Ovariohysterectomy is a surgical procedure widely employed in practice by vets. It is indicated in cases of pyometra, uterine tumours, or other pathologies. This procedure should only be undertaken if the bitch is in a fit state to withstand general anaesthesia. However, the procedure is contradicated if the bitch presents a generalised condition with hypothermia, dehydration, and mydriasis. Ovariohysterectomy is generally performed via the linea alba. Per-vaginal hysterectomy can also be performed in the event of uterine prolapse, if the latter cannot be reduced or if has been traumatised to such an extent that it cannot be replaced safely. Specific and nonspecific complictions can occur as hemorrhage, adherences, urinary incontinence, return to oestrus including repeat surgery. After an ovariectomy, bitches tend to put on weight, it is therefore important to inform the owner and to reduce the daily ration by 10%.
Ovariohysterectomy in the bitch is a surgical procedure consisting of laparotomy with ablation of both ovaries and the uterus.
This procedure is indicated for the following [
Uterine tumours.
Serious uterine lesions, whether traumatic or infectious in origin; the most common cause being dystocia during parturition.
Other pathologies that justify an ovariohysterectomy include metorrhagia, pyometria, glandular-cystic uterine hyperplasia with secondary infection leading to chronic metritis; the latter usually occurs postoestrus (“postoestrus metritis”) and is initially treated medically, as with acute postpartum metritis, surgery becomes a necessity once the disease becomes chronic and recurrent [
These alterations in the uterine mucosa are the result of ovarian hormonal imbalances.
Metritic pathologies have become increasingly common since the introduction and growing popularity of synthetic progesterone treatments such as medroxyprogesterone acetate, which are used to prevent or eliminate heats where the onset of metritis is common especially if they are used after the 3rd day of pro-oestrus [
This procedure should only be undertaken if the bitch is in a fit state to withstand general anaesthesia. She will reabsorb the toxins produced in the uterus, or lick any pus that accumulates at the lower commissure of the vulva, leading to gastroenteritis and hepatonephritis and subsequently diarrhoea, vomiting, and raised urea (normal value around 0.6 g/L), and creatinine (normal value around 10 mg/L).
However, if the ureamia is greater than 0.6 g/L, we advise the administration of Lespedeza capitata LESPEDEZIA N.D.v, 0.7–1 mL/kg morning and evening for 2 days via IM or SC injection, without exceeding 20 mL/injection/animal. The latter is a mild diuretic, hypoazotemic agent that acts via renal vasodilatation and stimulates the activity of the renal parenchyma. These injections should be combined with intravenous fluid therapy with isotonic NaCl solution at 0.9% and the urea levels checked 2 days later. Antibiotic prophylaxis with Cefalexin RILEXINE N.D.v, at a dose of 20 mg/kg every 12 hours during 3 days, is also advisable to prevent bacteraemia.
Another indication is that of convenience, that is, sterilisation, as many owners complain of the manifestations of heat with vulvular discharge, as well as the problems associated with repeated matings.
Finally, and with the owner’s consent, ovariohysterectomy can be proposed as a radical alternative to medical abortion following an unwanted pregnancy, as it also involves definitive sterilisation [
However, there are certain contraindications to the procedure, such as if the bitch presents with a generalised condition with hypothermia, dehydration, and mydriasis. Similarly, animals presenting with hepatorenal insufficiency should not undergo general anaesthesia if the urea levels are greater than 0.6 g/L and the creatinine is greater than 10 mg/L, such animals are associated with poor peri- and postoperative survival. It is therefore essential to perform a complete, detailed preoperative clinical examination, with blood tests for serum biochemistry.
The genital apparatus of the bitch is primarily located in the abdominal cavity, with the exception of the vagina, which lies in the pelvis [
Arteries and veins of the genital apparatus of the bitch (Seen side left).
Uterine irrigation.
The neck of the uterus is relatively short, it measures 1-2 cm long, and lies a few centimetres in front of the anterior border of the pubis; it is followed by the body of the uterus, which measures 3–5 cm in length in the intrabdominal position, and which starts from the anterior straight of the pelvis then divides after a few centimetres into two divergent horns, which lie on the floor of the abdomen on either side of the linea alba, then travel back up towards the ovaries; the latter are situated in the costolumbar angle, one or two centimetres from the bisection and buried in a fatty ovarian sac, which opens medially [
The uterus receives its blood supply from the right and left uterine arteries (Figures
The uterine artery provides the majority of the organ’s blood supply and serves no other organs; it originates from the internal iliac artery along with the umbilical artery.
