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Midline versus flank approach and wound complications in neutering of cats

Clinical Scenario

Miss Tabby brings you a colony of feral cats she has trapped in her garden to be neutered. The cats cannot be handled, and will be monitored post-op by visual inspection at least ten feet away. She asks you if they can be spayed via a flank approach, so that she will be able to see the incision site more easily. However, as the cats can only be monitored from a distance, and re-trapping after surgery would be difficult, any post-operative complications would be very difficult to address and potentially a serious welfare concern. You wonder if using a flank approach will lead to more post-operative wound complications than the midline approach...

3-Part Question (PICO)

In [female cats that are being neutered] does a [midline surgical approach as compared to flank] [decrease wound complications following surgery]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR queen.mp. OR queens.mp. OR felis.mp. OR felidae.mp. OR exp Cats/ OR exp Felis/ OR exp Felidae/)

AND

(spey.mp. OR speyed.mp. OR spay.mp. OR spayed.mp. OR spaying.mp. OR speying.mp. OR neuter.mp. OR neutered.mp. OR neutering.mp. OR ovariectomy.mp. OR ovariohysterectomy.mp. OR hysterectomy.mp. OR sterilised.mp. OR sterilized.mp. OR sterilisation.mp. OR sterilization.mp. OR de-sex.mp. OR desexed.mp. OR desexing.mp. OR desex.mp. OR de-sexed.mp. OR de-sexing.mp. OR gonadectomy.mp. OR exp Ovariectomy/ OR exp Sterilization, Reproductive/ OR exp Hysterectomy/)

AND

(midline.mp. OR flank.mp. OR linea alba.mp. OR laparotomy.mp. OR coeliotomy.mp. OR celiotomy.mp. OR lateral approach.mp. OR exp Laparotomy/)

CAB Abstracts 1910 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR queen.mp. OR queens.mp. OR female cat.mp. OR female cats.mp. OR felis.mp. OR felidae.mp. OR exp cats/ OR exp Felis/ OR exp Felidae/)

AND

(spey.mp. OR speyed.mp. OR spay.mp. OR spayed.mp. OR spaying.mp. OR speying.mp. OR neuter.mp. OR neutered.mp. OR neutering.mp. OR ovariectomy.mp. OR ovariohysterectomy.mp. OR sterilised.mp. OR sterilized.mp. OR sterilisation.mp. OR sterilization.mp. OR desex.mp. OR de-sex.mp. OR desexed.mp. OR de-sexed.mp. OR de-sexing.mp. OR desexing.mp. OR gonadectomy.mp. OR hysterectomy.mp. OR exp ovariectomy/ OR exp gonadectomy/ OR exp sterilization/ OR exp hysterectomy/)

AND

(midline.mp. OR flank.mp. OR linea alba.mp. OR laparotomy.mp. OR coeliotomy.mp. OR celiotomy.mp. OR lateral approach.mp. OR exp laparotomy/)

Search Outcome

MEDLINE

  • 85 papers found in MEDLINE search
  • 84 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 0 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 154 papers found in CAB search
  • 150 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 3 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Coe et al. (2006) UK

Title:

Comparison of flank and midline approaches to the ovariohysterectomy of cats.

Patient group:

66 female cats undergoing ovariohysterectomy

Study Type:

Randomised controlled trial

Outcomes:
  • Wound complications: discharge, excessive licking, swelling, wound breakdown
Key Results:
  • 5/17 cats with a flank approach had mild wound discharge compared to 3/24 cats with a midline spay that developed severe swelling
  • No wounds broke down, irrespective of the approach
  • 3 cats with severe swelling using midline approach; none using flank approach
Study Weaknesses:
  • Comparison of groups not presented in this paper (although is elsewhere)
  • Surgeries performed by many different students, therefore may have given more complications and pain as compared to a single, more experienced surgeon
  • Outcomes assessed by individual owners and highly subjective, arguably poor reliability of outcome measure
Attachment:
No attachments.

Comments

Some of the methods and additional data pertaining to this study are presented elsewhere—see Grint et al. Journal of Feline Medicine and Surgery (2006) 8: 15-21. As the surgeries in this study were performed by an assortment of veterinary students with a variable degree of surgical experience, some of the variation may have come from the surgeon. Although this is explored in the discussion, the study would have been much strengthened and had more external validity had it been conducted by one or a small number of surgeons of similar ability.

Bottom line

There is little evidence that either the flank or midline approach gives a greater rate of wound complications.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Coe RJ, Grint NJ, Tivers MS, Moore AH, Holt PE (2006) Comparison of flank and midline approaches to the ovariohysterectomy of cats. Veterinary Record 159: 309-313.

About this BET

First author:
Jenny Stavisky
Second author:
Marnie Brennan
Institution:

CEVM, University of Nottingham

Search last performed:
2016-05-13 08:30:44
Original publication date:
2013-09-13 08:30:44
Last updated:
2016-05-13 08:30:44
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