Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs
The main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a ‘complete ligation where possible’ philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligatio...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Veterinary Sciences |
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| Online Access: | https://www.mdpi.com/2306-7381/10/7/480 |
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| author | Victoria Lipscomb Chloe Cassie Ben Ritchie Stephen Greenhalgh Mickey Tivers |
| author_facet | Victoria Lipscomb Chloe Cassie Ben Ritchie Stephen Greenhalgh Mickey Tivers |
| author_sort | Victoria Lipscomb |
| collection | DOAJ |
| description | The main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a ‘complete ligation where possible’ philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligation versus partial thin film band (TFB) attenuation of a CPSS in dogs. Dogs that could not tolerate acute complete shunt ligation at surgery received partial shunt attenuation with TFB. Peri-operative complications, mortality, follow-up imaging findings, pre- and post-operative bile acid stimulation test results and details of any revision surgery performed were recorded. A follow-up health-related quality of life questionnaire enabled the calculation of a postoperative clinical shunt score, a quality of life score, and determined if any dogs were still on a hepatic diet and/or other medical management at a minimum of 6 months after surgery. Of the 110 dogs enrolled, 57 received complete ligation and 53 received partial TFB attenuation. Peri-operative mortality, the occurrence of post-attenuation neurological complications, the occurrence of multiple acquired shunts, the postoperative clinical shunt score and quality of life score were not significantly different between the two groups. Dogs in the C group were older, heavier and demonstrated a greater number of shunt classifications where the entry into the systemic circulation was the phrenic vein or azygous vein. Dogs in the TFB group had a greater number of unchanged bile acid concentrations after surgery, were more likely to remain on the hepatic diet and/or medical management after surgery and underwent a greater number of revision surgeries. There was variability in the precision of both ultrasound and computed tomographic angiography follow-up imaging compared to intra-operative mesenteric portovenography findings at revision surgery. Overall, dogs with an extrahepatic portosystemic shunt receiving either complete acute shunt ligation or partial TFB shunt attenuation are expected to have an excellent long-term clinical outcome and there is no reason to suggest that a dog able to tolerate complete acute shunt closure should be denied the benefit of this. |
| first_indexed | 2024-03-11T00:34:45Z |
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| id | doaj.art-eeba261f4def4e7abd722f404f493c90 |
| institution | Directory Open Access Journal |
| issn | 2306-7381 |
| language | English |
| last_indexed | 2024-03-11T00:34:45Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Veterinary Sciences |
| spelling | doaj.art-eeba261f4def4e7abd722f404f493c902023-11-18T21:43:13ZengMDPI AGVeterinary Sciences2306-73812023-07-0110748010.3390/vetsci10070480Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in DogsVictoria Lipscomb0Chloe Cassie1Ben Ritchie2Stephen Greenhalgh3Mickey Tivers4Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UKDepartment of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UKDepartment of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UKDepartment of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UKParagon Veterinary Referrals, Wakefield WF1 2DF, UKThe main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a ‘complete ligation where possible’ philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligation versus partial thin film band (TFB) attenuation of a CPSS in dogs. Dogs that could not tolerate acute complete shunt ligation at surgery received partial shunt attenuation with TFB. Peri-operative complications, mortality, follow-up imaging findings, pre- and post-operative bile acid stimulation test results and details of any revision surgery performed were recorded. A follow-up health-related quality of life questionnaire enabled the calculation of a postoperative clinical shunt score, a quality of life score, and determined if any dogs were still on a hepatic diet and/or other medical management at a minimum of 6 months after surgery. Of the 110 dogs enrolled, 57 received complete ligation and 53 received partial TFB attenuation. Peri-operative mortality, the occurrence of post-attenuation neurological complications, the occurrence of multiple acquired shunts, the postoperative clinical shunt score and quality of life score were not significantly different between the two groups. Dogs in the C group were older, heavier and demonstrated a greater number of shunt classifications where the entry into the systemic circulation was the phrenic vein or azygous vein. Dogs in the TFB group had a greater number of unchanged bile acid concentrations after surgery, were more likely to remain on the hepatic diet and/or medical management after surgery and underwent a greater number of revision surgeries. There was variability in the precision of both ultrasound and computed tomographic angiography follow-up imaging compared to intra-operative mesenteric portovenography findings at revision surgery. Overall, dogs with an extrahepatic portosystemic shunt receiving either complete acute shunt ligation or partial TFB shunt attenuation are expected to have an excellent long-term clinical outcome and there is no reason to suggest that a dog able to tolerate complete acute shunt closure should be denied the benefit of this.https://www.mdpi.com/2306-7381/10/7/480congenitalportosystemic shuntliversurgeryportovenography |
| spellingShingle | Victoria Lipscomb Chloe Cassie Ben Ritchie Stephen Greenhalgh Mickey Tivers Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs Veterinary Sciences congenital portosystemic shunt liver surgery portovenography |
| title | Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs |
| title_full | Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs |
| title_fullStr | Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs |
| title_full_unstemmed | Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs |
| title_short | Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs |
| title_sort | prospective study comparing outcome following complete polypropylene suture ligation versus partial thin film band attenuation of congenital portosystemic shunts in dogs |
| topic | congenital portosystemic shunt liver surgery portovenography |
| url | https://www.mdpi.com/2306-7381/10/7/480 |
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