Easy access to the genital apparatus is gained via the linea alba; the incision starts at the umbilicus and ends 2 to 3 cm cranial to the anterior border of the pubis. This approach provides direct access to the uterine horns and facilitates prehension of the ovaries.
Ensure that the bitch has been fasted since the previous day especially in the context of elective surgery: however, in an emergency situation, after induction of anaesthesia rapid intubation with a cuffed endotracheal tube should prevent aspiration of stomach contents due to gastric reflux.
In the event of pyometria or metritis, the bitch’s organism has to eliminate the toxins produced during the infection, it is therefore essential for the success of the procedure to choose anaesthetic agents with minimal toxicity. Various protocols are available, these include: IV premedication with valium and morphine at 0.25 mg/kg and 0.1 mg/kg, respectively, followed by induction of anaesthesia with propofol at a dose of 5 mg/kg, the volume is increased slowly until the animal is sufficiently well anaesthetised to enable intubation. Isoflurane gas is then used to maintain anaesthesia; a flow rate of 2% is normally sufficient to maintain a good level of anaesthesia until the end of the procedure. To control perioperative pain, morphine can be administered at the same dose as for premedication, to a maximum of 10 injections/hour to avoid exceeding the threshold of toxicity.
Once anaesthetised, the bitch is positioned in dorsal recumbency with her front legs pulled forward and tied to the table, and the back legs tied back; the bitch is then put on a drip with previously warmed normal saline (0.9%) with glucose.
The surgeon should wear a clean and sterile gown, scrub their hands thoroughly using surgical scrub solution, and wear sterile gloves.
In addition to the standard laparotomy kit, the surgeon requires the following instruments: 2 babcock forceps, 4 artery forceps, 4 doyen bowel clamps, resorbable multifilament suture material, VICRYL, dec. 3.
And finally material for the septic phase of the surgery: scalpel, mayo scissors, and resorbable VICRYL Dec 3.5 or 4 for closure of the abdominal wall.
The surgical zone should be carefully scrubbed using the same type of surgical scrub solution as used by the surgeon, and disinfected using alcohol and surgical antiseptic solution several times over.
The skin is incised along the linea alba, that is, the sheath of the rectus abdominus, starting from the umbilicus and ending a few centimetres in front of the pubis.
Using a pair of scissors, the subcutaneous connective tissue, which may contain a substantial amount of fatty tissue, is bluntly dissected to visualise the linea alba.
Haemostasis is performed before opening the abdominal cavity. If simple swabbing proves insufficient, any bleeders should be ligated or twisted to obtain a very clean surgical field.
Using rat-tooth forceps, the linea alba is grasped in the middle and tented up before being incised with a pair of scissors. The peritoneum is then punctured using a cannula that is slid towards the umbilicus to enable incision of the linea alba without damaging the abdominal contents, with the cutting edge of the blade turned uppermost. The same procedure is then performed in the opposite direction towards the pubis.
If the uterine horns are voluminous they will be seen in the bottom of the surgical field following incision of the peritoneum; normal-sized horns will not be visible, for example, following recovery from postoestral metritis or during routine spaying.
To find the uterine horns easily, the operating table is tilted so that the animal’s head is below its feet, to move the abdominal organs towards the diaphragm; this is known as the TRENDELENBURG position.
To locate the genital apparatus with ease, the bladder is retracted laterally; cranial to the bladder, the body of the uterus and bifurcation of the horns are easily locatable. One of the horns is then followed cranially up to the ovary, which is hidden in the fat-filled ovarian bursa. The ovary is not visible but can be felt through this ovarian bursa. It is a 1-2 cm long mass, which is exposed after incision of the bursa.
The broad ligament is then punctured with a clamp to grasp the suture material and a ligature is placed in the ovarian pedicle as close as possible to the lumbar wall. Once this ligature has been placed, the ends of the threads are kept long so that the ovarian pedicle can be found with ease in the event of haemorrhage. A clamp is then placed between this ligature and the ovary, and the pedicle is sectioned between the two. The ovarian pedicle is held throughout this procedure with a clamp. The quality of the haemostasis is checked; the long ends of the suture material on the ovarian pedicle are then cut. In some cases, such as in the event of hypertrophy of the vascular bundle, it may be advisable to place two ligatures, one around the artery and one around the ovarian vein. Never hold the ligature itself with the clamp, as it might slip off the pedicle when being released back into the abdomen. However, if the vessels are invisible and buried under fat, the ligament can simply be torn in the middle above the uterine artery by exerting traction between two swabs with the fingers to tear it from front to back to the level of the cervix, and as close as possible to the lumbar wall. A point of resistance will be encountered within the round ligament; this corresponds to the vaginal process (which corresponds to the scrotum in the male) which explains the risk of inguinal herniation of the uterus in bitches following relaxation of the latter. Another technique for sectioning the broad ligament involves the placement of a row of overlapping mattress sutures along the length of the ligament before making the section with a scalpel or a pair of scissors. Once the ovarian pedicle has been sectioned, the second horn is located and the corresponding ovarian bursa grasped with Babcock forceps. The ovarian pedicle and broad ligament are sectioned as described previously. Finally, the two uterine horns are replaced back onto pelvis.
