Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi‐centre retrospective review of 31 dogs

Abstract

The Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian EH25 9RG, UK § Anderson Moores Veterinary Specialists, Hampshire SO21 2LL, UK 1 Corresponding author email: barney.dean@scvetspecialists.co.uk Objectives: To report surgical technique, intra-and post-operative complications, and short-and long-term outcome following canine hepatobiliary surgery in which exposure of intra-abdominal hepatobiliary lesions was aided by diaphragmotomy. Materials and MethOds: Clinical records from four multi-disciplinary UK-based small animal referral hospitals were retrospectively reviewed for dogs in which diaphragmotomy was performed between January 2014 and May 2019. Signalment, diagnosis, surgery performed, diaphragmotomy technique, management of diaphragmotomy and pneumothorax, intra-and post-operative complications, short-term outcome and long-term outcome were recorded.results: Thirty-one cases were identified. The most common hepatobiliary surgeries performed alongside diaphragmotomy were single hepatic lobectomy (14/31) and cholecystectomy (11/31).The most common diagnoses were hepatocellular carcinoma (10/31), gall bladder mucocoele (7/31) and hepatic nodular hyperplasia (4/31). Peri-operative mortality rate was 9.7% (3/31 cases) though none of these deaths were considered attributable to diaphragmotomy. Post-operative complications were encountered in 67.9% (19/28) cases that survived the peri-operative period, of which 25.0% (7/28) suffered complications that were considered attributable or likely attributable to diaphragmotomy. These seven complications resolved following non-surgical intervention.Follow-up was available for 26 of 28 patients that survived to discharge at a median of 4-months (range 10 days to 24 months) following surgery and revealed no evidence of complications related to diaphragmotomy.clinical significance: Diaphragmotomy appears safe and increases abdominal exposure of hepatobiliary lesions. The benefit of improved exposure must be carefully weighed up against the risks inherent in inducing pneumothorax.

Association between divisional location and short‐term outcome of liver mass resection in 124 dogs

“…Dean et al were the first to report on the use of diaphragmotomy to aid with hepatobiliary surgery. 12 In that paper, dogs that received a diaphragmotomy suffered a 68% postoperative complication rate. Median sternotomy incisions to aid with the exposure of hepatobiliary surgery have also been reported by Linden and colleagues, with the postoperative morbidity of this procedure being well reported.…”

“…This increased incident of incision extension is again likely a reflection upon the anatomical challenge of right divisional lobectomies. Dean et al were the first to report on the use of diaphragmotomy to aid with hepatobiliary surgery 12 . In that paper, dogs that received a diaphragmotomy suffered a 68% postoperative complication rate.…”

Surgical management of intrathoracic wooden skewers migrating from the stomach and duodenum in dogs: 11 cases (2014–2020)

“…Thoracic approaches were attempted via diaphragmotomy in eight of 11 cases, of which only one required conversion to a median sternotomy due to active haemothorax (case 2). Transdiaphragmatic thoracotomy provides enough exposure to inspect the caudal hemithoraces, the mediastinum and the caudal pericardial surface (Hunt 2018) without the morbidity and mortality intrinsically related to median sternotomy (Pelsue et al 2002, Dean et al 2020. Furthermore, the upper gastrointestinal tract is known to have lower bacterial concentrations (Cornell 2018).…”

“…2002, Dean et al . 2020). Furthermore, the upper gastrointestinal tract is known to have lower bacterial concentrations (Cornell 2018).…”