Page 630 - WSAVA2018
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 25-28 September, 2018 | Singapore
1. Perianal fistula repair-cryosurgery or excision
2. Perianal gland adenoma removal-cryosurgery or excision
3. Perineal hernia repair
4. Anal sacculectomy
5. Anoplasty procedures
6. Removal of malignant neoplasm
When this type of injury occurs unilaterally, the patient may still maintain enough sphincteric continence to be considered an appropriate house pet. With partial loss of anal sphincter tone, fine control of defecation is lost, but the patient still has the ability to sense the urge
to defecate and can position properly. However, the
fine control necessary to terminate a bowel movement without dropping a piece of stool is compromised. Also, when the patient is excited, startled, or barks loudly causing increased intra-abdominal pressure; a piece of stool may drop out of the rectum. The important thing to remember is that the patient retains the urge to defecate and can control, to some extent, bowel movements.
Anal Sacculitis: Anal sac impaction and abscessation
is the most common anorectal disorder diagnosed by the small animal practitioner. Diagnosis is confirmed by clinical signs, visual and digital rectal examination. Relief of impaction by digitally expressing the anal sacs is easily performed during rectal examination. If an anal sax abscess is present, infusion of an antibiotic preparation may be sufficient to eliminate the infection. Systemic antimicrobial treatment may be required in resistant cases. If the anal sac abscess becomes a chronic recurrent problem, surgical excision of both anal sacs
is the treatment of choice. Surgery should be delayed however until the immediate infection or abscess has been controlled medically as described above.
Surgical Techniques: There are a variety of techniques currently used to successfully remove anal sacs. One such technique includes using a pair of Metzenbaum scissors to cut into the anal sac through the duct. The sac is opened to expose the glistening greyish colored interior lining. Hemostats are used to grasp the full thickness of the anal sac wall, being careful to avoid
the external anal sphincter muscle fibers. A number 15 BP scalpel blade is used to carefully scrape the gland from the underlying external anal sphincter muscle. The external anal sphincter m., subcutaneous tissue and skin are closed with a synthetic absorbable suture material in a simple interrupted pattern.
An alternate method is to incise over the anal sac, dissect through the subcutaneous tissue, locate the sac and excise it toward the duct.
Regardless of the procedure used, if the entire anal sac is removed and the caudal rectal nerve avoided the
prognosis is excellent.
Mila Anal Sac Catheter Technique (the authors A novel approach for safely and completely removing anal
sacs relies on the use of a 6 French balloon catheter with a 3cc bulb (Foley or Mila). The balloon catheter is placed into the anal sac through the anal sac orifice
and its cuff inflated. Once introduced into the sac, the catheter bulb is inflated with 2-3 cc of air or saline. The bulb distends the anal sac making identification and palpation of the gland simple. The protruding catheter allows the surgeon, or the surgeon’s assistant, to
place gentle traction on the gland during dissection. A 360-degree skin incision is made around anal sac duct and the protruding catheter. Care is taken to leave at least 2mm of skin from the anal sac duct and the incision. Metzenbaum scissors (curved) are then used to dissect to the plane of tissue between the anal sac wall and external anal sphincter. Identification of the anal sac wall is made by identifying its grayish color in comparison
to the deep red color of external anal sphincter muscle fibers that will be carefully dissected off of the anal sac wall. As the dissection progresses constant traction
is placed on the Foley catheter to accentuate to sac. When performing the deep dissection of the sac wall care is taken to make certain the dissection does not go deep to the sac wall. This is the location of the caudal rectal nerve fibers. Dissection is continued until the
sac is completely dissected free and removed from its surrounding tissue.
Closure consists of suturing together any cut fibers of the external anal sphincter muscle with 3-0 Maxon and the skin closed with 4-0 Biosyn using an intradermal technique. This is the authors preferred technique for anal sacculectomy.
This technique is illustrated on the Anal Sacculectomy video located in the GI Surgery I DVD. Check it out at

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