Anal Sacculectomy Complication Rates

Anal sac disorders in dogs are common; when medical management fails, surgical removal (anal sacculectomy) may be indicated. This retrospective case review examined the complication rate for bilateral closed anal sacculectomy and investigated breed groups at risk for requiring surgery. Anal sacculectomy using a para-anal incision was performed in 62 dogs. Anal sacs were distended before dissection using either a gel (Group G) or blunt probe (Group P). Dissection, transection of the duct, and closure were completed using standard protocol. Patient signalment and follow-up data were recorded and postoperative complications were graded using a standardized rating scale. Postoperative complication rate was 32.3%, with defecatory complications at 14.5%; complications included perineal pruritus, weak anal tone causing perineal soiling during defecation, occasional indoor soiling, minor bruising, and temporary fecal incontinence. The majority of these complications resolved without specific treatment by suture removal. No dogs developed permanent fecal incontinence. Dogs weighing <15 kg were more likely to have postoperative complications, as were dogs in Group G. Cavalier King Charles spaniels, Labrador retrievers, and Labrador crossbreeds were overrepresented in this population of dogs receiving anal sacculectomy. The authors conclude that complications following bilateral anal sacculectomy are common but are typically mild and self-limiting. Prospective studies are warranted to better assess complication rates when gel versus probe is used to guide dissection.

Commentary

The risk of permanent fecal incontinence is one of the major reasons that surgeons do not recommend performing a single stage bilateral anal sacculectomy. For the same reason, some owners are resistant to having a single stage bilateral anal sacculectomy performed on their dog. Of the 62 dogs that underwent closed, bilateral anal sacculectomy in this study, none developed permanent fecal incontinence. Therefore, when using good surgical technique and good case selection, surgeons may expect few to no cases of permanent fecal incontinence. While this study reports good results, dogs undergoing bilateral anal sacculectomy for anal sac tumors were not included. Therefore, each case should be carefully considered to assess individual risk.—Kelley Thieman Mankin, DVM, DACVS