One of the most common surgical procedures performed at the Long Beach Animal Hospital on dogs is a spay, known medically as an ovariohysterectomy (removal of the ovaries and uterus). We usually abbreviate it as an OVH.
It is performed for several medical reasons:
- It prevents dogs from going into heat
- It prevents dogs from getting pregnant
- It prevents dogs from getting a uterine infection called a pyometra
- It significantly helps prevent dogs from get breast cancer later in life
The arrows point to two lumps at the mammary glands that are cancerous
It prevents canines from getting uterine infections later in life. An infected uterus is called a pyometra, and is a serious disease. After you view the pictures of a routine surgery on this page you will be given a chance to see a picture of the uterus of a dog that has a pyometra at the end of this page.
In addition to these medical reasons, it prevents unwanted pregnancies, a significant problem in our society. Millions of canines are euthanized every year because they are strays.
We usually spay a dog when it is around 6 months of age. On larger breed dogs we sometimes wait longer for full bone development.
This timetable is variable, the important point is to perform the surgery before it goes into heat. The ongoing old wives tale that states dogs should go into heat before spaying is incorrect. Most dogs go into heat starting around 9 months of age, and do it twice each year.
Day of Surgery Protocol
On the day of surgery we need your dog in the hospital between 7:30 AM and 8 AM. Please take away all food when you go to bed the evening before surgery. Let your pet have water during the night. Do not give your dog anything to eat or drink the morning of surgery.
Our surgeon will review all lab data pertinent to your dog and perform a pre-anesthetic exam. After that exam you will be called to go over his findings and to answer any questions you might have.
When everything is in order an IV catheter will be placed and your dog will be given fluids prior to the surgery. Only once they are flowing and your pet has had a prescribed amount based on our surgeon’s calculations will anesthesia be administered. Giving these fluids like this prior to surgery greatly enhances safety and minimizes anesthetic risk.
A pre-anesthetic tranquilizer/pain medication is also given prior to surgery. We want your pet calm during the whole process, and to wake up with pain medication already on board.
Our surgeon will call you after the surgery is complete and your dog is awake. Depending on the exact time of surgery it can go home in the late afternoon or early evening the day of surgery. Please call our office at 4 PM for pickup time, you will be given written post operative instructions then. We are open in the evening if you need to pick up later.
This area contains graphic pictures of an actual surgical procedure performed at the hospital. They are put here to show you that this is major abdominal surgery, and not “just a spay”.
A pre-anesthetic exam is performed several days prior to surgery. After the exam one of our doctors will go over any questions you have.
Dr. Wood is carefully checking the heart rate on this dog as part of this exam
As part of this exam we will submit a blood panel to our lab to make sure all important organs are functioning normally and your pet is ready for anesthesia and surgery. The report comes back to us in 24-48 hours. We will call you to discuss it and see if there are any last minute questions.
The blood panel is very thorough and checks many organ systems
Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners. On the day of surgery all of our spays receive a physical exam just prior to surgery.
Talia and Dr. Kennedy are performing this exam just prior to giving anesthesia
When everything is to our satisfaction we will administer a sedative. This will calm your pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once your pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.
Once our surgeon has reviewed lab data and performed a physical exam he starts his sterile scub while our patient is being anesthetized
After scrubbing and gowning our surgeon opens the sterile instrument pack to make sure everything is in order and all instruments are sterile.
While all of this is transpiring with our surgeon our patient is brought into the surgery suite and a final prep is performed. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around. All of this is to minimize anesthetic time.
We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem. This machine monitors:
- Heart Rate
- Heart rhythm
- Oxygen saturation
- Carbon dioxide level
- Respiratory rate
This is the screen we constantly monitor during surgery
In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters like heart and respiratory rate and quality
She also checks something called Capillary Refill Time to make sure the heart is pumping enough oxygenated blood to the organs. When she presses on the gums to make them blanch white for a second, she measure how long it takes them to go back to their original pink color. It should be less than two seconds.
