Modified closed sacculectomy in 50 dogs with non-neoplastic anal sac disease

OBJECTIVE

To describe a modified closed sacculectomy technique for non-neoplastic anal sac disease in dogs, and to describe the management and short-term outcomes in dogs undergoing sacculectomy by the described technique.

STUDY DESIGN

Retrospective case series.

SAMPLE POPULATION

A total of 50 dogs.

METHODS

Electronic medical records were reviewed to identify dogs undergoing bilateral anal sacculectomy for non-neoplastic anal sac disease using the described closed technique between January 1, 2013 and February 1, 2024.

RESULTS

A total of 50 dogs underwent bilateral anal sacculectomy for non-neoplastic anal sac disease. Intraoperative anal sac perforation was reported in five dogs (10%). A total of 43 dogs were available for two-week follow-up. Grade 1 complications were reported in 14/43 dogs (32%), grade 2 complications in 2/43 dogs (5%), and grade 3B in 2/43 dogs (5%). At two-weeks postoperatively, 13/14 dogs (93%) had resolution of grade 1 complications. Both dogs with grade 2 complications had resolution reported at two weeks postoperatively, and both dogs with grade 3B complications had resolution reported at two weeks following revision surgery.

CONCLUSION

Intraoperative complications consisted of anal sac perforation without further complication. Minor postoperative complications were mostly self-limiting, supporting previous literature. Major complications were infrequent and resolved following single revision surgery.

CLINICAL SIGNIFICANCE

The technique reported provides an alternative to excise intact and non-neoplastic anal sacs in dogs. The key features of this technique are immediate anal sac identification by following the anatomic path of the duct, minimal peri-saccular dissection, no requirement for packing of the anal sac, and complete removal of the duct and anal sac.

Outcomes of dogs with apocrine gland anal sac adenocarcinoma treated via modified closed anal sacculectomy (2015-2022)

OBJECTIVE

To evaluate the postoperative complication rate and local recurrence rate of apocrine gland anal sac adenocarcinoma (AGASACA) in dogs surgically treated with a modified closed anal sacculectomy technique between 2015 and 2022.

STUDY DESIGN

Observational clinical retrospective study.

ANIMAL POPULATION

Forty-seven client-owned dogs histologically diagnosed with AGASACA.

METHODS

Medical records were evaluated for patient demographics and history, physical examination findings, diagnostic imaging, incidence of concurrent neoplasia, postoperative complications, and incidence and time to local recurrence. Dogs with at least 150 days of follow-up were included in evaluation of local recurrence.

RESULTS

Two dogs were euthanized at 4 and 11 days after surgery. Forty-five dogs were included for long-term local recurrence evaluation, with a median of 364 days of follow-up (range 156-2156 days). Only one dog (2.2%) developed local recurrence with a time to recurrence of 90 days. Postoperative complications were reported in 15 dogs (31.9%) and were considered minor in 14 dogs (93.3%) and major in one dog (6.7%). Mean survival time for the 20 dogs that were deceased as of November 1, 2022 was 521 days (range 156-1409 days) and the median survival time was 388 days.

CONCLUSION

The modified closed anal sacculectomy technique resulted in a lower AGASACA local recurrence rate than previously reported in the veterinary literature with a comparable postoperative complication rate.

CLINICAL SIGNIFICANCE

Given the low recurrence rate found in this study, the modified closed anal sacculectomy technique may reduce the need for adjuvant radiation therapy and potentially chemotherapy in AGASACA patients.

Histopathological diagnosis and surgical complications following bilateral anal sacculectomy for the treatment of unilateral canine apocrine gland anal sac adenocarcinoma: 35 cases (2019-2023)

OBJECTIVES

To report the histopathological diagnosis of both anal sacs in dogs undergoing bilateral anal sacculectomy for the treatment of unilateral apocrine gland anal sac adenocarcinoma and to compare the surgical complication rate associated with this procedure in this population with previously published literature.

