Complications

Hemorrhage

If hemorrhage is suspected, each ligature / vascular stump should be inspected.  This will likely require that you extend your incision, depending on its initial length.  The ovarian pedicles will be located just caudal to the kidneys and the uterine stump will be dorsal and slightly caudal to the urinary bladder.  Use of a Balfour retractor or assistance for retraction of the abdominal wall is helpful.

Exposing the left ovarian pedicle will sometimes require that the ovariohysterectomy incision be extended cranially.  Identify the descending colon along the left side of the abdominal wall and use the mesocolon to ‘basket’ and retract the small intestine towards the animal’s right side.  A large spleen may require cranial or right lateral retraction to allow visualization of the left paravertebral space.

Exposing the right ovarian pedicle generally requires that the ovariohysterectomy incision be extended cranially.  Identify the duodenum and use the mesoduodenum to "basket" and retract the small intestine towards the animal’s left side.  This is more difficult and less effective than with the mesocolon.

Uterine StumpUterine StumpThe uterine stump can be found by retroflexing (exteriorizing) the urinary bladder; this will expose the ligated stump between the neck of the bladder and the rectum.  The incision may need to be extended caudally.  

The broad ligament may also be a source of bleeding.  Inspect the transected broad ligament between the ovarian and uterine stumps on either side of the abdominal cavity.

Other sources of hemorrhage include small vessels that run with the suspensory ligament (these do not typically require ligation) and abdominal wall or subcutaneous bleeding vessels that can cause a small amount of blood to pool in the abdominal cavity.

If you must exteriorize abdominal organs to explore and control hemorrhage, these should be covered with moist laparotomy sponges to prevent tissue dessication.

Other complications:

  • Incisional complications (infection, seroma, abdominal wall hernia / evisceration). These are the same as those associated with any other abdominal incision.
  • Inadvertent ureteral ligation can occur at the level of the uterine body if the surgeon does not carefully identify the structures being ligated (typically with a full bladder) or when a dropped or bleeding ovarian pedicle is clamped and ligated without carefully identifying the structures included in the clamp/suture.
  • Ovarian RemnantOvarian RemnantOvarian remnant. An animal that has been ovariohysterectomized and develops signs of heat weeks to months postoperatively typically has an ovarian remnant due to incomplete ovarian tissue resection. This often results from transecting too close to the ovary but can also occur with fragmentation of the ovarian tissue and revascularization into the omentum or mesentary
  • Erosion of the uterine vessels causing intermittent vaginal bleeding in the days/weeks that follow ovariohysterectomy. Typically the result of a single ligature along the uterine body. This generally requires revision surgery to ligate the bleeding uterine vessel.
  • Uterine stump pyometra requires that a source of progesterone be present (i.e. incomplete ovariectomy or external administration.
  • Urinary incontinence (especially in dogs)
  • Fistulous tracts and granulomas.  Described with the use of non-absorbable, braided suture.