Laparoscopic portosystemic shunt attenuation in 20 dogs (2018‐2021)

Abstract

Objective To describe the technique, complications, and outcome of laparoscopic portosystemic shunt attenuation (LPSSA) in dogs. Study design Retrospective study. Animals Twenty client‐owned dogs. Methods Medical records were searched for dogs with a single congenital extrahepatic portosystemic shunt (CEPSS) that was treated with LPSSA. Signalment, clinical signs, CEPSS location, diagnostic imaging, laparoscopic approach, operative technique, complications, and clinical outcome were reviewed. Results Fourteen dogs with CEPSS located in the epiploic foramen had a right (13/14) or left (1/14) paramedian approach. In 6 dogs a CEPSS was not located in the epiploic foramen, and a left paramedian approach was used. A 3 or 4‐port technique was used in 7 and 13 dogs, respectively. A thin film band was used for CEPSS attenuation in all dogs. The median operating time for LPSSA was 62 min (range 27‐98 min). Intraoperative complications requiring conversion to an open technique occurred in 5 dogs. Mild perioperative self‐limiting portal hypertension occurred in 3 dogs, while severe portal hypertension with surgical revision occurred in 1 case. The complications were resolved, and all dogs had a good outcome. Conclusion Laparoscopic portosystemic shunt attenuation can be performed in dogs, in particular for a CEPSS located in the epiploic foramen using a right paramedian approach. For CEPSS not located in the epiploic foramen, a left paramedian approach is recommended. Conversion to open celiotomy was required in around a third of cases. Clinical significance Laparoscopic attenuation of CEPSSs can be performed in dogs and has a good clinical outcome, particularly for CEPSS located in the epiploic foramen.

Laparoscopic portosystemic shunt attenuation in two cats

“…Laparoscopic EHPSS attenuation was found to be a feasible, complication-free procedure in these cats and was associated with low morbidity. The same technique has been reported in dogs with PSS, 2 , 4 but, to our knowledge, this is the first description of PSS attenuation using laparoscopy in cats. An important step was identifying the shunts preoperatively using CTA or ultrasonography, in agreement with the recommendations of others.…”

Laparoscopic attenuation of a congenital extrahepatic portosystemic shunt in a dog—a thin-film banding for splenophrenic shunt: A case report

“…Although an intraoperative attenuation to make the shunt diameter less than 3 mm during TFB used to be recommended, TFB without intraoperative attenuation had been found to be also effective (21). In the latest study of 20 canine laparoscopic CEPSS attenuations using TFB with intraoperative partial occlusion (50%) (11), four dogs (20%) experienced postoperative portal hypertension; three of them recovered with conservative therapy, but the remaining needed a revision surgery with severe clinical signs. Although conversion to open surgery was required in five dogs (25%), 19 dogs (95%) had a good outcome showing resolution of clinical signs within 2 months, consequently.…”

“…In general, TFB takes 8 weeks to close the shunt; however, there has been inconsistency concerning the long-term surgical outcome, which is attributed to factors like diameter of the shunting vessel, degree of intraoperative attenuation performed by surgeons, and material composition of TFB ( 3 , 17 ). TFBs that have been used for PSS attenuation vary in composition and molecular structure from medical grade pure cellulose-based cellophane to non-medical polypropylene ( 3 , 11 ). A recent study reported that non-cellulose-based TFB (polyolefin/polypropylene fiber) resulted in similar surgical outcomes for gradual attenuation of a single CEHPSS in comparison with ARC with low postoperative morbidity in short- and long-term follow-up ( 3 ).…”

“…As in this case, TFBs are usually placed in three folds and secured using 3–4 metallic hemoclips ( 3 , 11 , 12 ), but Joffe et al recommended a four-layer cellophane band secured with a single medium-sized PLLC or TLC with a minimal failure in a recent study ( 22 ). If postoperative CTA is planned, PLLC would be better as it is inert, non-conductive, compatible with CT or MRI.…”

“…Surgical attenuation has been performed almost exclusively via celiotomy. In the literature, there are only two case reports available that describe laparoscopic approaches in canine CEPSSs ( 10 , 11 ). This report describes a case of laparoscopic attenuation for splenophrenic shunt in a dog with a clinical course of preoperative diagnosis, detailed surgical procedure, and 31 months of follow-up, including post-attenuation computed tomography angiography (CTA).…”