Anal sacculectomy or marsupialization surgery report
Prior to surgery, an epidural injection of preservative-free morphine or morphine/lidocaine/bupivicaine
With the patient in sternal recumbency (perineal position) and the tail fixed dorsally over the back, the pelvis was elevated and the hindlimbs padded. The anal sac(left, right or both) were palpated to determine their location. Using (closed, open or marsupialization) technique, the anal sac(s) were approached and removed.
Closed technique – A small balloon-tip catheter was inserted into the orifice of the anal sac duct and filled with saline until the lateral extent of the anal sac could be identified. A curvilinear incision was made over the anal sac, separating the internal and external anal sphincter muscles. Dissection was used to free the sac and duct to the mucocutenous junction. A ligature using (3-0, 4-0) (polydioxanone, glyconate, poliglecaprone 25) was placed around the duct and the anal sac and duct were removed inspecting for remaining sac tissue. Subcutaneous tissues were apposed with (3-0, 4-0) (polydioxanone, glyconate or poliglecaprone 25) sutures and the skin was apposed with (3-0, 4-0) (polydioxanone, glyconate, poliglecaprone 25, nylon, polyprolene) sutures.
Open technique – A scissor blade or groove director was placed into the duct of the anal sac. Medial traction of the duct was applied while incising through the skin, subcutaneous tissue, external and internal anal sphincter, duct and sac. The incision was continued to the lateral extent of the anal sac. The cut edge of the anal sac was elevated and dissected free from its attachments to muscle and surrounding tissue. Subcutaneous tissues were apposed with (3-0, 4-0) (polydioxanone, glyconate or poliglecaprone 25) sutures and the skin was apposed with (3-0, 4-0) (polydioxanone, glyconate, poliglecaprone 25, nylon, polyprolene) sutures.
Marsupialization technique – Similar incision approach as open technique. The sac lining is then sutured to the skin margins using (3-0, 4-0) (polydioxanone, glyconate or poliglecaprone 25, nylon or polyprolene) interuppted sutures.
Amoxicillin Keflex Clavamox every 6 8 12 24 hrs. Other?
Buprinex Morphine Butorphanol Hydromorphone Tramadol Previcox Rimadyl Derramax Metacam Domitor MLK Drip every 6 8 12 24 hrs. How many days?
Telephone (800) 707-0167/(210) 706-0167
A stool softener may be added to the diet 2-3 times per week:
Colace: Dogs – 50-200mg PO, Cats – 50mg PO Dulcolax: Dogs – 5mg/kg PO, Cats – 2.5-5mg/kg PO Lactulose: Dogs – start with 1ml/4.5kg PO (titrate to effect), Cats – start with 5mls/cat PO (titrate to effect) Metamucil: Dogs – 1 teaspoon/5-10kg in food (titrate to effect), Cats – 1 teaspoon/cat in food (titrate to effect) Canned pumpkin: Cats – 1-4 tablespoons PO Coarse Wheat Bran: Dogs – 1-4 tablespoons PO
An e-collar is mandatory for 10-14 days to protect the skin incision from licking. Recommend suture or staple removal in 10-14 days with referring veterinarian. Food and water may be offered 8-12 hours postoperatively. See Post Surgical Care Instructions for more details regarding at-home care for Anal Sacculectomy or Marsupialization.
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