days (range 2-1460 days). No association was detected between ulcer size or location and mortality. CONCLUSION: Most dogs who underwent primary repair of complete gastroduodenal ulcers survived. Gastroduodenal perforations were generally due to the administration of higher or longer doses of NSAIDs, or concurrent administration of another NSAID or corticosteroid. CLINICAL SIGNIFICANCE: Primary closure may be associated with a high success rate in dogs with full thickness gastroduodenal ulcers.

The development of ventricular fibrillation as a complication of pericardiectomy in 16 dogs.

OBJECTIVE: To describe the clinical characteristics, perioperative protocols, and outcomes in dogs diagnosed with ventricular fibrillation (VF) while undergoing pericardiectomy. STUDY DESIGN: Retrospective, multi-institutional study. ANIMALS: Sixteen client-owned dogs. METHODS: Cases were accrued through a listserve request posted to 3 subspecialty veterinary societies. Dogs were included if they developed VF during a pericardiectomy performed through an open or thoracoscopic approach. Data collected included signalment, history and physical examination, surgical approach, histopathology, treatment, and outcome. RESULTS: Indications for pericardiectomy included idiopathic chylothorax (n = 7), neoplasia (4), idiopathic pericardial effusion (4), and foreign body granuloma (1). Surgical approaches included thoracoscopy (12), intercostal thoracotomy (3) and median sternotomy (1). Electrosurgical devices were used to complete at least part of the pericardiectomy in 15 of 16 dogs. Ventricular fibrillation appeared to be initiated during electrosurgical use in 8/15 dogs. However, in 5/15 dogs it was not obviously associated with electrosurgical use. In 3/16 dogs the timing of initiation of VF was unclear. In 7/16 dogs, cardiac arrhythmias were noted prior to the development of VF. Fourteen of 16 dogs died from intraoperative VF. CONCLUSION: In most dogs ventricular fibrillation was a fatal complication of pericardiectomy. Ventricular fibrillation might be associated with the use of electrosurgical devices and cardiac manipulation during pericardiectomy although a causal link could not be established from the data in this study. CLINICAL SIGNIFICANCE: Surgeons must be aware of the risk of VF during pericardial surgery. Electrosurgery might need to be used judiciously during pericardiectomy, particularly in dogs exhibiting cardiac arrythmias.

Most students have experience making radiographs prior to veterinary school but have limited radiation safety training.

The use of radiation for the diagnosis of various medical conditions is ubiquitous in veterinary medicine, and manual restraint of a patient during X-ray exposure has become commonplace. Many prospective veterinary students have been involved with radiographs in general practice prior to veterinary school. Their experiences and level of safety training are largely unknown.   This prospective survey study involved two web-based questionnaires that were used to evaluate the experiences, knowledge, and attitudes toward radiation and how these changed following a radiation safety lecture as part of their first-year curriculum. The questionnaires were distributed to 122 first-year veterinary students before and after this lecture. All participating students (100%) had worked in a veterinary hospital prior to admission to veterinary school and 79% were involved in making radiographs; however, only 28% reported receiving radiation safety training. The content of the safety training reported was variable. After the radiation safety lecture, students were more likely to report that the radiation safety training they had received was useful, but fewer students reported feelings of safety when using radiation. Despite most students being involved with radiation in practice, few had received radiation safety training, as hypothesized. Contrary to our second hypothesis, a single lecture did significantly improve knowledge and attitudes in several, but not all, instances. Importantly, once students gained knowledge regarding radiation, they placed more importance on its safe use. These results suggest that in-clinic training of students in radiation safety is insufficient and that lecture-based training is useful for certain concepts.

The effect of laparoscopy on intracranial pressure as measured by optic nerve sheath diameter: A review.

