Useful Information

The Surgical Procedure

The patient undergoes a pre-operative examination, then a combination of sedative/painkiller is administered. The patient is then anaesthetised, and the rear end is clipped short and cleaned. The anal sacs are flushed with antiseptic. The vet prepares a resin which is instilled into the sacs, making them easier to surgically dissect. A short incision is made into the skin over the gland, and the surgeon gently dissects the sacs out from between the muscle layers around the rectum. Once the sac is removed, sutures are placed to close the space, these may either be dissolving sutures underneath the skin, or skin sutures which sit on top of the skin. The patient is cleaned and recovered from anaesthesia by the nursing team.

What to Expect Immediately After Surgery

Any surgery around the rectum and the rear end is very uncomfortable. We supply pain relief by injection, while the dog is in the surgery, and often an Elizabethan Collar is required. Preventing the dog from licking at the area and worsening the discomfort and soreness. Pain relief will be provided for use at home, however, in some cases, antibiotics may be required.

The recovery phase differs, tremendously, for this procedure. Some dogs act as if nothing has happened and return to normal within 24 hours of the procedure, whereas some refuse to pass faeces for several days post-operation. Other patients exhibit diarrhoea after the surgery, often when scarring is present, and the tissues have had to be manipulated extensively. If this is the case, then you may be required to keep the dog restricted to a small area and clean the rear end regularly. This will resolve in a matter of days, and medication can be provided to help reduce the volume of diarrhoea. Some dogs lose some ability to hold faeces and may need to poo more regularly. We recommend frequent opportunities for toileting in the week post-operation, or for the dog to be kept restricted to an area, where the furnishings can be more easily cleaned. For a few weeks post-surgery, your dog may have accidents, where faeces are passed unexpectedly, this usually occurs when they bark or jump up and is caused by the swelling and tissue disruption during the surgery. In majority cases, this resolves over a few weeks. Very occasionally, we see infections in the surgical sites, this is made more likely if the patient can lick and interfere with the site and should be treated with bathing and antibiotics.

Long Term Expectations

We expect a full recovery within a month of the procedure and return to normal toileting patterns. With any surgery in this area, there is a risk of long-term incontinence. This is a rare long-term side effect, and usually where a very large dissection has been required to remove a cancer of the anal sac. If the anal sac has ruptured before surgery, there may be small pieces of the sac tissue within the surgical site that aren’t removed, and these may then cause an abscess or irritation after the surgical site has healed, this would mean a second surgery was needed. This only happens very rarely.

Preparing for the TECA

Radiographs or a CT scan to assess the tympanic bullae are helpful. It is useful to know before surgery how bad the bullae look, how narrowed the ear canals are and if they are mineralized, and if there is an obvious tumour growing. These images help confirm that the surgery is appropriate for the patient.

The ear may be cultured, and this helps get the patient on an effective antibiotic right from the beginning. Further cultures may still be required once the bullae are opened. It is important to assess the patient's cranial nerve function before surgery. If these nerves are diseased before surgery, it is unlikely that they will regain function after surgery. Nerve disease that results from surgery is usually temporary, so it is important to know if the nerve problems exist before surgery.

The facial nerve runs just near the base of the ear, and this nerve controls facial expression. Facial paralysis is not uncommon after long-standing ear disease. This means that the patient is slack-jawed, usually on one side of the face, and may not be able to blink. After a time, the eye usually retracts into the eye socket to facilitate tear lubrication, so that the loss of blinking does not lead to eye damage. Initially, lubricating gels are helpful.

Hearing is usually diminished after long-term ear infections. Further hearing loss after ear ablation may not represent a dramatic change for the patient. Most owners have a good sense of whether their pet can hear, so it is rarely necessary to formally test hearing. After the ear canals are ablated, in many patients, some hearing remains as sound waves can still be transmitted through the tissues.

What Happens in Surgery

Before surgery, the ears and head are shaved, and the ear canal is flushed one last time to remove as much infected material as possible. This is done to minimize bacterial contamination of the normal tissue.

Both the vertical and horizontal portions of the ear canal are removed as one long intact curved cylinder. The bones of the middle ear and the eardrum are removed as well, with the bone of the tympanic bulla exposed and opened. Any material is flushed out, and the cellular lining of the bone is scraped away. Any material left inside after closure will lead to chronic drainage of liquid from the incision. Sometimes an external drain is left in place during the healing period.

Oral antibiotics and pain medication can be expected after surgery, as can an Elizabethan collar to protect the delicate incisions from scratching.