We have a detailed page on anesthesia to learn more.
Every major surgery we perform begins with proper patient preparation. This will help prevent infection, which could be a serious complication in this surgery because during a spay we have an opening into the abdomen.
Our nurse is using a special cleaning agent and scrubbing the skin 3x in a circular motion. After our patient is clean our surgeon completes the draping.
When our surgeon is comfortable that everything is in order he starts the sterile draping procedure
Graphic Surgery Photos to Follow
The surgeon makes an incision near the umbilicus (the belly button). We try to make our incisions as small as possible to minimize anesthetic time when we suture the incision at the end of surgery. A small incision also decreases post operative discomfort, and minimizes healing time.
The final layer we need to cut before we are actually into the abdomen is called the linea alba. It is an area of muscle in the center of the abdomen that is covered by a tough layer of tendinous tissue. This is the most important layer re-sutured at the end of the surgery because it is the only layer strong enough to hold the abdominal muscles together to prevent a hernia.
In this picture the linea is being held up with a forceps and a scalpel blade (held upside down) is being used to make the incision.
A scissors is used to extend the linea incision and facilitate exposure to the abdomen. Care has to be taken not to puncture internal organs like the bladder.
The incision is complete and our surgeon is holding up the cut linea, giving him access to the abdomen
A special instrument called a spay hook is utilized to gently pull one of the uterine horns through the abdominal incision. This hook lets us keep the incision small.
The spay hook is traced into the body cavity until the ovary is found. It has to be gently teased from its location near the kidneys in order to be able to pull it out through the abdominal incision. In older dogs this part of the procedure is more difficult because the tendon is not as flexible as a younger dog.
The ovaries and uterus are buried in fat. The arrow points to the ovary.
Once the ovary is completely exteriorized two clamps are put below the ovary. You can see the ovary above the top clamp. These clamps are were the sutures will go and allow us to cut the ovary away from its blood supply
A third clamp is put above the ovary to control bleeding when we cut the ovary away
The two lower clamps have been removed and you can see where our surgeon is tying the second of two ligatures. We always use two ligatures for safety reasons, and is one of the ways we do not cut corners on this surgery.
When our surgeon has confirmed that both knots are secure the ovary is cut away. The top clamp is still attached, only the two bottom ones have been removed. This is repeated for the ovary on the other side.
With both ovaries removed our surgeon works on the body of the uterus at the cervix. The arrow points to the cervix where two sutures will be placed. Everything above the arrow, which includes both ovaries under the surgeon’s thumbs, will be removed.
You can see the extensive blood supply to the body of the uterus
The uterine body is double ligated just like the ovary. Everything above the top suture in this picture will be cut away.
Our surgeon checks to make sure there is no bleeding before placing the remainder of the uterine horn back in the body cavity
Suturing the muscle layer back together at the linea alba is crucial in order to prevent a hernia. You can see the needle coming through the linea alba, which is the whitish area. The abdominal muscles do not have the strength to hold the suture like the linea alba.
This is what the linea alba incision looks like after all of the sutures have been carefully placed. The subcutaneous (the fatty area just under the skin) tissue is now sutured as a second layer of strength to prevent a hernia.
The third layer of sutures are called subcuticular because they are put just under the skin. These will dissolve on their own and your pet does not need to come back for suture removal. Being just under the skin they are also harder for your pet to pull out.
All of our pets that have abdominal skin incisions are given therapy laser treatment before they wake up from anesthesia. This decreases post operative pain and swelling and aids the healing process.
We use the Therapy Laser in many different surgeries. In this video it is being used after a laser neuter.
Prior to the surgery your pet is given a pain injection, which will be in full effect when it wakes up.
Post Operative Care
After surgery our surgeon will call you. When you pick up your dog you will be given a chance to talk to one of our staff and you will also be given written post operative instructions.
