Flank Approach Research Articles

An apparently healthy female British shorthair cat with a rare complication of colonic stenosis after flank approach ovariohysterectomy

BackgroundColonic stenosis is a rare postoperative complication of ovariohysterectomy in cats, leading to dyschezia and fecal diameter reduction. In cats, while there are reports of colonic stenosis after midline approach ovariohysterectomy, there are no specific reports of flank approach ovariohysterectomy.Case presentationThis report describes a severe case of a one-year-old British shorthair female cat presenting with gastrointestinal signs, including dyschezia and reduced fecal diameter, three weeks after flank approach ovariohysterectomy. Despite abdominal radiography, proctography with barium sulfate, colonoscopy, CT, and hematological analysis, the cause of colonic stenosis remained unclear. During exploratory laparotomy, an annular tissue band was found encircling the descending colon, resulting in severe local stenosis. After excision of the tissue band, the presenting clinical signs of the cat were rapidly improved. This result suggests that colonic stenosis caused by tissue band should be considered when diagnosing postoperative complications in flank approach ovariohysterectomy in cats.ConclusionColon stenosis due to annular tissue band restriction should be considered one of the differentials for postoperative complications in flank approach ovariohysterectomy in cats.

Ovariectomy in mouflons under field conditions: a comparative assessment of midventral and flank laparotomy approaches.

Ovariectomy is the best method to control the density of wild ungulate populations. The present study aimed to compare two surgical approaches of ovariectomy, via the flank and midventral, in mouflons under field conditions. A total of 20 female mouflons were enrolled in the study. The animals were divided randomly into two equal groups; group F animals were gonadectomized via the flank approach, while group L animals were sterilized via the linea alba access. The parameters evaluated were duration of surgery, duration of anesthesia, recovery time, intraoperative and postoperative complications, intraoperative nociception, and pain during the postoperative period. There were no intraoperative and postoperative complications. The evaluated parameters showed a very similar trend in both groups. Both techniques were found to be effective and safe in execution.

Comparison of lateral flank approach and low anterior access for single port (SP) retroperitoneal partial nephrectomy: an analysis from the single port advanced research consortium (SPARC).

Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to compare outcomes of two commonly described incisions for retroperitoneal SP RPN: lateral flank approach (LFA) and low anterior access (LAA). We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 to 2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, t test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust and logistic regressions. A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. Overall, there were no significant differences in baseline characteristics between the two groups. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, p < 0.001) and more varied tumor locations (p = 0.002). In the bivariate analysis, there were no statistically significant differences in ischemia time, estimated blood loss, or complication rates between the groups. However, the LAA group had longer operative times (101 vs. 134min, p < 0.001), but was more likely to undergo a same-day discharge (p < 0.001). When controlling for other variables, LAA was associated with shorter ischemia time (p = 0.005), but there was no significant difference in operative time (p = 0.348) and length of stay (p = 0.122). Both LFA and LAA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes. This early data suggests the LAA is more versatile for varying tumor locations; however, larger cohort studies are needed to ascertain whether there is an overall difference in patient recovery.

Technical and Anatomical Aspects of Retroperitoneoscopic Renal Surgery: A Summary of Tribulations and Resolutions Encountered at a Tertiary Care Institute of North India.

