Laparoscopic Sterilization (2). Ovariohysterectomy

In North America the favored elective sterilization procedure in female dogs and cats remains to be ovariohysterectomy (OHE). Ovariectomy (OVE) has recently started to gain acceptance as an equally acceptable technique. However, among veterinary practitioners a resistance to substitute OHE with OVE appears to have a strong hold.

Traditionally, OHE has been advocated in order to negate the risks for uterine pathology, but there is no evidence in the literature that dogs undergoing OVE has any increased risk of developing future uterine disorders. At the same time, clear benefits of performing OVE have likewise never been presented. It appears as if in the vast majority of elective sterilizations, it remains a surgeon’s choice for which surgery type to use. Laparoscopic surgeons generally perceive that OVE is easier and faster to perform than OHE, and OVE may require fewer portals than OHE.

Importantly though, presently we lack clinical evidence supporting that pre-existing uterine disease, most notably cystic endometrial hyperplasia (CEH) and concurring mucometra or hydrometra, pyometra or neoplasia will reverse if ovarian hormon secretion is disrupted. The available studies mainly investigated OVE in young adults, less likely to be affected by CEH. Also, there have been no studies presenting a risk estimation for complications when ovariectomy is performed in canine or feline pregnancy. Good practice is to carefully assess the female dog and the uterus for any signs of pregnancy or possible CEH- pyometra and to perform OHE if any such signs are noted. Unfortunately, these conditions may have few clinical signs, and may have to be excluded by ultrasonographic examination. Dogs with clinically evident CEH may show mild abnormalities on blood cell counts and biochemistry, such as anemia, leukocytosis, thrombocytopenia and alkaline phospatase increase. The mean age of 10 dogs operated for CEH was 6.6 years (S.D. +/-3 years) with a range from 1 to 10 years. No information is available on how long CEH may have been present prior to clinical signs. Therefore, to use age less than 2 years as cutoff 1 for when to recommend OVE, may still lead to inclusion of some dogs with uterine changes.  [...]