Most dogs go home late in the afternoon or early evening on the day we perform the surgery. They might be groggy from the pain injection, which is advantageous because they will remain calm and allow the healing process to start immediately. By the following morning the grogginess will have worn off. If your pet has an E-Collar leave it on until healing is complete.
When you first get home do not be in a big rush to feed. After 1 hour at home offer a small amount of food and water. If the appetite is good, offer more several hours later. Do not over do the feeding the first night because anesthesia can make them nauseous.
Give the prescribed pain medication until your pills are gone.
Keep contact with children and other pets to a minimum the first night, and restrict activity for several days to allow the incision to heal. Do not let your dog go outside until healing is complete.
We have a page called Home Care of the Surgical Patient for more information.
Infected Uterus (pyometra)
A pyometra is an infected uterus. In an open pyometra the cervix is open and the pus inside the uterus is able to drain out at the vulva. In a closed pyometra the cervix is closed and the pus (medically it is called purulent material) cannot drain. This causes serious problems with the kidneys. The uterus might even rupture causing peritonitis.
A diagnosis of pyometra is made based on several findings. There is a history of being in heat a few months prior, along with lethargy, lack of appetite, and sometimes even vomiting. Most dogs will be drinking and urinating excessively (called PU/PD- Polyuria/Polydipsia) because of the toxic effects of the infection on the kidneys. These toxic effects on the kidneys are usually from an anaerobic bacteria called E. coli (Escherichia coli).
A blood sample will commonly show a very elevated white blood cell count. This is called leukocytosis, and is a major clue to a pet that has pyometra.
This blood panel is from the dog with the ruptured uterus above. It has 30,000 white blood cells (WBC’s), when the high end of normal is 16,000
Abdominal radiographs (X-rays) are also used to make a diagnosis. Normally you cannot see the uterus on a radiograph. Click here to learn why from our X-ray page.
The red circled area is not the uterus, it is the spleen. The infected uterus is all those large whitish areas above and to the right.
The white tubular structures in the middle right of this radiograph are an infected uterus
If you cannot visualize it the labeling below might help. The infected uterus is in the blue circle. The other organs are:
S.I.- Small Intestine
L.I.- Large Intestine
This is a moderately sized pus filled uterus
The enlarged and pus filled uterus can be seen in the red circle on the V-D (ventro-doral) view
Surgery needs to be performed. If it is an open pyometra the patient is usually not severely ill and the surgery can be performed on a routine basis. If the pyometra is closed surgery needs to be performed immediately in most cases to prevent more kidney damage and prevent a uterine rupture.
Prior to surgery these patient need IV fluids and antibiotics to be stable enough for anesthesia. They might also be dehydrated and hypothermic, which will be addressed along with any other problems.
There is so much inflammation that the abdomen is filled with fluid (called ascites) and our surgeon needed to suction this fluid before he could visualize the internal organs properly and bring out the grossly distended uterus.
The uterus is completely filled with pus, and this dog is very ill.
It turns out that the uterus in this dog had already ruptured before the owner brought her in for diagnosis and surgery. This causes sepsis, and can easily lead to death.
Because of the peritonitis (inflammation of the lining of the abdominal cavity) the abdomen had to be flushed copiously prior to suturing the linea alba. It is also closely monitored after surgery, and antibiotics are utilized for 14 days.
The abdomen is flushed with warm sterile saline many times
Dogs can be so ill from a pyometra that it becomes an emergency, like the dog above that had a ruptured uterus leading to a peritonitis. The Long Beach Animal Hospital, staffed with emergency vets, is available until the evenings 7 days per week to help if your pet is having a problem. We serve all of Los Angeles and Orange county, and are easily accessible to most everyone in southern California.
If you have an emergency always call us first (562-434-9966) before coming in so that our veterinarians can advise you on what to do at home and so that our staff and doctor can prepare for your arrival. To learn more please read our Emergency Services page.
If you would like to learn more about how we do surgery at the Long Beach Animal Hospital on a wide variety of animals please follow this link.