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Spays are one of the most common surgeries performed in veterinary practices. However common it is, this procedure has the strange propensity to generate heated discussions between advocates of the ovariectomy (OE) and proponents of the ovariohysterectomy (OHE).
So let’s try to stay away from the controversy and concentrate on the science. Why is OE vs. OHE even a debate? It is based on the assumption that diseases of the uterus are prevented by removing it—no uterus, no future disease?
OE Preferred in Europe This argument doesn’t fly in Europe, where OE has been practiced for decades with reportedly no increased incidence of uterine disorders. The risk of uterine tumor in particular is extremely small (0.003 percent). In addition, the uterus atrophies after ovariectomy, which may further reduce the risk of disease.
Elizabeth Arnold Stone, a board-certified surgeon at the Ontario Veterinary College in Canada, writes in the last edition of Slatter’s Textbook of Small Animal Surgery: “There is no definitive advantage for removing the uterus in addition to the ovaries during routine neutering. Ovariectomy is less invasive and takes less time than ovariohysterectomy.” This also means that anesthesia is shorter with OE. The complications are similar, although with OE, there is theoretically less risk of hemorrhage, which is the No. 1 complication with OHE. The risk of ovarian remnant syndrome is similar. The risks of urinary incontinence and weight gain are similar. What about the current literature?
This columnist was eager to review for Veterinary Practice News readers over 30 years worth of literature about the art of spaying. Luckily, a group recently did just that for us. A team from the University of Utrecht in the Netherlands, led by van Goethem, performed an extensive review of scientific articles published from 1969 to 2004. The conclusion of the Veterinary Surgery article is fairly straight-forward: “There is no benefit and thus no indication for removing the uterus during routine neutering in healthy bitches. Thus we believe that OE should be the procedure of choice for canine gonadectomy.” First, Do No Harm Van Goethem, et al, also write: “The surgeon has to choose the least invasive, fastest and safest procedure.” If we agree with that basic principle—reminiscent of the “First, do no harm” mantra—and as long as there are no medical contraindications, then it is difficult to argue that OHE is a better choice than OE in selected cases.
Proponents of OE maintain that the risk of pyometra is minimal since the pet will no longer have heat cycles. Multiple long-term studies confirm this statement: Stump pyometra did not occur in any patient who had undergone OE. One concern of OHE advocates is that an OE patient exposed to progestagens—endogenous (tumors, ovarian remnant) or exogenous (medications for dermatological diseases)—may be at risk for pyometra. These risks are small, and there are safer alternative to progestagens for dermatological diseases.