Introduction
One of the most common surgical
procedures we perform on dogs is a spay, known medically as an
ovariohysterectomy (removal of the ovaries and uterus). It is
performed for several medical reasons:
- It prevents dogs from going into heat.
- It prevents dogs from getting pregnant.
- It significantly helps prevent dogs from
get breast cancer later in life.
- It prevents dogs from getting uterine infections
later in life. An infected uterus is called a pyometra, and is a serious disease.
After you view the pictures of a routine surgery you will be given an chance
to see a picture of the uterus of a dog that has a pyometra.
In addition to these medical
reasons, it prevents unwanted pregnancies,
a significant problem in our society. Millions of dogs are euthanized
every year because they are strays.
We usually spay a dog when it is around 6 months
of age. This timetable is variable, the important point is to perform
the surgery before it goes into heat. The ongoing old wives tale
that states dogs should go into heat before spaying is incorrect.
Most dogs go into heat twice each year.
On the day of surgery we need your pet in the hospital between
7:30 AM and 9
AM. Please take
away all food and water when you go to bed the evening before surgery, and do
not give your dog anything to eat or drink the morning of surgery. It will go
home in the late afternoon the day of surgery. Please call our office at 4 PM
for pickup time, you will be given post operative instructions then.
Anesthesia
Pre-anesthetic preparation is important in
every surgery we perform, no matter how routine, because surgery is not an area
to cut corners. All of our spays receive a physical
exam prior to surgery. Only if they
pass this exam will we draw a small amount of blood for an in-hospital
pre-anesthetic test.
When everything is to our satisfaction we will administer a sedative. This will
calm the pet down and make the administration of the actual anesthetic, along
with post operative recovery, much smoother. Once a pet is anesthetized,
prepared for surgery, and had its monitoring equipment hooked up and reading
accurately, the surgery can begin.
The following area
contains graphic pictures of an actual surgical procedure performed
at the hospital. It may not be suitable for some children (and some
adults also!).
Surgery
Every major
surgery we perform begins with proper patient preparation. This
will help prevent infection, which could be a serious
complication in this surgery because during a spay we have an
opening into the abdomen.
This is the
final look of the skin in a pet that is ready for surgery. In
the very center of the screen is the umbilicus (belly button),
an important landmark for the surgery.
The surgeon
makes an incision near the umbilicus and extends it 3-5 inches
in the direction of the tail (the tail is at the left in this
picture). We try to make our incisions as small as possible to
minimize anesthetic time, decrease post operative discomfort,
and minimize the healing time.
The tissue
just underneath the skin is called the subcutaneous layer. It
consists mostly of fat and small blood vessels, and is the next
layer we cut into after the skin. If these small blood vessels
don't clot within a few minutes they are clamped with
instruments, and if necessary, they are
cauterized.
The final
layer we need to cut before we are actually into the abdomen is
called the linea alba. It is an area of muscle in the center of
the abdomen that is covered by a tough layer of tissue. This is
the most important layer resutured at the end of the surgery
because it is the only layer strong enough to hold the
abdominal muscles together to prevent a hernia. In this picture
the linea is being held up with a forceps and a scalpel blade
(held upside down) is being used to make the
incision.
A scissors is commonly
used to extend the linea incision and facilitate the removal of the uterus.
Care has to be taken not to puncture internal organs like the bladder.
Buried within the abdominal organs and abdominal
fat is the uterus. A special instrument called a spay hook is sometimes
utilized to gently pull one of the uterine horns through the abdominal incision.
In this picture our surgeon is using his finger to bring the uterus out
of the incision.
The uterine horn is traced
into the body cavity until the ovary is found. It has to be
gently teased from its location near the kidneys in order to be
able to pull it out through the abdominal incision. In older
dogs this part of the procedure is much more difficult. The
ovary (arrow) is usually covered with fat.
The blood supply to the ovary
is extensive so a special technique is utilized to prevent
hemorrhage. This technique involves the use of 3 clamps. In
this picture the first clamp is being applied to the left of
the ovary (arrow). Besides making it easier to place a suture
on the tissue, this clamp stops the flow of blood from within
the abdomen to the ovary.
A second clamp is
applied just above the first. The third and final clamp is applied to the
right of the ovary (arrow). All
of the tissue to the right of the second clamp is removed during the surgery.
The tissue is cut with a
scissors between the second and third clamp
The third clamp (with ovary)
is pulled away leaving the first two clamps to prevent any
hemorrhage.
Two sutures are securely
placed under the first two clamps. When the surgeon is certain
there is no risk of bleeding the clamps are released and the
sutured tissue is allowed to fall back into the abdomen. In
this picture one of the two clamps has been removed and the
second suture is being placed. This whole process is repeated
for the other ovary that female dogs have in their
abdomen.
Both ovaries with their
attached clamps have been removed from the abdominal cavity.
They have been pulled towards the right enabling the surgeon to
gently pull the cervix out of the abdominal cavity
also.
In this picture the two
ovaries are off the screen to the far right. Two clamps are
placed at the cervix and the remaining body of the uterus with
its two attached ovaries is cut away.
The uterus is sutured in the
same manner at the ovaries, with two secure stitches placed
under the clamps. Once our surgeon is certain the cervix
sutures are secure the cervix is placed back into the abdominal
cavity.
The linea alba is now securely
resutured. Stainless steel sutures are sometimes used because
they are very strong, cause minimal tissue reaction, and show
up vividly on an x-ray of the abdomen .
The subcutaneous layer is now
closed with a type of suture that dissolves over several
months.
The last layer sutured is the
skin. Sometimes we put the sutures on the outside, which means
they have to be removed in 7-10 days. In this example we put
the sutures in just under the skin, so no removal is needed.
They will dissolve on their own in a few months just like the
sutures in the subcutaneous tissue.
It is at this point that we will
give a pain
injection, which might
make this dog groggy for the evening. When you pick up a pet after a
spay operation you will be given detailed post operative
instructions.
Infected Uterus
This is a picture of a uterus in
a female dog that has an infected uterus, called a pyometra. The
uterus is completely filled with pus, and this dog is very ill. If
surgery is not performed to remove this uterus it could rupture
and even cause death. The uterine tissue is very fragile and can
easily rupture during the surgery, so great care is taken to
prevent any release of pus into the abdominal
cavity.
An occasional pyometra
can be tremendous in size. Great care has to be taken to minimize this uterus
from rupturing during the surgery.
A diagnosis of pyometra
is made based on several findings. There is a history of being in heat a few
months prior, along with lethargy, lack of appetite, and sometimes even vomiting.
Most dogs will be drinking and urinating excessively because of the toxic effects
of the infection on the kidneys.
A blood sample
will somtimes show a very elevated white blood cell count, and an x-ray of the
abdomen might show an enlarged uterus.
This x-ray shows an enlarged uterus in the abdomen. The
uterus (U) is the area just to the left of the bladder (B). You can see
it as several areas that are circular or elongate. A
normal uterus does not usually show up on an x-ray.
Postoperative
Care
Most dogs go home late in the
afternoon on the day we perform the surgery. They might be groggy
from the pain injection which is advantageous because they will
remain calm and allow the healing process to start immediately. By
the following morning the grogginess will have worn off.
When you first get home do not be in a big
rush to feed. After 1 hour at home offer a small amount of food and water. If
the appetite is good, offer more several hours later. Do not over do the feeding
the first night because anesthesia can make them nauseous.
Keep contact with children and
other pets to a minimum the first night, and restric activity for
several days to allow the incision to heal. Do not let your dog go
outside until healing is complete.
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