Kidneys are a retroperitoneal organ but the widely practiced laparoscopic approach torenal surgery is transperitoneal due to the advantages of greater working spaceat the cost of entering the peritoneal cavity, risk of injury to intraperitoneal organs, and the increased risk of postoperative bowel complications. The classic open approach to kidney procedures has been the flank approach without violating the peritoneal cavity instead of the retroperitoneal approach to renal surgery with the advantages of direct access to the renal hilum, especially the renal artery. Being a technically challenging procedure,the retroperitoneoscopic approach is less practiced and needs an experienced surgical team. Through this study, we have tried to unveil the myths and illustrate the exact position of ports, which is the decisive initial step in retroperitoneoscopic surgery. This retrospective study was conducted at a developing tertiary centerin northern India with novice staffmainly todetermine the technical and anatomical caveats pertaining to the retroperitoneoscopic approach for renal surgeries, the challenges faced, and their resolutions. The decision for the site of incision for primary or camera port was taken only after a proper anatomical study of the cadavers and ongoing retroperitoneal surgical experience while treating various patients suffering from renal diseases. The study comprised eight patients, during the period from June 2023 to March 2024. Various parameters, such as demographic variables, diagnosis, mean operative time, estimated blood loss, technical difficulties encountered and their resolution, complications, and reasons for conversion were studied.A total of 15 cadavers were dissected during the above time period to study finer anatomical details of port positioning and other details. After an elaborate study of 15 cadaversand thereafter performing surgeryon eight patients during the above time period, surgery was successfully performed on six patients, and two patients needed conversion to open procedure due to dense adhesions and non-progression whilecomplications occurred in two patients (peritoneal rent and renal vein injury), which were managed laparoscopically. Nonetheless, restrictions of surgical space make retroperitoneoscopic space a challenging procedure but with elaborate experience, which we gained through cadaveric study, and surgical results obtained during the initial few cases such as the exact site of the primary port and technical intricacies, and handling of complications if and when faced, we hope our study will certainly make retroperitoneal space more amicable to urologists.

Midline and Flank Approaches for Spaying: A Comparative Study in Cats

The study was conducted to compare midline and flank approaches for spaying in cats. Cats were divided into two groups based on surgical approaches for spaying, Group A (Flank approach) and Group- B (Ventral midline approach). To evaluate the best approach for spaying, various parameters such as length of the surgical incision, the extent of haemorrhage, ease of location and exteriorization of ovaries and uterus, duration of surgery, postoperative complications, and time required for complete wound healing were recorded. In addition, the heart rate, respiration rate, and temperature were recorded before the operation and on different days after the operation. The physical parameters significantly (P&lt;0.05) differed between the two groups. In both groups, the average length of skin incision was 2.8 cm. The average time of exteriorization of ovaries and uterus was higher in the ventral midline approach as compared with the flank approach. The average duration of surgery was (23.25±4.20) min in group A and 29·25±4.88 min in group B. The average wound healing time (days) was also higher in the ventral midline approach (16.50±1.26) compared to the flank approach (13.75±7.85). During Spaying in cats, the extent of haemorrhage was mild to moderate in the flank approach, whereas there was no haemorrage or sometimes less in the ventral midline approach. The post-operative complications were less in flank methods than in ventral midline approaches. It is concluded that spaying through the flank approach is superior to the ventral midline approach due to convenience, faster healing, rapid recovery, and fewer postoperative complications. Vol. 10, No. 3, December 2023: 319-326

Laparoscopic partial pancreatectomy through an advanced lateral approach as treatment for insulinoma in dogs: a case series.

A minimally invasive partial pancreatectomy was performed through a novel laparoscopic lateral flank approach in sternal-oblique recumbency in four clinical cases presented with an insulinoma. All four cases were female castrated dogs of older age (range 7-9 years) and different breeds (Wire haired dachshund, German shepherd, Jack Russel terrier, and Boxer), and all presented with episodic weakness, tremors, and/or seizures. The diagnosis was based on plasma glucose level below reference range with concomitant increased or normal insulin level. A laparoscopic approach was considered based on triple-phase contrast-enhanced computed tomography findings of the abdomen, revealing a pancreatic mass situated in the right pancreatic limb or left pancreatic limb without suspicion of metastasis. Laparoscopic procedures were performed without any major complications, and peri-operative glycemia increased to (supra-)normal levels in all cases. Histopathologic reports qualified the masses as neuroendocrine carcinomas, and in conjunction with the clinical picture, this neoplasia was further defined as insulinoma. Post-operative care in an intensive care unit was of short duration, and all animals were discharged being clinically normal and normoglycemic in between 1.5 and 2.5-day post-surgery. At short-term follow-up, no dogs showed clinical abnormalities, all recovered well from the surgical procedure, and blood glucose levels remained in the normal range. During long-term follow-up, 2 cases remained clinically normal at the time of writing, 564 and 1,211 days after surgery, 1 dog had recurrence of hypoglycemic episodes after 246 days and was euthanized after 673 days of surgery due to progressing disease, and 1 dog was euthanized after 1,028 days of surgery due to reasons unrelated to the insulinoma. Survival times ranged from 599 to 1,232 days after diagnosis. Considering the highly metastatic nature and difficulty of full laparoscopic staging of insulinoma patients, thorough pre-operative disease staging is warranted when considering a laparoscopic approach. This case series shows the feasibility of a novel laparoscopic flank approach for right and left partial pancreatectomy in dogs. Furthermore, proper case selection resulted in favorable outcome in these insulinoma patients.

