Long-Term Outcome After Surgical Ligation for Treatment of Congenital Portosystemic Shunts in Dogs
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Objective: To report long-term clinical outcome and dissolution of ammonium urate bladder uroliths and crystalluria in dogs treated for congenital portosystemic shunting (CPSS) with complete or partial ligation and to develop a scoring system to determine persistent or recurrent shunting. Study Design: Retrospective. Animals: Dogs (n=167) with surgically attenuated CPSS, intra- or extrahepatic. Methods: Review of medical records of dogs with CPSS treated by ligation. Long-term information was obtained by telephone interviews with veterinarians and questionnaires send to owners. A randomized group of 21 dogs came back for check-up to determine persistent or recurrent shunting. Results: Preoperative results showed that ammonia metabolism was abnormal in all dogs in which fasting ammonia was determined or an ammonia tolerance test was performed. In most dogs the shunt was partially ligated. Mortality postoperatively (< 1 month) was 11%. At routine check-ups all dogs improved, only 8% still showed signs of HE. After surgery in 26% dogs with PC, 30% in PAZ and 66% dogs with intrahepatic CPSS, there was evidence of persistent shunting by abnormal ammonia metabolism. Urine samples were only tested when urological signs were seen, in 68% of the dogs bladder uroliths dissolved. A concept of a PSS scoring system was developed. Preoperative a PSS score of 43 (SD 27) and postoperative a PSS score of 11 (SD 13) was calculated. The improvement was significant (P < 0.001). Long-term check-up showed in 58% of the dogs no shunting, in 16% asymptomatic shunting and in 26% symptomatic shunting. Conclusion: Shunt attenuation by ligation is an effective technique to improve the quality of life of dogs with CPSS. Bladder uroliths dissolved in most patients. The concept of the PSS scoring system developed shows a promising additional method for diagnosing clinical PSS.