Abstract

To report the short- and long-term outcomes of one- or two-staged suture attenuation for complete closure of intrahepatic congenital portosystemic shunts in dogs. Retrospective cohort study of dogs surgically treated for intrahepatic congenital portosystemic shunts between February 2000 and March 2015. Long-term follow-up was conducted by telephone conversations with the referring veterinary surgeon, owner, or both. In total, 55 dogs had suture attenuation of their intrahepatic congenital portosystemic shunt; 10 dogs (18·2%) tolerated complete attenuation, whilst 45 dogs (81·8%) tolerated partial attenuation. Postoperative complications occurred in 24 dogs (43·6%), and six dogs (10·9%) died. Repeat surgery was performed in 33 of 39 dogs (84·6%) that had previously undergone partial attenuation, and 27 of these (84·9%) ultimately achieved complete shunt attenuation. One dog (3·0%) died following second surgery, resulting in an overall postoperative mortality of seven of 55 (12·7%). Detailed follow-up was available for 22 dogs that were still alive at a median of 29 months after surgery (7·4 to 103·1) with a subjectively good quality of life. Of 17 dogs (82·4%), 14 with complete attenuation in one or two surgeries had an excellent outcome compared with one of five dogs (20%) with persistent shunting. Staged suture ligation resulted in a high proportion of complete attenuation and reduced persistent shunting compared with a single surgery. Repeat surgery was associated with fewer complications than the first surgery. The proportion of dogs with an excellent outcome was greater for those that had complete attenuation in one or two surgeries compared with those with persistent shunting.

Highlights

  • Intrahepatic congenital portosystemic shunts (CPSS) are seen less commonly in dogs than their extrahepatic counterparts, making up approximately 25-33% of the total (Berent and Tobias 2009, Berent and Tobias 2012)

  • Repeat surgery was performed in 33/39 dogs (84.6%) that had partial attenuation and 27 of these (84.9%) achieved complete CPSS attenuation

  • We have described the short and long-term outcome for 55 dogs with intrahepatic CPSS (IHCPSS) treated with suture ligation in one or two surgeries

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Summary

Introduction

Intrahepatic congenital portosystemic shunts (CPSS) are seen less commonly in dogs than their extrahepatic counterparts, making up approximately 25-33% of the total (Berent and Tobias 2009, Berent and Tobias 2012). For both types of CPSS surgical attenuation is recommended to restore normal portal blood flow and resolve clinical signs (Berent and Tobias 2009, Tivers et al 2012, Greenhalgh et al 2014, Tivers et al 2017). There is limited long-term follow-up information on dogs with IHCPSS and only one comparative study, making the evidence base for choosing one technique over another even more challenging (Mehl et al 2007, Tivers 2017)

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