Sterilization of free-ranging female capybaras (Hydrochoerus hydrochaeris): a comparison between two surgical techniques.

This study evaluated two surgical sterilization techniques in free-ranging female capybaras (n = 21). The first group underwent uterine horn ligature (HL; n = 11), while the second was subjected to partial salpingectomy (S; n = 10). We assessed total operative time, incision length, the ease of identifying reproductive structures, the adequacy of exposure for surgical performance through flank or midline approaches, and the extent of abdominal viscera manipulation for each method. The HL method emerged as faster, with an average operative time difference of 16 minutes. In the S group, a flank mini-laparotomy over the ovarian topography facilitated easy exposure of the ipsilateral ovary and uterine tube, enabling ligature and partial resection of the uterine tube but not the uterine horn exposure. However, accessing the contralateral uterine tube without a bilateral incision was impractical, thus prolonging the total operative time due to the need for patient repositioning and new antisepsis procedures. Conversely, a post-umbilical approach for the HL method necessitated only one mini-laparotomy incision, offering ample uterine exposure for hysterotomy in pregnant females. Both methods involved minimal abdominal viscera manipulation and resulted in no fatalities or postoperative complications. Although direct comparison is limited by the distinct sterilization techniques and surgical approaches, this study underscores the challenges and surgical access of each method. Our findings endorse the HL technique as an effective contraception method for female capybaras to prevent the birth of seronegative offspring that could amplify Rickettsia sp., the causative agent of Brazilian spotted fever.

Comparison of bacterial profile and antibiotic susceptibility isolated from surgical site after ventral midline and lateral flank approaches of ovariohysterectomy in queens and bitches

Comparison of bacterial profile and antibiotic susceptibility isolated from surgical site after ventral midline and lateral flank approaches of ovariohysterectomy in queens and bitches

VENTRAL MEDIAN AND LATERAL FLANK APPROACH FOR OVARIOHYSTERECTOMY IN CAT

This study was conducted to compare Ventral Median Approach (OHM) and Lateral Flank Approach (OHF) for feline ovariohysterectomy (OH). Fifteen healthy local female cats (Felis catus) with body weights ranged 2-4 kg and aged 1-2 years were divided into two groups, OHM (n= 8) and OHF (n= 7). Prior to OH, the cats were anesthethized using ketamine-xylazine and the sugery was performed by the same operator. The wound scoring showed a significantly higher difference in the OHM group on day 3 and 4 post-surgery. Scores of erythematous, swelling and dehiscence showed no significant differences. The 4Avet pain scale was significantly higher in OHF at the 2, 6, and 12-hours post surgery. The pain response was evaluated using baseline tactile Semmes-Weinstein Monofilaments and was significantly higher in OHF than OHM on day 1 to day 5 post surgery. Blood hematology, blood glucose and wound healing duration did not differ significantly between groups. The OHF approach showed greater post-operative pain than the OHM approach. Wound dehiscence was observed in two cats (25%) in OHM group from day 4 post-operative. The OHM approach showed a greater risk of complications than the OHF group and therefore requires better post-operative care. The OHF group showed a smaller risk of complications but requires better post-operative analgesic therapy.

