Exploratory Surgery

cocoanlace

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My cat Monkey has a large pseudocyst outside his liver with several other cysts inside the liver. Very rare. The challenge for this board certified surgeon would be to remove the outer cyst without disturbing the others that could leak bile into the abdominal cavity which would be terminal. So it's risky. Imagine fluid filled balloons all connected together and trying to remove the top one, sealing off the others, to prevent leakage. The surgeon is suggesting as a first step to do exploratory surgery. To me this means he would like to open up my cat and just have a good look around. Is that what it would mean to you? To me it means two surgeries. First a preview to see if anything can be done and then the real one after. I don't like putting my cat through two surgeries. Opinions?
 

Furballsmom

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I don't like putting my cat through two surgeries.
Hi!
My opinion would be the same as yours, but it's admittedly based on emotion. There's a fair bit here that I don't know.

I think one of my biggest questions is whether you trust this surgeon?
 

Kieka

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Years ago when my cat had cancer they did exploratory surgery. The vet went ahead and removed the mass while they were doing the surgery because once he was in he thought he had a good chance to remove it. The second time, when the growth came back, he didn't remove anything and came back saying that it was too risky to remove.

To me, it means that the vet will take a look and if it is low risk he might be able to do it then. If the risk is higher, he will close your cat up and consult with you before proceeding. I would clarify with the vet that if in his opinion the surgery would have a good chance of success to proceed while the cat is under but to close up and consult if it looks like it would have complications. It's hard to know sometimes until they see how it looks in person. You could also ask if you could wait in the lobby and they could consult with you on how to proceed once they have him under and open (but the longer your cat is under the greater risk so the vet may decide not to). In my cats case, the imaging looked the same but once they opened him up they saw the cancer had wrapped around his artery and sent a piece inside it. If they had removed it, he would have bled out.
 

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As was stated, there are a lot of variables with exploratory surgery and if I were you I would ask the surgeon what all the possible options/outcomes might be. Kieka Kieka has laid out some possible courses and I would turn those into questions for the surgeon.

You are going to pay a lot of money to a board certified veterinary surgeon (been there, done that) and you have a right to ask questions. I would want to be in the waiting room if possible and would want immediate updates, if not in person then immediately by phone.

I am sorry that you are faced with this and I hope that your cat has a hopeful prognosis.
 
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cocoanlace

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I think one of my biggest questions is whether you trust this surgeon?
A good friend of mine used this surgeon to remove a cyst from her cat's pancreas. The cat was older than Monkey and had other issues. She has a lot of faith in him but even the surgeon says there are challenges with this particular surgery. He obviously hasn't addressed anything like this or he would have said so. And I really doubt that many vets have. So the answer is yes, I trust him. But there's no way of knowing if the surgery will be a success or a failure. One part of me thinks that for a surgeon of this caliber, who teaches across the country and whose partner has often been on daytime television shows in Los Angeles, this is a very interesting case and he would probably love to perform surgery for the experience. You know what I mean? My friend's surgery was about $7,000. I would hate to spend that kind of money just so this vet could be enlightened.
 
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cocoanlace

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Kieka said:
To me, it means that the vet will take a look and if it is low risk he might be able to do it then. If the risk is higher, he will close your cat up and consult with you before proceeding. I would clarify with the vet that if in his opinion the surgery would have a good chance of success to proceed while the cat is under but to close up and consult if it looks like it would have complications. It's hard to know sometimes until they see how it looks in person. You could also ask if you could wait in the lobby and they could consult with you on how to proceed once they have him under and open (but the longer your cat is under the greater risk so the vet may decide not to). In my cats case, the imaging looked the same but once they opened him up they saw the cancer had wrapped around his artery and sent a piece inside it. If they had removed it, he would have bled out.
I agree with your thinking. The vet already knows this is high-risk surgery because he hasn't given me any indication that it would be a simple procedure without risks that could end in death. I would definitely be waiting in the lobby for my cat or really nearby as this place is over an hour from where I live and I would not go home. I just would not be able to leave.
 

Furballsmom

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I don't know, have we helped you?

I guess I wish they could figure out a way to simply drain off the fluid, since I'm assuming this thing is affecting your baby?
 
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cocoanlace

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I don't know, have we helped you?

I guess I wish they could figure out a way to simply drain off the fluid, since I'm assuming this thing is affecting your baby?
I haven't explained all the details since the onset of this liver cyst but in 2018 we were draining it every other month to keep him comfortable. But in May of this year he went berserk when they tried to do it, hyperventilating, eyes dilated. Then again in early October, recently, I had changed vets and this vet used pain killer at the injection site followed by sedation but my kitty still had this bizarre reaction so the procedure was stopped. So we are not going to try that anymore. Draining it is out of the question. I have done some reading on liver cysts in children and they often drain the cyst but after awhile complications do arise like fibrosing for instance or leakage after the procedure which can be very painful when that bile enters the abdomen.
 

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You really are on top of this and have entered that gray area where no one knows the outcome, no matter how educated or skilled. Very hard place to be. You raised a good point about is the surgeon possibly doing this for the experience but then the other side becomes someone has to perform risky surgeries, so you go in a circle. Your baby is beautiful with those celadon eyes...she looks like one of my favorite, and longest lived cats, Grandchatine.
 
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cocoanlace

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I wanted to close out this thread by informing everyone that Monkey had the high-risk surgery on September 14th. Once inside, the surgeon saw that the cysts were not actually cysts at all. The monster, which was filled with six cups of fluid, was actually his common bile duct. And the recent tubular cysts we saw via ultrasound last week were his other bile ducts, also enlarged and filled with bile. Apparently his actual gallbladder went on vacation years ago and was atrophied and empty. I like to think that his body figured out a way to digest his food anyway by filling the bile ducts with the fluid it required. It was a challenging surgery, but Dr. Holzworth resected that CBD into a medium-sized one and connected it to Monkey's intestines. There were tense periods in OR when his blood pressure was so low it did not register on the machine. But this morning they are calling him a trooper because he is eating on his own. His prognosis is guarded of course but I am glad I went ahead with the surgery. His health was deteriorating as he could no longer keep food down and was on gabapentin for pain. The cost was $13,000 and may go over that should he need to be hospitalized longer than a few days. Just wanted to let you know this in case some vet someday somewhere tells you your cat has a cyst on his liver. It may not be that at all.
 

fionasmom

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Thank you so much for posting and the best of wishes for Monkey's recovery. You must be so relieved that you were able to determine what was happening and correct it. Vet care of this kind hits the 5 digit mark very quickly and Monkey is lucky that you were there for him.
 
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