Pediatric ovariohysterectomy may be performedsimilarly to adult ovariohysterectomy with some slightmodifications [30–32]. Generally, the uterus is moreeasily exposed in puppies if the incision is startedrelatively more caudal to the umbilicus than adult dogs(at least 2–3 cm caudal to the umbilicus) resulting in theincision positioned at, or near, the middle third of thedistance from the umbilicus to the pubis, similar to afeline incision. In kittens, the incision is placed in asimilar location as in an adult cat. Upon entrance intothe abdomen, it is common to encounter substantialamounts of serous fluid in both puppies and kittens,which may need to be removed using gauze sponges toimprove visualization. The use of a Snook ovariohysterectomyhook should be avoided in pediatric patientsdue to the delicate nature of the tissues. Because ofincision location in both puppies and kittens, the uterusis easy to locate by retracting the bladder and lookingbetween the urinary bladder and colon. Uterine tissuesare extremely small and friable in young puppies andkittens, therefore care must be taken to avoid excessL.M. Howe / Theriogenology 66 (2006) 500–509 503traction and tearing of tissues. After the uterus has beenlocated, the procedure may be performed similarly tothe adult OHE, using care when breaking thesuspensory ligament and ligating the fragile pedicles.Although the triple-clamp method may be used inpediatric OHE, it is often difficult to place clampsappropriately without tearing tissues, and provescumbersome. Closure is routine, however, it isimportant to carefully identify the ventral fascia(external rectus sheath) and differentiate it from theoverlying subcutaneous tissue since they can occasionallybe difficult to distinguish (particularly in somepuppies). The subcuticular layer may be closed with anabsorbable suture material in a continuous intradermalpattern to avoid the use of skin sutures. Alternatively,skin sutures may be loosely placed following closure ofthe subcutaneous tissues.