Fetal mummification in a goat

A 5-year pet doe (unknown breed) was presented (~ 1 month after her expected day of kidding) with a history of vaginal discharge and fetal membranes hanging from the vulva. She was bright, alert, and responsive with an elevated heart rate and respiratory rate. Blood chemistry panel was unremarkable. Vaginal speculum examination was attempted; however, her vulva was 1 inch in length (dorsal to ventral commissure) making it very hard. Transabdominal uterine ultrasonography revealed no fetus and uterus had an irregular echogenicity. A small fetus was identified via transrectal uterine ultrasonography. Decision was to perform cesarean surgery (left flank approach). A mummified fetus was extracted from the left uterine horn.

Comparison of Ventral Midline and Right Flank Approaches of Ovariohysterectomy in Bitches

Comparison of Ventral Midline and Right Flank Approaches of Ovariohysterectomy in Bitches

Surgery for Xanthogranulomatous Pyelonephritis: A Comparison of Midline Transperitoneal and Flank Retroperitoneal Laparotomy Approaches to Nephrectomy.

Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory disease often associated with high morbidity and mortality. Whether the midline transperitoneal or the flank retroperitoneal approach is superior remains unknown. We searched through pathology databases and reviewed 86 patients with an XGP diagnosis from 2000 to 2021 at our institution. After the patients who did not meet the inclusion criteria were excluded, 35 patients who had undergone nephrectomy through the midline transperitoneal or the flank retroperitoneal laparotomy approach were recruited. Nine (25.71%) of the thirty-five patients underwent nephrectomy through a midline approach, whereas twenty-six (74.29%) received a flank approach. Patients in the midline approach group had a longer surgical time (p = 0.03) than those in the flank approach group. In addition, patients in the flank approach group took less time after surgery to resume oral intake than those in the midline approach group (p = 0.01). No significant differences in the rates of intraoperative and postoperative complications such as peritonitis or intraabdominal infection were observed between the groups. For the patients with XGP who are good candidates for surgery, nephrectomy is a relatively safe surgical treatment method. Both surgical methods produced favorable surgical outcomes, and the patients who received these methods had similar complication rates.

Comparison of post-surgical complication rates and potential confounding factors in two common approaches for elective altering in female rats (Rattus norvegicus)

Elective altering in small mammals is a routine surgery in many exotic companion animal practices. Two techniques, the flank approach (FA), and ventral midline approach (VMA) have been well described in the literature. Flank approach and VMA are utilized for ovariectomy (with or without partial hysterectomy) and ovariohysterectomy respectively. The objective of this study is to compare complication rates between these two approaches as well as identify predictors for adverse events post operatively. A retrospective analysis was performed at a single private practice to compare postoperative complication rates and potential influence of patient related variables for the two approaches for elective reproductive altering in female rats. A total of 457 female rats were included in this study. Elective altering was performed via FA in 396 rats and via VMA in 61 rats. Medical records were reviewed and data analyzed for complications accounting for patient age, weight, and surgeon expertise. Reported complications were grouped by incision-related, mortality within 48 hours postoperatively, and postoperative pathologic findings. To test for normality of continuous data, the Shapiro-Wilk test was used. Binary logistic regression was then performed to identify predictors of adverse events. Complications were noted in 22 of 396 rats (5.6%, 95% CI: 2–6%) undergoing FA and in (9.8%, 95% CI: 3–9.9%) undergoing VMA (difference in proportion: (6.0%, 95% CI: 4.3–8.7%). Pathologic findings were present in 3 of 396 (0.8%, 95% CI: 0.3–2.2%) in the FA group accounting for uterine disease and representing risk of remaining reproductive tissue through this approach. The VMA group had 1 of 61 (1.6%, 95% CI: 0–8.7%) pathologic findings (difference in proportion: 0.1%, 95% CI: 0–0.2%). Through binary outcome analysis via logistic regression, surgeon expertise, patient age, and weight failed to predict complications for both approaches and was not statistically significant. Surgeons should be aware of the advantages and complications of either technique when choosing a surgical approach for female elective altering in rats.

