Animal Welfare Professionals

I coordinate a small spay-neuter program in a little Balkan country called Montenegro.  It is  a very under-resourced country, with a community cat population that rivals Greece, Turkey, or Cypress.  Working with 4 partner vets, our program has provided free or "donate what you can" spay-neuter for nearly 10,000 cats there (just 121 cats to go!!)

Our primary vet trained 2 of our other vets to do "keyhole" or "small incision" surgeries.  He trained them both for ovariohysterectomies.  Somewhere during the first year we discovered one of the cats he spayed had kittens.  And then one continued to go into heat...  There are at least 5 cats I personally know of and dealt with for whom his ovariectomy failed.  Three had more kittens, and one is still breeding, having avoided the trap for at least 2 years now.

A second vet was shown how to do ovariectomies by a visiting vet trained by a Swiss program.  He then adopted the procedure, and had failures as well, but it's a smaller town, no other vet, so people got in touch with him and he re-did the spays, and voluntarily told me what had happened, and that he has gotten better and no longer has issues.

Our American consulting vets told me oviectomies are safe and effective and I should not tell our vets how to do their job.  But now a new Russian vet arrived in Montenegro doing keyhole ovariohysterectomies, and the large expat Russian community is spreading the word that our program doesn't provide effective or safe (threat of pyometra) spays.  So we can no longer ignore the issue. 

I can't say whether there are more failures than I know of, which it sounds like there may be. Or maybe the rumor mill is simply amplifying what we already know about.  

Has anyone else ever dealt with this?  Are there any stats on ovariectomy "failure" rates?  Is there research or anything that could back me up if we change our contracts to require ovariohysterectomies for all female cats?  It seems like the procedure allows too much room for error when performed in chaotic clinic environments.

Thanks for any feedback and information you can share!

#Medicine,SurgeryandSterilization

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April King
Volunteer and Board Member
Kotor Kitties
+1 206 407 5336
http://www.kotorkitties.org
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Hello April,

There should be no differences in failure rates for ovariectomies (ovaries removed) vs ovariohysterectomies (ovaries and uterus removed). Doing keyhole surgeries comes with time and experience. They may need to start with larger incisions and then gradually reduce incision length as skill develops. 

The most common long-term complication of either technique is leaving some ovary behind so the cats go back into heat. This can start right away or even years later.  In theory, in the case of ovariectomy, that could result in a pregnancy, although I've never heard of that. When the same complications are repeated multiple times, it would be common for a vet to ask another expert vet to observe them to see what advice could be given on technique. It's really not harder, slower, or a larger incision to do a full OVH in a cat, so it might be a good idea to go back to basics with that technique for now. 

There should be operative reports on what was found on the exploratory for the second surgery. That may give clues about what the errors are.  It could be leaving pieces of ovary behind, leaving a whole ovary, or not removing anything at all (usually because it is thought mistakenly that the cat was already spayed). We've also seen where cats are mixed up and the pregnant cats are not the same ones as the vets spayed. 

Regardless, this complication rate sounds high and if that's correct, some more coaching may be in order. This can be done remotely over videoconference if there is no one local.  The vets can also show the tissue that was removed so the coach can confirm it's correct.

Best,

-Julie

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Julie Levy, DVM
Shelter Medicine Program at the University of Florida
Maddie's Million Pet Challenge
https://sheltermedicine.vetmed.ufl.edu
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Original Message:
Sent: 09-16-2023 10:52 PM
From: Julie Levy
Subject: Feline ovariectomy failures

Hello April,

There should be no differences in failure rates for ovariectomies (ovaries removed) vs ovariohysterectomies (ovaries and uterus removed). Doing keyhole surgeries comes with time and experience. They may need to start with larger incisions and then gradually reduce incision length as skill develops. 

The most common long-term complication of either technique is leaving some ovary behind so the cats go back into heat. This can start right away or even years later.  In theory, in the case of ovariectomy, that could result in a pregnancy, although I've never heard of that. When the same complications are repeated multiple times, it would be common for a vet to ask another expert vet to observe them to see what advice could be given on technique. It's really not harder, slower, or a larger incision to do a full OVH in a cat, so it might be a good idea to go back to basics with that technique for now. 

There should be operative reports on what was found on the exploratory for the second surgery. That may give clues about what the errors are.  It could be leaving pieces of ovary behind, leaving a whole ovary, or not removing anything at all (usually because it is thought mistakenly that the cat was already spayed). We've also seen where cats are mixed up and the pregnant cats are not the same ones as the vets spayed. 

Regardless, this complication rate sounds high and if that's correct, some more coaching may be in order. This can be done remotely over videoconference if there is no one local.  The vets can also show the tissue that was removed so the coach can confirm it's correct.

Best,

-Julie

------------------------------
Julie Levy, DVM
Shelter Medicine Program at the University of Florida
Maddie's Million Pet Challenge
https://sheltermedicine.vetmed.ufl.edu
------------------------------