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Spay it forward: Ovariectomy vs. ovariohysterectomy in veterinary medicine

Posted Dec 20 2008 6:37pm

Did you know that sometimes veterinarians spay in different ways? Some of us take out the ovaries and the uterus. Others take the ovaries alone.

The debate among veterinarians on this point has often been heated. European vets can’t for the life of them figure why American vets take it all out. Vice versa’s typically the case, too. Why NOT prevent all those pesky potential uterine issues while you’re at it? Well, why offend the bloody uterus if she don’t really NEED to go? You can always take it out later, right?

This is an issue worth talking about now that the spay-and-neuter-always mantra is being slowly eroded. Whether by veterinary science or by those who would seek idealized individual care for their pets, questions are arising as to the ideal timing of pet sterilization. Here’s a post on this.

Meanwhile, the debate on the uterus: “Don’t throw out the baby with the bath water,” holler the Europeans. “But the baby’s a liability!” argue the Americans.

A recent article by veterinary surgeon Phil Zeltzman in this month's Veterinary Practice News discusses this point in some detail. He’s a Belgian trained doc spracticing in the US so he's in a unique position to observe both sides of the fence. Yet predictably, perhaps, his view seems slanted in favor of removing the ovaries alone.

He argues that if our reigning principle as medically trained personnel is “above all do no harm,” then the possible complications involved in removing a healthy uterus must be considered: a greater risk of excess bleeding, longer time under anesthesia and more significant pain.

Considering that excessive bleeding is the number one surgical complication of the spay procedure, and the anesthetic risk the second likeliest intra-op issue, it would seem the ovariectomy would be the best way, right?

Problem is, some veterinarians argue that leaving the uterus behind confers some significant disadvantages—namely, the risk of uterine infection and uterine cancer. “Above all do no harm” to this camp means removing the potential source of a future problem… as long as you’re in there anyway.

So far, however, there’s no evidence to back the claim of the ovariohysterectomizers. No uterine infections have been the result of hundreds of thousands of simple ovary removals in Europe. That’s because removing the ovaries means no more of the hormones whose fluctuations give rise to uterine infections. And uterine cancer? Occurring at a rate of 0.003 percent, is that really a good reason?

I’m with Dr. Zeltzman. I’m all for sticking with ovary removal alone. But there’s a catch. It’s called the “legal” trap. When the rest of your country does things one way and you do things another, your chances of getting into trouble for your efforts to do things better increase.

I’ve learned this the hard way. When I’ve used different suturing techniques than other vets (usually because my veterinary surgeon boyfriend argues convincingly that a new way might be better), the emergency veterinarians who have had to recheck my patients for a minor complaints have expressed dismay (to the owner!) over my different approach. They’ve suggested to my client that my new technique gave rise to the complication their pet is experiencing.

When that happens, the trust my clients place in me can be eroded. In at least a couple of cases I’ve had to explain 1) why I believe that my techniques did not cause the problem and 2) why my new way might be better. That’s hard to do convincingly after they’ve spent $400 at the ER.

So when I perform ovariectomies (usually on large breed dogs) I explain to my clients the benefits this method confers. I give them a choice. That may mean more explaining but I think it’s worth the effort.

Nonetheless, should their dog acquire a rare form of uterine cancer in the future… will they blame me?

In Europe no one would bat an eye. In the US, another veterinarian might suggest the uterine cancer is the result of my negligence. “You should have removed that sucker like the rest of us do.”

No matter that I’ve saved hundreds of dogs the risks, complications and discomfort of the hysterectomy—I’m more likely to be sued over this one case.

That’s why this topic is worth talking about. YOU are the ultimate arbiters of what happens to your pets when they get spayed and neutered. It may be a routine procedure but you DO have choices. If owners start asking their veterinarians WHY they do things one way versus another (while being careful to respect their healthcare providers’ rationale, of course) then perhaps more veterinarians will come to understand what I believe:

Just as no anesthetic protocol, no suturing technique and no vaccination protocol is one size fits all, sterilizing animals requires individualized approaches based on the needs of our individual pets. Practicing veterinary medicine requires a series of judgment calls when it comes to any given problem. So why should spaying your pet be any different?

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