Spays and Neuters
What is a Spay and Neuter?
Gonadectomy, encompassing ovariohysterectomy (spay) and orchiectomy (neuter), refers to the surgical removal of an animal’s gonads to achieve permanent sterilization. In the female, this involves removal of the ovaries and typically the uterus (OH), while in the male, both testes are removed.
These procedures are among the most frequently performed soft tissue surgeries in small animal practice and are indicated primarily for population control, prevention of hormone-associated diseases, behavior modification, and, in some cases, management of specific medical conditions.
Situational Awareness
While commonly referred to as “routine,” spay and neuter procedures vary significantly in complexity and must be approached with surgical discipline. Factors such as patient size, body condition, age, reproductive status, and anatomical variation directly influence intra-operative difficulty and postoperative complication risk.
There are many discussions happening at this time whether one should do an ovariectomy (OVE) instead of an ovariohysterectomy (OVH). The recent literature supports the ovariectomy as being a more rapid procedure with no significant longterm problems associated with leaving the uterus in situ, however, there is a porosity of clinical studies in the literature to support this and I think we will be seeing a shift in how things are done in the future.
Having said, it is important to stay up to date on this topic as the results of more clinical trials are made available to us.
The other trend that we are seeing now is the scrotal approach rather than the prescrotal approach when neutering a dog. For my entire career I practiced and preached the prescrotal technique because the scrotal incision risked causing more irritation to the dog. However, there were no studies to support this.
Clinical studies are also being published indicated that increased irritation and therefore licking do not appear to be a problem.
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Get ready to Perform Spays and Neuters
- Patients presenting for elective spay or neuter are typically young, healthy patients.
- Obtain a good history to ascertain that there are no co-morbidities.
- Prepare a patient for a spay surgery by shaving from the xiphoid to the pubis. This way, you are prepared to handle any and all complications that may arise.
- Clients should understand the benefits and potential risks:
- Benefits:
- Prevents unwanted pregnancies.
- Reduces the risk of diseases like pyometra, mammary tumors, testicular cancer, and prostatic disease.
- Decreases undesirable behaviors: roaming, urine marking, heat behaviors, and some forms of aggression.
- May be associated with increased lifespan, particularly in females.
- Potential Risks:
- Potential for post-op complications, although the risk is quite low, owners should be made aware (e.g., bleeding, swelling, wound infection or dehiscence).
- Obesity risk is higher in altered pets and must be proactively managed.
- Discussion of potential negative issues that are being discussed on line today (behavioural, endocrine/metabolic, secondary characteristics)
Key Points to a Successful Spay
- 1. Place skin incision caudal to the umbilicus (start 2-4cm caudal to the umbilicus in the dog and centred mid-point between the umbilicus and pubic rim for cats).
- 2. Once the abdomen has been entered through the linea alba, use a spay hook to exteriorize the LEFT uterine horn. Figure: Spay 1
- 3. Break the suspensory ligament, create a window in the mesovarium, and clamp, ligate, and divide the ovarian pedicle. Figure: Spay 2
- 4. Break the broad and round ligaments to the level of the uterine body on the left side. Figure: Spay 3
- 5. Repeat the same with the right ovary and ligaments.
- 6. Clamp the body of the uterus just proximal to the cervix. Double ligate and transect. Figure: Spay 4
- 7. Check all pedicles and close in routine fashion.
- Spay 1
- Spay 2
- Spay 3
- Spay 4
Key Points to a Successful Neuter
- 1. Decide if doing a scrotal or prescrotal technique and incised skin accordingly (use scrotal in cats).
- 2. Incise through the thick spermatic fascia and allowing testicle to pop through the incision. Figure: Neuter 1
- 3. Pull testicle away from spermatic fascia by disrupting the ligament of the tail of the epididymis by pulling them apart. Figure: Neuter 2
- 4. Testicular vessels can be either be clamped and ligated with suture or autoligated in the smaller, immature patient. Figure: Neuter 3
- 5. Remove testicle by cutting between the it and the ligated vessels.
- 6. Consider ligating the tip of the cremaster muscle in larger and mature pets. Figure: Neuter 4
- 7. Replace the spermatic fascia into the scrotum and repeat the procedure with the other testicle.
- 8. Close prescrotal with subcutaneous and intradermal/subcuticular closure; place one or two subcutaneous sutures in the scrotal incisions (be sure to bury your knot).
- Neuter 1
- Neuter 2
- Neuter 3
- Neuter 4
Get ready to Perform Spay and Neuter
Post-Op Considerations:
- Manage pain appropriately.
- With the scrotal approach it is common to notice a serosanguinous discharge from the incision for the first 12 hours or so...
- For the females: minimize activity for 10-14 days to allow the abdominal incision to heal.
- Monitor incisions on all patients for signs of inflammation, irritation, discharge and swelling.
- An informational session on the pros and cons of gonadectomy procedures on pets. This section is a comprehensive review of the recent and relevant historic literature identifying the salient features for you regarding the potential positive and negative side effects associated with spays and neuters and the timing of the surgeries.
- An information video on the spay technique: including the anatomy, the prep, the more difficult sections of the procedure and how to deal with those, how to handle and prevent complications; the pros and cons of the various techniques and case selection.
- An information video on the neutering technique: including the anatomy, the prescrotal and scrotal approaches are described; ligation techniques as well as preventing complications. There is also a discussion on the open vs the closed techniques.
- Several videos of the spay and neuter procedures being performed on patients by a variety of clinicians. All these videos are narrated to ensure full comprehension.