Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers.

OBJECTIVE: To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS. STUDY DESIGN: Canine cadaveric model. ANIMALS: Fifteen medium- to large-breed canine cadavers. METHODS: Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed-rank test was used to compare baseline to post-TEA RGA. RESULTS: The mean baseline RGA was 0.52 ± 0.28 cm3 and mean post-TEA RGA was 0.78 ± 0.37 cm3 (p-value < .0001). The LEGS remained intact post-TEA in all cadavers. CONCLUSIONS: The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS. CLINICAL SIGNIFICANCE: The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.

Prospective evaluation of lymphatic embolization as part of the treatment in dogs with presumptive idiopathic chylothorax.

OBJECTIVE: To describe the embolization technique and short-term clinical outcome in dogs undergoing lymphatic embolization (LE) as part of treatment for presumptive idiopathic chylothorax (IC). Additionally, to document findings in computed tomography lymphangiography (CTLa) following embolization. STUDY DESIGN: Prospective case series. ANIMALS: Eight client-owned dogs. METHODS: Dogs underwent CTLa followed by thoracic duct ligation (TDL), pericardiectomy (PC) and LE. A mixture of 3:1 lipiodol: n-butyl cyanoacrylate embolic solution was injected through a catheterized mesenteric lymphatic vessel via limited abdominal approach using intraoperative fluoroscopy. CTLa was scheduled for 12 weeks postoperatively, and long-term follow-up was obtained via telephone contact. RESULTS: LE was technically successful in six of the eight dogs; and clinically successful in five of the six dogs. In the unsuccessful dog, a diagnosis of lymphangiosarcoma was determined, and the owners elected for euthanasia. Five dogs who underwent successful LE underwent CTLa at 12 weeks. Complete resolution of pleural effusion occurred in three dogs and scant pleural effusion in two dogs. A robust lymphatic embolus preventing antegrade continuation of radiocontrast was documented in all five dogs. Five of the six dogs that underwent LE, were alive and clinically normal at 358-960 days postoperatively. CONCLUSIONS: LE is a feasible part of treatment for dogs with IC. Additionally, a robust lymphatic embolus and lack of radiocontrast flow past the embolus was documented at 12 weeks following surgery. CLINICAL SIGNIFICANCE: LE has the potential to reduce surgical failure by reducing efferent lymphatic chyle flow, occluding missed lymphatic branches and preventing the development of collateral branches.

Long-term outcome and quality of life of dogs that developed neurologic signs after surgical treatment of a congenital portosystemic shunt: 50 cases (2005-2020).

OBJECTIVE: To determine survival time and quality of life of dogs that developed postattenuation neurologic signs (PANS) after surgical treatment of a single congenital portosystemic shunt and survived at least 30 days and identify whether neurologic signs present at the time of discharge would resolve or reoccur. ANIMALS: 50 client-owned dogs. PROCEDURES: Medical records were retrospectively reviewed, and follow-up data relating to neurologic signs and seizure activity were obtained. Owners were asked to complete a questionnaire related to the presence of neurologic signs, including seizures, and their dog's quality of life. RESULTS: Thirty of the 50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs, and 20 (40%) had neurologic signs other than seizures. Neurologic signs had fully resolved by the time of discharge in 24 (48%) dogs. Signs resolved in 18 of the remaining 26 (69%) dogs that still had PANS other than seizures at the time of discharge. Seizures reoccurred in 15 of the 30 dogs that had postattenuation seizures. Twenty-seven of 33 (82%) owners graded their dog's long-term (> 30 days after surgery) quality-of-life as high. Forty-five (90%) dogs survived > 6 months. Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved. CLINICAL RELEVANCE: Findings highlighted that survival times of > 6 months and a high QOL can be achieved in most dogs with PANS that survive at least 30 days. Most neurologic signs other than seizures resolved within 1 month postoperatively. Half of the dogs with postattenuation seizures had a reoccurrence.

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008-2019).

OBJECTIVE: To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine. ANIMALS: 131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA). PROCEDURES: Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up. RESULTS: Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques. CONCLUSIONS AND CLINICAL RELEVANCE: Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

Prevalence and impact of cholecystitis on outcome in dogs with gallbladder mucocele.

BACKGROUND: Gallbladder mucocele is a potentially life-threatening extrahepatic biliary disease in dogs. The primary aims of this study were to evaluate the prevalence of cholecystitis in dogs with gross and histopathologically confirmed gallbladder mucocele and to investigate if there is an association between cholecystitis, including its subtypes (eg, acute, acute on chronic, with necrosis, chronic), and survival. Our secondary objective was to evaluate if there is an association between cholecystitis and intraoperative bacteriological culture positivity. KEY FINDINGS: Two hundred nineteen dogs with gallbladder mucocele were included in this multi-institutional retrospective study, of which 63 (28.8%) dogs had histopathological evidence of cholecystitis. The most common forms of cholecystitis were acute on chronic (n = 22/63, 34.9%) and with necrosis (n = 20, 31.7%). Thirty-one (14.1%) dogs had growth of at least 1 bacterial isolate; however, 88.7% had antimicrobials administered within the 48 hours before surgery or intraoperatively. There was not an association between cholecystitis or its subtypes and survival. Furthermore, there was not an association between cholecystitis and intraoperative bacteriological culture positivity. A total of 38 (17.4%) dogs either died or were euthanized during hospitalization. SIGNIFICANCE: Cholecystitis is a common comorbidity in dogs with gallbladder mucocele but was not associated with decreased survival.