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Anal Sacculectomy

Anal Sacculectomy. By: Jamie Naumann. What purpose do anal sacs have?. In normal digestion, the anal sacs work to promote digestive constriction and passing of feces through the anus

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Anal Sacculectomy

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  1. Anal Sacculectomy By: Jamie Naumann

  2. What purpose do anal sacs have? • In normal digestion, the anal sacs work to promote digestive constriction and passing of feces through the anus • Periodically, the anal sacs may become impacted and require routine and regular anal sac emptying by placing slight pressure on the sac, removing the impaction and fluid.  • In situations where anal sac glands are not expressed, or remain impacted, the development of an abscess may occur. (Cadena, 2006.)

  3. Why is it necessary? • Some dogs (especially small) may have frequent problems with their anal glands • Examples may be.. • Anal Sac Impaction • Abscesses • Neoplasia • Infection – (foul smelling, pasty discharge)

  4. Clinical Symptoms • Bleeding, swelling, or redness • Could be sticky drainage on either side of the anus • When the sac or duct becomes obstructed the skin above the sac breaks open • “Scooting” • Biting at rear end • Chasing tail • Excessive licking (rear end) • Pain & Straining to defecate

  5. Signalment? • Obese cats • Small dogs • Older female dogs

  6. Why surgically remove? • If frequent problems occur it is best to just remove the problem itself, dogs (or cats) do not NEED their anal glands • Infection/Abscess • Neoplasiaof the glands • Tumor of sac wall

  7. A right anal sacculitisin a 12-year-old female bulldog. • A right anal sac carcinoma in an 8-year-old male bassett hound.

  8. Complications of Surgery • Incontinence if anal sphincter is cut or damaged (caudal rectal nerve damage) • Considered permanent after 3 or 4 months – sometimes it can resolve • Failure to remove entire sac • Resulting in continued secretion, infection or fistulation • Hemorrhage

  9. Prognosis • Post-surgical complications • Most dogs do well after surgery despite, being quite painful for them • Fecal incontinence may result from the surgery

  10. Surgery Overview • Must treat impaction or infection before surgery • Antibiotics are giving preoperatively • Considered a contaminated surgery • Manual emptying of feces may be necessary • Two options for surgery • Open • Closed • Done on ferrets and neoplastic sacs

  11. OPEN • Patient placed in perineal position with rolled towel under caudal abdomen • One blade of a pair of scissors is placed through the duct into the sac, and the scissors are closed, incising through the skin, SQ, external anal sphincter, duct, and anal sac. • Grasp the edges of the anal sac (grey and shiny) with several hemostats. • Dissect the sac free from the sphincter muscle fibers with scissors or a 15 blade. • A finger can be inserted into the open sac and the blade scraped across the outside of the sac to break away fibers. • The sac is removed and the SQ and skin are closed, or left open to heal by 2nd intention. (Tobias, 2005)

  12. CLOSED • In dogs is usually facilitated by inserting something into the sac (a Foley catheter, umbilical tape, hemostat) unless there is a tumor in the sac wall. • The animal is prepped and placed in a perineal position. • In the dog, something is inserted into the sac to facilitate locating the tissue. • An incision (curvillinear) is made parallel to the anus over the sac. • The sac is identified, and fibers of the internal and external anal sphincter muscles are dissected off the sac, staying directly against the sac to avoid vessel and nerve damage (especially medially). • Ligatethe duct at the mucocutaneous junction. • After gland removal, inspect the area to make sure no mucosa is left. • Flush the area if contamination has occurred. Appose the SQ and skin. (Tobias, 2005).

  13. SURGERY WHEN CANCER INVOLVED • The patient is placed in the standard perineal position. A rolled towel is placed under the caudal abdomen, and the hind limbs are not tied tightly in order to prevent lesions to the femoral nerves. • A purse string is not desirable either because the surgeon might need access to the anal sac duct opening. In some cases, parts of the rectal wall will need to be sacrificed. • Anal sac cancer can only be excised via the closed technique, which provides a less contaminated surgical site. Excision cannot be reliably complete because sacrificing a large portion of the anal sphincter will lead to fecal incontinence.

  14. Continued.. • A curvilinear skin incision is made at the 3 or 9 o’clock position. Via sharp and blunt dissection, the mass is carefully excised. • Hemostasisis performed with ligatures. The duct, if still recognizable, can be ligated with 3/0 or 4/0 absorbable, monofilament suture material. • After copious lavage, the remainder of the external sphincter muscle is reapposed with monofilament, synthetic, 3/0 suture material. • Subcutaneous and intradermal sutures are placed. Skin sutures or staples are rarely necessary. (Zeltzman, 2009).

  15. CVT Role • Patient preperation • Monitor Patient Vitals • TPR, Pulse Ox, Anesthetic Level, Etc • Assist surgeon in cutting suture & handing instruments

  16. Take home.. • Confinement (Restrict movement) and E-Collar for 2 weeks • Or until suture recheck/removal • Antibiotics • NSAIDS & Opioids for at least 1 week • A source of fiber (recommended to prevent constipation) • Pet may need help going to the bathroom

  17. Preventative Medicine • Getting pets anal glands checked & expressed (if needed) regularly by a CVT or DVM • This can help prevent abscess and infection • Anal gland must be expressed fully and correctly to prevent infection!

  18. Works Cited Cadena, Christine (2006). Anal Sacculectomy; An overview of Anal Sac Glands and the Surgical Option. Yahoo Health and Wellness. Retrieved 21 November 2010 from http://www.associatedcontent. com/article/58209/anal_sacculectomy_an_overview_of_anal.html?cat=70 Novartis Animal Health . (2010). Anal Sacculectomy. Retrieved 21 November 2010 from http://www.ethicon.novartis.us/ surgeryOverview/anal/default.htm Tobias, Karen. (2005). Abdominal and Gastrointestinal Surgery: Tips and Tricks. World Small Animal Veterinary Association. Retrieved 21 November 2010 from http://www.vin.com/proceedings/Proceedings.plx?CID= WSAVA2005&PID=10962&O=Generic Zeltzman, Phil. (2009). Veterinary Practice News. Step by Step Surgery for Anal Gland Cancer. Retrieved 21 Novemeber 2010 from http://www.veterinarypracticenews.com/vet-practice-news-columns/surgical-insights/step-by-step-surgery-for-anal-sac-cancer.aspx

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