The Antepsoas (ATP) Surgical Corridor for Lumbar and Lumbosacral Arthrodesis: A Radiographic, Anatomic, and Surgical Investigation.

Retrospective review of prospectively collected data. To investigate the size of prepsoas surgical corridors, developed between the iliopsoas and prespinal vessels, at all disk levels between L1 and S1 granted by left and right lateral antepsoas (ATP) approaches. Secondary aims include evaluation of presurgery radiographic prepsoas windows between L1 and S1 with respect to the intraoperative findings. The ATP technique is an evolving alternative to the transpsoas and direct anterior exposures for lumbar fusion. However, the vascular morphometric data of the ATP approach remain underexplored, especially at L5-S1. Patients indicated for ATP lumbar-lumbosacral fusion between September 2018 and February 2020 were enrolled (n=121). Data were collected prospectively, including the following (in mm): intraoperative manual measurements of the premobilization psoas-vessel (pre-PV) window, the final postmobilization psoas-vessel (post-PV) window, and the preoperative radiographic psoas-to-vessel distance at the respective studied disk levels. A total of 121 patients (75 female, mean age: 55.3yr, 81.8% right-sided approach) underwent a total of 279 levels of spinal fusion. Irrespective of the ATP access laterality, we noted ample postmobilization psoas-vessel (post-PV differential) corridors: largest at L4-L5 (36-38mm) followed by L5-S1 (31-35mm), L3-L4 (32-33mm), L2-L3 (28-30mm), and L1-L2 (20-24mm). Similarly, the relative increases of the psoas-vessel corridors (post-PV and pre-PV differentials, averaged: 31mm at L5-S1, 32mm at L4-L5, 26mm at L3-L4, 25mm at L2-L3, and 14mm at L1-L2) were also significant in both lateral approaches. In right flank approaches, the right vascular structures projected more dorsally compared with left-sided vasculature ( P <0.05). The ATP access offers generous bilateral prepsoas surgical windows to L1-S1 intervertebral disks, allowing for a safe anterior column release, decompression, instrumentation, and fusion.

Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients.

Background and objectiveThe field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center.Materials and methodsWe conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY).ResultsA total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m2). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m2. Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors.ConclusionMini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.

