Updates in Hepatobiliary Surgery

Wallace, Mandy L.

doi:10.1016/j.cvsm.2021.11.001

Cited by 2 publications

(7 citation statements)

References 66 publications

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“…Liver‐specific diets, antibiotics, and soluble fiber products are associated with reduced levels of ammonia 1,17 . Increased median survival times long term are seen in surgically managed dogs with congenital EHPSS compared to those who are medically managed in several studies reflective of common shunt demographics 3,5,11,18 …”

Section: Introductionmentioning

confidence: 99%

“…4 EHPSS is thought to develop as a result of genetic and environmental influences. 4,5 The relationship between small breed dogs and congenital EHPSS has been well-documented. [6][7][8][9] Breeds like the Yorkshire terrier, Havanese, and Maltese are overrepresented in cases of EHPSS.…”

Section: Introductionmentioning

confidence: 99%

“…1,17 Increased median survival times long term are seen in surgically managed dogs with congenital EHPSS compared to those who are medically managed in several studies reflective of common shunt demographics. 3,5,11,18 Unusual extrahepatic shunt morphology has been shown to occur in breeds without an established predisposition for EHPSS, 1,9 but whether this influences clinical outcomes is unknown. There is minimal information published describing the demographics, clinical presentation, vascular anatomy, outcomes or complications specific to EHPSS in larger dogs.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is little information in the present body of literature to help guide case selection for surgery and inform owner expectations, leaving clinicians in a place of uncertainty when faced with these cases. Surgical management has consistently been shown to be more successful compared to medical interventions alone in the management of EHPSS in smaller dogs 3,5,11,19 but whether this applies to larger dogs is unknown. The aim of this study was to describe demographics, clinical presentation, vascular anatomy, shortterm outcomes, and complications of EHPSS in dogs ≥15 kg treated with or without surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Most often, shunting occurs via anomalous flow through the left gastric vein 4 . EHPSS is thought to develop as a result of genetic and environmental influences 4,5 …”

Section: Introductionmentioning

confidence: 99%

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Clinical presentation and short‐term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts

Spies,

Ogden,

Sterman

et al. 2023

Veterinary Surgery

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ObjectiveTo describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery.Study DesignMulticenter retrospective (10 university hospitals, one private referral institution).AnimalsDogs ≥15 kg (n = 63).MethodsMedical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow‐up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed.ResultsMedian age was 21.9 months (IQR: 9–36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short‐term complications, and 3/45 (6.7%) had shunt‐related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt‐related medication regimens.ConclusionsClinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short‐term outcomes as small breed dogs.Clinical SignificanceClinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Most often, shunting occurs via anomalous flow through the left gastric vein 4 . EHPSS is thought to develop as a result of genetic and environmental influences 4,5 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical presentation and short‐term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts

Spies,

Ogden,

Sterman

et al. 2023

Veterinary Surgery

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Surgical Management Of Feline Biliary Tract Disease: Decision-making and techniques

Low,

Williams

2023

Journal of Feline Medicine and Surgery

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Practical relevance: Diseases of the hepatobiliary system are not uncommon in first-opinion practice. The anatomy of the feline hepatobiliary tract differs from that of dogs and may predispose cats to inflammatory hepatobiliary disease. Case management can be challenging, and the prognosis is variable and dependent on the underlying disease process. Clinical challenges: Biliary tract disease in the cat has non-specific clinical signs that overlap with those of diseases of other body systems. Diagnostic tests of the hepatobiliary system are widely available, but interpretation of results can be challenging. Deciding on medical or surgical management can also be challenging; for example, various degrees of cholestasis may be seen with different diseases and disease severities, and will influence the decision to manage the patient medically or surgically. Surgery is indicated in cases of bile peritonitis, severe cholestasis, focal neoplasia or disease that is refractory to medical management. Intensive perioperative and postoperative management, with 24 h hospitalisation facilities, is essential. Audience: This review article is written for the small animal general/primary care practitioner, with an emphasis on decision-making in the surgical management of feline hepatobiliary disease. Evidence base: Evidence available in the published literature is reviewed and presented, and the inherent limitations are discussed.

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Updates in Hepatobiliary Surgery

Cited by 2 publications

References 66 publications

Clinical presentation and short‐term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts

Clinical presentation and short‐term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts

Surgical Management Of Feline Biliary Tract Disease: Decision-making and techniques

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