Dr. Benjamin McRae
BSc BVMS MANZCVS (Small Animal Surgery)
For many general practitioners interested in advancing their surgical knowledge there is often a tendency to focus on orthopaedic courses and procedures. However it is important to remember that upskilling in soft tissue surgery can be just as rewarding, both professionally and financially, whilst also expanding the scope of procedures you can safely and competently offer to your patients.
Some soft tissue surgeries are of course quite simple. A routine cystotomy is less complicated than an ovariohysterectomy, the anatomy for the most part is simple and the complication rate is quite low. On the other hand, perineal hernia repair and perineal or scrotal urethrostomy are both excellent examples of incredibly satisfying, delicate, complicated and sometimes life saving soft tissue surgeries if performed correctly, which require a detailed knowledge of anatomy and high technical ability. Having a successful outcome can have a massive positive impact on an animal’s welfare, and often results in very grateful clients. However, unfortunately these procedures are not easy, and the risk of significant complications is very real, especially when performed by untrained or inexperienced surgeons.
Even in the hands of skilled specialists, perineal hernias have a reported recurrence rate of up to 30% and almost all recent literature concerning the procedure has been aimed at bringing this recurrence rate down. In addition to recurrence, the list of potential complications is long and some are serious such as urinary and faecal incontinence, sciatic nerve entrapment and neuropraxia and rectal prolapse. Further to this, not all perineal hernias are created equal. Some may be considered relatively straightforward to repair, whilst others can be a disaster waiting to happen. Being able to tell the difference and knowing when to make a patient someone else’s headache is a very important skill. Fortunately, with appropriate guidance and particularly with a thorough understanding of the regional and surgical anatomy, the risk of these complications can be reduced to a manageable level, and once you feel competent, being able to offer this procedure in-house can not only bring a large level of professional satisfaction to your career, but also represent a new source of income.
Some of the above comments are also true for urethrostomy procedures. However instead of recurrence, urethral stricture is the complication constantly in the back of our mind. The primary indication for this procedure is in male cats with recurrent urethral obstruction due to FIC/FLUTD, which is a very common presentation in general practice medicine, and with complication rates as high as 42% it is also not a procedure to be undertaken lightly. Again though, with appropriate practical training and education this procedure can be mastered and the risk of complications reduced. As this is a much more common condition than perineal hernias, and especially if referral is something your clients have limited access to due to geography or financial constraints, being able to comfortably and confidently perform this surgery will be a great asset to your patients, your clients and your practice.
Fortunately, This year Practical CPD is offering detailed hands-on courses that cover both of these topics and more, starting with the Perineal and Urogenital Surgery two day wet-lab at the Kahuvet Education Centre, Auckland in March, which will be repeated at the Vet Partners Veterinary Training Centre, Sydney in August. During this course participants will learn how to diagnose and treat these conditions, how to perform the surgery safely to minimise the risk of complications, and how to manage complications when they do arise.
Don’t assume soft tissue surgery is easy and that you can get all the information you need from a textbook description. Get the hands-on training you need to perform these procedures competently. Learn when to refer and when to tackle these cases head on. But most of all, have fun while learning a new skill and expanding what you can safely offer to your clients.