V13-05 A NOVEL SUPINE APPROACH TO ROBOTIC RADICAL NEPHRECTOMY AND LEVEL III INFERIOR VENA CAVA THROMBECTOMY

You have accessJournal of UrologyCME1 May 2022V13-05 A NOVEL SUPINE APPROACH TO ROBOTIC RADICAL NEPHRECTOMY AND LEVEL III INFERIOR VENA CAVA THROMBECTOMY Christopher Dall, James Mason, Charlotte Goldman, Sholklapper Tamir, Jason Hawksworth, and Keith Kowalczyk Christopher DallChristopher Dall More articles by this author , James MasonJames Mason More articles by this author , Charlotte GoldmanCharlotte Goldman More articles by this author , Sholklapper TamirSholklapper Tamir More articles by this author , Jason HawksworthJason Hawksworth More articles by this author , and Keith KowalczykKeith Kowalczyk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002646.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although multiple surgeons have successfully performed robotic nephrectomy and thrombectomy for level I-II thrombus, robotic nephrectomy with thrombectomy for level III-IV tumors is less common given the complexity of such cases and difficulty with visualization of the retrohepatic IVC. We describe our experience performing a robotic right radical nephrectomy with thrombectomy of a level III (IVC) thrombus utilizing a novel multidisciplinary approach with urologic oncology and hepatobiliary surgery services. METHODS: A 37-year-old male presented with back pain and a new 6.7x7cm right renal mass with level III tumor thrombus and a single enlarged retrocaval node without evidence of metastasis. The patient was taken for robotic-assisted laparoscopic right radical nephrectomy with IVC thrombectomy and lymph node dissection jointly with the urology and hepatobiliary teams. Rather than utilizing the common transperitoneal flank approach, the patient was placed in a supine position with a small bump under the right flank, and ports were placed in the lower abdomen aligned towards the right shoulder as commonly placed during robotic liver resections. A gelport was placed in the lower abdomen to allow for easy access to the abdomen in the case of intraoperative bleeding (Image 1). The retrohepatic IVC was circumferentially dissected up to the level of the hepatic veins and clamped above the tumor thrombus. The thrombus was excised and the cavotomy primarily closed robotically. RESULTS: Operative time was 384 minutes and the IVC clamp time was 33 minutes. No intraoperative blood transfusions were administered. Final pathology showed pT3bN1 clear cell renal cell carcinoma. Postoperatively, the patient was anticoagulated for three months. Patient remains free of disease without adjuvant therapy at 10 months followup. CONCLUSIONS: Radical nephrectomy with IVC thrombectomy can be safely performed robotically, however higher level tumors are challenging and require a multidisciplinary approach. We describe a novel approach to these challenging cases utilizing a novel port placement that allows for superior dissection of the retrohepatic IVC for level III thrombus. This approach allows excellent visualization and access to the IVC and should be considered in select patients. Source of Funding:- © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1032 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Dall More articles by this author James Mason More articles by this author Charlotte Goldman More articles by this author Sholklapper Tamir More articles by this author Jason Hawksworth More articles by this author Keith Kowalczyk More articles by this author Expand All Advertisement PDF DownloadLoading ...

Conventional ventral midline and right flank approach for ovariohysterectomy in female dogs

The present study was conducted in 12 intact female dogs presented for elective ovariohysterectomy. Animalswere randomly divided into two groups of six each. Group I animals were subjected to conventional ventral midlineovariohysterectomy and in Group II animals, right flank ovariohysterectomy was performed. Clinical efficacyof surgical techniques was evaluated on the basis of clinico-physiological and haemato-biochemical parameters.Surgical duration for performing ovariohysterectomy was comparatively less in right flank approach as comparedto ventral midline. Physiological parameters like rectal temperature showed non-significant variations in all theanimals. Respiratory rate decreased marginally whereas transitory increase in heart rate was observed for short time. Haematological and biochemical observations revealed marginal changes during the period of study in both the groups. The length of surgical incision, duration of procedure and healing were significantly less in Group II as compared to Group I. However, the operative haemorrhage was comparatively more in right flank ovariohysterectomy. The ease of exteriorization and ligation of uterus and ovaries was easy in Group II (right flank approach) as compared to Group I (ventral midline approach). Wound dehiscence was observed in two dogs of Group I whereas Group II animals showed uneventful recovery. Hence, right flank approach is a good alternative over the conventional midventral approach for performing ovariohysterectomy in female dogs

Left lateral flank approach for spaying in cats.

Background:Spaying is considered a reliable surgical method for birth control and preventing potential feline reproductive diseases.Aim:This experiment was carried out to evaluate the suitability of the left lateral flank approach for routine spaying in cats.Methods:Twenty-seven queens of 7–24 months old and 1.5–3.5 kg body weight (BW) were spayed through flank laparotomy on the left lateral side of the abdomen. The cats were categorized into two groups: Group A (n = 12; cats did not yet give birth) and Group B (n = 15; cats gave birth before). The studied variables included age, BW, vaccination history, skin incision length, total surgical duration, the time needed for ligating ovarian pedicles and uterine body, suture materials, postoperative complications, and healing duration.Results:There were no significant differences (p < 0.05) in age, BW, and vaccination history of the cats between the two groups. The mean incision length and total duration of surgery were greater in the case of Group B than in Group A. The ease of entering into the peritoneal cavity, duration of ligating the ovarian pedicles, and transfixing the uterine body did not vary significantly (p < 0.05) between the groups although a longer time was taken for Group B than Group A. 62.96% spayed cats were found with no postoperative complication. The observed complications included wound site infection (7.41%), dehiscence of suture lines (11.11%), bleeding (3.70%), and oozing (14.82%) from wounds which were further treated successfully for complete recovery.Conclusion:Left lateral flank approach can be an effective method of spaying in queens without any life-threatening complications.