The prolapse of intestinal loops through the incision can cause significant heat and fluid loss, which can have very serious consequences, especially if the bitch is already suffering from deterioration in general status due to severe pyometria, for example. It is therefore advisable to suture the anterior portion of the laparotomy wound before continuing the surgery.
However, if the haemostasis of the ovarian pedicles or broad ligaments is a source of concern, the placement of a few forceps should suffice to provide temporary closure of the anterior portion of the laparotomy wound.
The veins can be visualised passing on either side of the cervix. The arteries run under the veins in the musculosa of the cervix, which is why the haemostatic sutures should transfix the lateral walls of the cervix. However, if the uterine artery is perforated during ligation, a wider transfixion is needed, more caudal to the previous attempt. The musculosa is then sectioned cranial to the intestinal clamp placed on the cervix; if the clamps have been placed correctly, no fluid should leak from the cut ends.
Section of the pathological cervix.
These suture procedures eliminate the risk of peritoneal infection, since the pathological secretions drain into the vagina.
The sutured stump is returned to the abdominal cavity and the abdominal wall is closed using “X”-shaped interrupted sutures with VICRYL N.D. Dec.4.
If the subcutaneous connective tissue is very abundant, a simple continuous subcutaneous suture is performed using VICRYL N.D. Dec.3.
Finally, the skin is sutured using simple interrupted sutures or mattress sutures with non-resorbable filament such as MONOSIN N.D. Dec.3. The wound is then disinfected with antiseptic solution and protected with a few swabs and an adhesive dressing.
Hysterectomy in the bitch via the linea alba is not very difficult. Nevertheless, it is sometimes necessary to perform the surgery via a vaginal approach rather than via the linea alba.
Per-vaginal hysterectomy is performed in the event of uterine prolapse, if the latter cannot be reduced or if has been traumatised to such an extent that it cannot be replaced safely.
The elective site for amputation is between the cervix and urinary meatus, in which case there are two different possible techniques, either with an elastic ligature, or by suturing.
An elastic band is placed between the cervix and the urinary meatus, the exeresis is then performed and the stump sutured by joining the internal and external segments with a perforating simple continuous suture.
Firstly, an intestinal clamp is placed between the cervix and the urinary meatus to crush the pedicle, then, either a transfixing suture or overlapping mattress suture is placed. Once the sutures have been placed, the vagina is excised.
The stump will be expelled within 15 days.
Firstly, advise perioperative oxygenation if the surgical shock is very great.
The animal is warmed, especially if the female was in poor condition prior to the procedure, she must be rolled in a blanket and placed in a heated kennel.
Intravenous fluid therapy is administered with isotonic saline along with an injection of Vitamin C and corticosteroids.
The bitch is then placed under antibiotic therapy for at least 5 days.
The sutures are removed after 10 days.
Any stagnant uterine secretions in the cervix and vagina will be eliminated in the days following and then cease completely.
These can be classified as general or specific.
Evisceration.
Abdominal herniation.
Suppuration from the cutaneous wound.
Peritonitis.
Haemorrhage: occurring during the intervention and continuing in the hours following. The latter represents one of the most common causes of the death of the animal. They can be situated at the level of the following.
Bitches who have undergone surgery for pyometria may present with thrombocytopenia: in the days following the procedure, the bitch presents with a marked tendency to haemorrhage. The mucosae are pale, the pulse weak, the bitch is hypothermic (
Complication: Pathological cervix amputation.
The current success rate is close to 95%, whilst several decades ago failures were to the order of 50%.
Ovariohysterectomy is the only effective treatment for pyometria and it is a radical treatment for postoestrus metritis when it recurs following failure of medical treatment. For the procedure to have the best chances of success, it is important to perform it on a bitch in good general condition.
It is also important to remember that after an ovariectomy bitches tend to put on weight, 1 kg for every 10 kg after 90 days; the metabolism of the bitch falls from 37 to 33 Kcal/day, it is therefore important to reduce the daily ration by 10%.