MATERIALS AND METHODS

Records were retrospectively reviewed for dogs that underwent bilateral anal sacculectomy for the treatment of apparently unilateral apocrine gland anal sac adenocarcinoma, at a single institute between 2019 and 2023. Clinical staging, surgical treatment, histological findings, intra- and postoperative complications were evaluated.

RESULTS

Thirty-five dogs were included. Only five of 35 (14%) dogs were found to have histologically normal contralateral anal sacs. Non-neoplastic anal sac disease was found in 23 of 35 (66%) dogs and bilateral apocrine gland anal sac adenocarcinoma was seen in seven of 35 (20%) dogs. None of the dogs diagnosed with bilateral neoplasia had evidence of bilateral neoplasia before surgery despite a thorough work-up. Complications attributable to the primary tumour removal were seen in 9% of dogs intraoperatively and 14% of dogs postoperatively, commonly tumour capsule disruption and surgical site infection, respectively.

CLINICAL SIGNIFICANCE

Bilateral anal sac disease was diagnosed histologically in the majority of presumed normal anal sacs, with 20% of cases being found to have bilateral apocrine gland anal sac adenocarcinoma. The surgical complication rates of this cohort were comparable to those reported for unilateral anal sacculectomy alone. These findings promote and encourage the use of bilateral anal sacculectomy in cases of suspected unilateral anal sac neoplasia.

Effect of hospitalisation on the rate of surgical site infection in dogs with Penrose drains

OBJECTIVES

The aim of this study is to retrospectively report complication and infection rates associated with the use of Penrose drains in a large population of dogs; and to compare complication and infection rates of dogs hospitalised for maintenance of their Penrose drains with those that were discharged home with their drains in place.

MATERIALS AND METHODS

We performed a retrospective search of medical records from 2014 to 2022 for dogs that had a Penrose drain placed into a wound in one institution. Our population was sub-divided into dogs discharged home with a drain in place; dogs discharged only after drain removal; and dogs recovered part of the time in hospital and part at home (with the drain in situ). Postoperative complications were graded using the Clavien-Dindo scale.

RESULTS

Two hundred and eight dogs were included. The overall complication rate was 40.9% (85/208), with most complications considered minor. The overall infection rate was 16.9% (35/207). Dogs discharged home with the drain in situ <24 hours after surgery (n=136) had similar complication (39.0%) and infection (16.2%) rates to dogs kept hospitalised for drain care (n=50, 42.9%, 18.4%) and dogs kept hospitalised for >24 hours but discharged with the drain in situ (n=18, 50.0%, 22.2%).

CLINICAL SIGNIFICANCE

Our study results show no significant influence on the complication or infection rates between dogs that were hospitalised for drain care and those discharged home with drains in situ within 24 hours of surgery.

Anatomic Variations of the Perineal Arteries and Nerves in the Male and Female Dog and Its Clinical Implications

The anatomic variations of the perineal arteries and nerves are studied in the dog. The aim of the study is to provide a more detailed understanding of the blood supply and innervation of the perineal region, providing detailed information on the perineal arteries and nerve distribution and their variability in male and female dogs. The study used 232 pelvic halves from 116 adult dogs and analysed the differences using the chi-squared test. The results showed that the presumptive model for perineal artery distribution described in N.A.V. was observed in 46% of the specimens. Additionally, a dorsal perineal artery "long type" was found in 13% of the dogs, and a perineal trunk was present in 41% of the dogs. In the study, there was no variation in perineal nerve distribution, and it was found that the perineal nerve did not run together with the dorsal perineal artery when it was the "short type" as described in the presumptive model for perineal artery distribution. Instead, it always followed the route of the dorsal perineal artery "long type" and the perineal trunk when they were present. The findings of the study may be useful for veterinary surgeons when approaching the perineal region in dogs.

Inside-out anal sacculectomy in small dog breeds and cats

This report describes a new, simple and rapid surgical technique for the removal of anal sac in small dogs and cats. The anal sacs were simply everted using mosquito hemostatic forceps and excised with the aid of an electrocautery surgical unit. On the evaluation of postoperative complications, only one dog of 28 animals experienced short-term minor complications of mild fecal incontinence and scooting. Thus, we suggest that this new surgical technique is easy, inexpensive and time-saving and some of the complications with previously reported methods used for small dog breeds and cats may be avoided by using this technique.

