Speaking Out Response

Dear Editor,

Dr. Veenis’ point is well taken; ovariectomy is an alternative procedure to ovariohysterectomy in healthy, nongravid bitches. We chose the ovariohysterectomy procedure for our minimally invasive project because it is the more common procedure performed in the United States.¹

Laparoscopic ovariectomy would be an interesting procedure to describe; however, it is possible that the complications of hemorrhage, cystic endometrial hyperplasia, and urinary incontinence would be of the same frequency and type in both minimally invasive techniques as they are in the open procedures.² One disadvantage that ovariectomy might hold is that exposure to progestational compounds, whether endogenous (ovarian remnant, progesterone-producing tumor) or exogenous (for dermatological disease),¹ is likely to result in a more profound mucometra, hydrometra, or pyometra simply because of the amount of tissue involvement. The risk of this development appears to be low, as one review of 72 animals ovariectomized and followed for 4 to 9 years had no incidence of pyometra.³ Another study, to which Dr. Veenis referred, found no incidence of cystic endometrial hyperplasia in 69 bitches that had ovariectomy or 66 bitches that had ovariohysterectomy performed.² While the incidence of hydrometra, mucometra, and pyometra in bitches that have had ovariectomy or ovariohysterectomy performed is low enough that it is not seen in the studies previously referenced, there is still evidence that these complications can occur in the presence of progestational compounds.⁴⁵ Because the complication is potentially fatal, some surgeons may still choose to perform ovariohysterectomy.

As Dr. Veenis notes, it has been shown in open procedures that adhesions can form with ovarian, uterine horn, and uterine stumps that sometimes result in colonic or ureteral obstruction.^6–9 Due to the formation of colonic obstructing adhesions with incompletely resected uterine horns, two authors recommend resecting the uterus as close to the cervix as possible to decrease the incidence of this complication.⁸¹⁰ Three reports also describe colonic obstructing adhesion formation with the cervical stump.⁶⁷¹¹ In our opinion, these reports demonstrate that the complications attributed to the cervix and transected broad ligament can also occur with any tissue ligated and transected in the abdomen. Therefore, in our opinion, neither surgical procedure has yet been shown to be superior, and the choice should remain the surgeon’s preference.

Finally, minimally invasive is not the equivalent of minimal surgery. Therefore, both techniques can be adapted for minimally invasive techniques. A retrospective study with a large population may eventually demonstrate the superiority of one technique performed in a minimally invasive manner, or it may remain, as it is currently in the open technique, surgeon’s preference.