English

BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis that is characterized by extensive enlargement and destruction of the involved kidney which ultimately results in non-functioning kidney. It often mimics other inflammatory or neoplastic renal disorders. Unlike chronic pyelonephritis, it spreads to the perinephric space with formation of multiple abscesses and fistulas. It is now being recognized as an important cause of renal morbidity and mortality worldwide. METHODS This is a case series undertaken in a tertiary care center. Clinical data was collected from last 6 years. Clinical features, radiological findings, treatment, and its outcome were analysed and presented. RESULTS A total of 23 cases diagnosed clinically were included in our study. The disease is more prevalent in females than in males with ratio of 1.8 : 1, with mean age of 47.04 years. Most of the patients presented with flank pain and fever. 2 patients had unusual presentations that are nephrocutaneous fistula and necrotising fasciitis of flank region. In our study, disease was associated with urolithiasis in 43.47 % and diabetes mellitus (DM) in 60.8 %. E. coli was the most commonly grown organism in urine culture. Most of the patients underwent initial percutaneous nephrostomy (PCN) or double-J (DJ) stenting followed by definitive treatment that is nephrectomy (21 patients, 2 patients lost to follow up). Extraperitoneal flank approach was most commonly chosen compared to subcostal transperitoneal approach. Excess blood loss was the most common complication encountered during surgery; 8 patients required post-operative blood transfusion. 5 patients required intensive care unit (ICU) care with inotropic support postoperatively. 6 patients had post-operative superficial surgical site infection. CONCLUSIONS XGP is a rare form of chronic pyelonephritis resulting in enlarged non-functioning kidney. UTI (urinary tract infection) and urolithiasis are the most important factors involved in pathogenesis. Prompt diagnosis and treatment is essential. Initial antibiotic treatment with drainage procedure (PCN or DJ stenting) followed by nephrectomy is treatment of choice. Early diagnosis and treatment may limit the disease process and associated morbidity, thus leading to good outcome. KEYWORDS Xanthogranulomatous Pyelonephritis, UTI (Urinary Tract Infection), Urolithiasis, Nephrectomy

Transient skin and fur color change after trichotomy of the sacrococcygeal region for epidural anesthesia in a domestic cat (Felis catus)

A clinical case in which skin and hair color change occurred after sacrococcygeal epidural anesthesia in a nine-month-old Siamese cross queen undergoing ovariohysterectomy (OHE) is described. Six weeks after surgery, during a re-check, it was noted that in the sacrococcygeal region the color of the skin and new hair growth was dark with a color comparable to the color present on the body extremities (muzzle, pinnae, legs, and tail). The skin and new hair growth of the shaved abdomen presented a standard color. The key enzyme of the melanogenic pathway in mammals is tyrosinase (TYR), and the Siamese temperature-sensitive phenotype is the result of genetic mutations that makes TYR function thermolabile. The activity of TYR in these cats is limited to the extremities where the temperature is lower while pigment production is impaired in the other body areas. The trichotomy of the sacrococcygeal region performed during wintertime in an outdoor cat was probably the trigger for increased activity of TYR in this area promoting pigment production. The absence of the same alterations in the abdominal area may be justified by less exposure of that region to the external environment, as well as to the feline habits of sedentarism, that avoid significant cooling in these regions. This report highlights the importance of taking this type of occurrence into account when performing an epidural in the Siamese cat breed. Also, to avoid skin color change in this breed, the authors recommend a midline abdominal instead of a flank approach to perform OHE.