A Cross-Sectional Study on Canine and Feline Anal Sac Disease

Simple Summary

Anal sac disease is a common problem in private practice, but there is surprisingly little information available about anal sac disease in the literature. In this article, the incidence, predisposing factors, diagnostics, treatment options, and recurrence rates were investigated by the use of a questionnaire which was distributed among veterinarians in private practice. Dogs were more commonly affected than cats. Diarrhea and skin problems increased the risk for anal sac disease, and certain breeds were more often affected. Diagnosis was made based on the presence of clinical signs and characteristics of the anal sac content. Manual expression and treating any potential underlying disease were the most important treatments. Surgical removal was performed in the case of frequent recurrence. Surgical outcome of anal sacculectomy can be improved when surgery is performed after medical management. Future studies should investigate if these findings reported by veterinarians can be confirmed by asking veterinarians to keep a logbook on dogs and cats with anal sac disease.

Abstract

Limited data are available on canine and feline non-neoplastic anal sac disease. Therefore, the aim of this study was to obtain observational data on the incidence, predisposing factors, diagnosis, treatment, and recurrence rate of canine and feline anal sac disease. To this end, a questionnaire was distributed among veterinarians. The incidence of non-neoplastic anal sac disease was estimated at 15.7% in dogs and 0.4% in cats. Predisposing factors were diarrhea, skin problems, several dog breeds, and particularly small breed dogs, male cats, British shorthairs, and obesity in dogs. Diagnosis was made based on the presence of clinical signs and characteristics of the anal sac content. Manual expression and treating any potential underlying disease were the most important treatments for all three types of non-neoplastic anal sac disease. Anal sacculectomy was performed in refractory cases. The most recurrent anal sac disease condition was impaction. Diagnosis of anal sac disease should be based on clinical signs and rectal examination, as the evaluation of the anal sac content is not reliable. Surgical outcomes of anal sacculectomy can be improved when surgery is performed after medical management. Future studies should investigate these findings in prospective trials.

Outcomes and complications of anal sacculectomy for non-neoplastic anal sac disease in cats: 8 cases (2006-2019)

OBJECTIVES

To describe the features of non-neoplastic anal sac disease in cats, the surgical procedure, complications, surgical outcome and prognosis compared to well-established data for anal sacculectomy in canine patients.

MATERIALS AND METHODS

A retrospective review of medical records of cats undergoing anal sacculectomy for non-neoplastic disease between 2006 and 2019.

RESULTS

Eight cats were included in the study of which four of eight developed minor and self-limiting complications including defaecatory complications in three cases and superficial corneal ulceration in one case. No cat developed permanent faecal incontinence. No long-term postoperative complication was recorded. Median surgical time was 35 minutes (range, 20 to 42). Median hospitalisation time was 1.5 days (range, 1 to 4). The incidence of short-term minor complications is higher than previously reported in dogs, although this might be in agreement with a reported higher incidence in dogs smaller than 15 kg.

CLINICAL SIGNIFICANCE

Anal sacculectomy for non-neoplastic anal sac disease is a safe procedure in cats with relatively high rate of short-term but self-limiting, minor, postoperative complications.