Laparoscopic surgery has many benefits over open surgery including lower complication rates, and shorter duration and lower cost of hospitalization. However, recent human literature suggests laparoscopy and carbon dioxide insufflation can result in intracranial hypertension. Invasive monitoring of intracranial pressure is not routinely performed in veterinary medicine, and ultrasonographic evaluation of the optic nerve sheath has been employed as an indirect measure of intracranial pressure in many species. The optic nerve sheath is continuous with the meninges of the brain and becomes distended with intracranial hypertension. Optic nerve sheath diameter is a reliable and consistent measure of intracranial pressure and has been utilized in humans to evaluate patients for intracranial hypertension secondary to laparoscopy and capnoperitoneum. No thorough evaluation of the effects of laparoscopy on intracranial pressure has been performed in dogs. Ultrasonographic evaluation of the optic nerve sheath is a safe, non-invasive, and inexpensive procedure that may allow for the evaluation of intracranial pressure without the need for invasive monitoring systems. As laparoscopic procedures are performed increasingly often, this review aims to inform the reader on the effects of capnoperitoneum and to facilitate appropriate patient selection, anesthetic considerations, and surgical planning.

L'effet de la laparoscopie sur la pression intracrânienne mesurée par le diamètre de la gaine du nerf optique : une revue. La chirurgie laparoscopique présente de nombreux avantages par rapport à la chirurgie ouverte, notamment des taux de complications plus faibles, une durée d'hospitalisation plus courte et un coût moindre. Cependant, la littérature humaine récente suggère que la laparoscopie et l'insufflation de dioxyde de carbone peuvent entraîner une hypertension intracrânienne. La surveillance invasive de la pression intracrânienne n'est pas systématiquement effectuée en médecine vétérinaire, et l'évaluation échographique de la gaine du nerf optique a été utilisée comme mesure indirecte de la pression intracrânienne chez de nombreuses espèces. La gaine du nerf optique est continue avec les méninges du cerveau et se distend avec l'hypertension intracrânienne. Le diamètre de la gaine du nerf optique est une mesure fiable et cohérente de la pression intracrânienne et a été utilisé chez l'homme pour évaluer les patients atteints d'hypertension intracrânienne secondaire à la laparoscopie et au capnopéritoine. Aucune évaluation approfondie des effets de la laparoscopie sur la pression intracrânienne n'a été réalisée chez le chien. L'évaluation échographique de la gaine du nerf optique est une procédure sûre, non invasive et peu coûteuse qui peut permettre l'évaluation de la pression intracrânienne sans avoir besoin de systèmes de surveillance invasifs. Les procédures laparoscopiques étant de plus en plus pratiquées, cette revue vise à informer le lecteur sur les effets du pneumopéritoine et à faciliter la sélection appropriée des patients, les considérations anesthésiques et la planification chirurgicale.(Traduit par Dr Serge Messier).

Validation of a Novel Ultrasound Simulation Model for Teaching Foundation-Level Ultrasonography Skills to Veterinary Students.

Veterinary ultrasonography is a complex, advanced skill requiring repetitive exposure and supervision to gain competence. Consequently, newly graduated veterinarians are underprepared and lack the resources to achieve basic ultrasound proficiency upon graduation. Ultrasound simulation has been proposed as an adjunct educational tool for teaching entry-level ultrasound skills to student veterinarians. The objectives of this multicentric prospective observational cohort study were to describe the development of a novel ultrasound training model, establish model construct and face validity, and seek participant feedback. The model was constructed using three-dimensional silicone shapes embedded in ballistics gel within a glass container. A novice cohort of 15 veterinary students and 14 expert participants were prospectively enrolled in the study. Each cohort underwent training and assessment phases using a simulation model. Participants were asked to (a) determine shape location, (b) identify shape type using a shape bank, and (c) measure shape axes using the caliper tool. Time for each phase was recorded. Anonymous post-participation survey feedback was obtained. For most shapes (4/6), experts performed significantly better than novices in identifying shape type and location. Generally, no significant difference was found in mean axis shape measurements between cohorts or compared to the true mean axis measurements. No significant difference was found in scan time for either phase. This study's results support the validation of this ultrasound simulation model and may demonstrate early evidence for its use as a training tool in the veterinary curriculum to teach entry-level ultrasound skills.

