Current Concepts

Portal Vein Thrombosis, In Depth

Portal vein thrombosis is being recognized with increased frequency in small animals due to greater awareness of hypercoagulable states and greater use of abdominal ultrasound in animals with gastrointestinal signs.  The veins of the hepatic portal system drain the digestive organs, spleen and pancreas and deliver blood to the liver via the hepatic portal vein. The portal vein is responsible for delivering close to 75 percent of the hepatic blood supply, the remaining being provided by hepatic arteries.  Obstruction of the portal vein occurs most commonly secondary to thrombus formation, or due to neoplastic infiltration and secondary thrombus formation.

A predisposing cause for hypercoagulability is identified Continue reading

Current Concepts

Wound Soaker Catheters for Control of Post-Operative Pain in Dogs and Cats

Alicia Karas, Emily McCobb, Lois Wetmore, Cheryl Blaze

History and Rationale

One of this decade’s remarkable advances in managing post-surgical pain involves delivering local anesthetic directly to the wound, and is easily adopted for use in veterinary patients. Traditional nerve block techniques eliminate the pain of surgery but mastery can require significant expertise.  In addition, commonly used local anesthetics have relatively short durations (lidocaine, 1 – 2 hours; bupivacaine, 4 – 6 hours). The availability of implantable infusion catheters makes it possible to use repeated dosing or continuous infusion of local anesthetics into surgical wounds, and improves pain control. FDA approved human use catheters are available, but costly. Two modestly priced catheters are commercially available for veterinary use (see below). Basically, they consist of a pliable catheter with tiny holes along the implanted end, functioning somewhat like a garden “soaker hose” (See figure 1a-c). The catheter is buried in the wound bed during surgical closure. Continue reading

Current Concepts

Minimally Invasive Surgery: Surgery with Less Pain

Robert J. McCarthy, DVM, MS, DACVS    

“I learned a long time ago that minor surgery is when they do the operation on someone else, not you”              

-Bill Walton of the Boston Celtics              

Philippe Bozzini, father of minimally invasive surgery

Philippe Bozzini, father of minimally invasive surgery, described in the early 1800s an examination with a "lichtleiter." (Image courtesy laparoscopy.com)

History and Rationale

 Although still in its infancy in veterinary medicine, minimally invasive surgery (MIS) has been performed in humans since the early 1800′s, when Bozzini described examination of the bladder and rectum with an instrument referred to as a “lichtleiter”. . While initially used sparingly, and only as a diagnostic tool, operative MIS gained explosive popularity after description of the first laparoscopic cholecystectomy in 1985. It is estimated that a staggering 600,000 laparoscopic cholecystectomies are now performed annually in the United States alone! MIS has now been investigated as an option to replace almost every imaginable open surgical procedure in humans.              

Colleagues have argued to me that if you add up the length of all the stab wounds for a MIS procedure, they could do the same intervention through an open approach. The lack of understanding is that it is not the total length of the incision that causes the trauma, but rather Continue reading