Post-operative complications following apocrine gland anal sac adenocarcinoma resection in dogs

Describe the complications associated with surgical resection of primary apocrine gland anal sac adenocarcinoma (AGASACA) tumours study design multi-institutional retrospective cross-sectional cohort study Animals Client owned dogs with spontaneous disease using the Clavien-Dindo classification system, post-operative events were assigned and described. Logistic regression analysis was used to analyse for risk factors for a significant association with complications. One hundred sixty-one dogs were included in the analysis. The post-operative sequelae, complication, and failure to cure rates specific to the anal sac site was 14%, 17% and 1%, respectively. The majority (68%) of complications were grade II or higher, therefore requiring some form of intervention. Intra-operative complications were identified in 11 cases (7%) with anorectal wall perforation being most common. An intra-operative complication was significantly associated with post-operative complications (p < 0.001; OR 7.4) while anorectal wall perforation was the only significant risk factor on regression analysis (p < 0.001; OR 19). Surgical site infection was identified in 20 of 161 (12%) of cases. Local recurrence (LR) occurred in 18% of cases at a median of 374 days (95% CI: 318-430). The only risk factor significantly associated with LR was the presence of vascular or lymphatic invasion (p = 0.008; OR 3). Post-operative complications were relatively infrequent but the risk was significantly increased when there was an intraoperative complication during resection of a primary AGASACA tumour. This study provides information for the clinician regarding risk factors for post-operative complications.

A comparison of the rates of postoperative complications between dogs undergoing laparoscopic and open ovariectomy

OBJECTIVES

To investigate whether dogs undergoing laparoscopic ovariectomy might have a lower overall and wound-healing complication rate than those undergoing an open surgical approach.

MATERIALS AND METHODS

A retrospective study of dogs that underwent laparascopic or open surgical ovariectomy between January 1, 2013 and January 1, 2018 by the same team of similarly experienced surgeons using standard practice anaesthetic, theatre and perioperative protocols. General complications were described and graded using the Clavien-Dindo system. Complication rates were compared between the two groups of dogs. Wound complications were further subdivided using the U.S. Centers for Disease Control guidelines.

RESULTS

According to the Clavien-Dindo system, 46 of 106 (44%) dogs undergoing open ovariectomy developed a complication. Thirty dogs (28.3%) had wound healing complications, the majority of which were minor and self-limiting. Superficial site infections occurred in 50 (5%) cases and deep surgical site infections in one dog (1%). Incisional herniation occurred in four (4%) cases. Thirty-one (20%) of 154 dogs undergoing laparoscopic ovariectomy developed a complication. Seventeen (11%) developed wound healing complications, most of which were minor; five (3%) developed superficial surgical site infections and none had deep surgical site infections. Incisional herniation occurred in none of the laparoscopic cases.

CLINICAL SIGNIFICANCE

The rates of overall and wound healing complications were lower for the laparascopic group than the open surgical group in this non-randomised study. Laparoscopy might be considered preferable for ovariectomy in dogs but confirmation requires a randomised trial.

Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs

OBJECTIVE

To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT).

STUDY DESIGN

Retrospective study.

SAMPLE POPULATION

One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed.

METHODS

Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups.

RESULTS

Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively).

CONCLUSION

Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival.

CLINICAL SIGNIFICANCE

A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Surgical management of primary, metastatic and recurrent anal sac adenocarcinoma in the dog: 52 cases

OBJECTIVES

To report the outcomes and complications of a cohort of dogs with primary and recurrent anal sac adenocarcinoma managed with surgery as the first-line treatment. To report the use of lymph node cytology for identification of metastatic disease.

METHODS

Retrospective review of case records of a single referral centre population of dogs diagnosed with anal sac adenocarcinoma.

RESULTS

Fifty-two clinical cases were identified. Altered ultrasonographic appearance of lymph nodes was highly consistent with metastatic disease as assessed by cytology and histopathology. Seven of 58 (12%) perineal surgeries had reported minor complications and seven (12%) others required further surgical intervention. Minor controllable intraoperative bleeding was the only complication noted associated with lymph node extirpation in two of 39 (5%) metastectomy procedures. Six dogs (12%) suffered local recurrence and 22 (42%) developed subsequent or recurrent nodal metastatic disease. From the time of detection of disease recurrence, median additional survival associated with a second surgical intervention was 283 days.

CLINICAL SIGNIFICANCE

Coeliotomy for lymph node metastatectomy in dogs with adenocarcinoma of the anal sac has low morbidity and should be considered in patients presenting with evidence of regional metastatic disease both at initial presentation and with recurrent disease.