Morphology of the cisterna chyli in nine dogs with idiopathic chylothorax and in six healthy dogs assessed by computed tomographic lymphangiography.

OBJECTIVE: To describe the morphology of the lymphatics in the region of the cisterna chyli in healthy dogs and in dogs with idiopathic chylothorax by using computed tomographic lymphangiography. STUDY DESIGN: Retrospective study. ANIMALS: Nine dogs with idiopathic chylothorax and six healthy dogs. METHODS: Computed tomographic lymphangiograms were reviewed to evaluate the number of cisterna chyli branches, total cross-sectional area of the branches normalized to the cross-sectional area of the aorta, number of branches with cross-sectional area greater than 25% of the aorta cross-sectional area, and ratio of the total perimeter to the total cross-sectional area of the branches. Data (mean ± SD) were compared between unaffected dogs and dogs with idiopathic chylothorax. RESULTS: The cisterna chyli included more branches in dogs with chylothorax (4.30 ± 1.57) than in unaffected dogs (1.67 ± 0.56, P = .02), occupying a relative perimeter approximately double that in unaffected dogs (P < .001). The relative cross-sectional area of the cisterna chyli was approximately twofold smaller in affected (0.73 ± 0.35) than in unaffected (1.63 ± 0.91, P = .02) dogs. The fraction of dogs with branches greater than 25% of the cross-sectional area of the aorta tended to be larger in unaffected dogs (P = .07). Most larger branches were located dorsal or to the right of the aorta. CONCLUSION: The cisterna chyli of dogs with idiopathic chylothorax contained smaller and more numerous branches compared with that of unaffected dogs. CLINICAL SIGNIFICANCE: Altered cisterna chyli morphology may impact the surgical approach for cisterna chyli ablation in dogs with idiopathic chylothorax.

Use of a surgical safety checklist after implementation in an academic veterinary hospital.

OBJECTIVE: To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN: Voluntary online survey and retrospective study. SAMPLE POPULATION: All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS: Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS: Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. CONCLUSION: The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). CLINICAL SIGNIFICANCE: The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.

Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: A multi-institutional retrospective study.

OBJECTIVE: To determine whether catheterization of the common bile duct (CBD) is associated with outcome in dogs undergoing cholecystectomy for gallbladder mucocele and to determine whether this association is modified by the catheterization method. STUDY DESIGN: Multi-institutional retrospective cohort study. ANIMALS: Dogs (n = 252) that underwent cholecystectomy for gallbladder mucocele. METHODS: Dogs were identified via electronic medical record review at four veterinary teaching hospitals. Baseline dog characteristics, surgical findings, and methods including normograde vs retrograde CBD catheterization, intraoperative outcomes, and postoperative outcomes and complications were recorded. Variables were compared between dogs with and without catheterization. RESULTS: Catheterized dogs had higher American Society of Anesthesiologists scores (P = .04), higher total bilirubin (P = .01), and were more likely to have dilated CBD at the time of surgery (P < .01). Incidence of major and minor intraoperative complications was similar between the two groups. Surgical time was longer for the catheterized group (P = .01). The overall incidence of postoperative complications was similar between the groups; however, postoperative pancreatitis was associated with performing CBD catheterization (P = .01). This association was retained as an independent association in a multivariable model that addressed baseline group differences (P = .04). Likelihood of developing postoperative pancreatitis was not different between normograde and retrograde catheterization (P = .57). CONCLUSION: Catheterization of the CBD was associated with development of postoperative pancreatitis. This was not influenced by the method of catheterization. CLINICAL SIGNIFICANCE: The requirement for catheterization of the CBD during open cholecystectomy in dogs should be carefully considered, particularly in dogs without evidence of biliary obstruction because the procedure may induce postoperative pancreatitis.