JAVMA BOAS study recap: CO₂ laser vs cut-and-sew vs LigaSure (413 dogs)

Many veterinarians treat BOAS patients or collaborate with teams who do. One of the most common clinical questions is simple: when you perform a staphylectomy, do outcomes differ based on the technique and tool used?

A recent JAVMA retrospective review provides real numbers for that discussion. The study evaluated 413 canine BOAS staphylectomy cases (2012–2024) and compared short-term major complications across multiple techniques.

What techniques were compared

Cases were grouped by staphylectomy method, including:

• Cut-and-sew
• CO₂ laser staphylectomy
• Bipolar vessel-sealing device (BVSD) using the LigaSure Precise handpiece (Medtronic)

(An additional group in the paper includes BVSD with suture apposition, but this recap focuses on the clearest day-to-day tool comparisons: CO₂ laser vs cut-and-sew and CO₂ laser vs BVSD.)

Group sizes were: cut-and-sew 94, CO₂ laser 101, and BVSD 104.

What counted as a “major complication”

Major complications were defined as clinically meaningful postoperative events that required a significant escalation of care. Examples included aspiration pneumonia, temporary tracheostomy, persistent regurgitation, post-op respiratory crisis requiring reintubation or oxygen supplementation, or erratic recovery requiring sedation.

The key numbers (major complication rates)

Across the full cohort, major complications occurred in 15.5% of dogs.

By technique, reported major complication rates were:

• Cut-and-sew: 20.2% (19/94)
• CO₂ laser: 12.9% (13/101)
• BVSD (LigaSure): 18.3% (19/104)

Putting the differences into plain language

CO₂ laser vs cut-and-sew

• 12.9% vs 20.2% major complications
• 7.3 percentage points lower with the CO₂ laser
• About 36% lower relative to cut-and-sew

CO₂ laser vs BVSD (LigaSure)

• 12.9% vs 18.3% major complications
• 5.4 percentage points lower with the CO₂ laser
• About 30% lower relative to BVSD

The authors also note in the discussion that, in this dataset, the CO₂ laser was least likely to result in a short-term major postoperative complication.

One more result worth noting

In multivariable analysis, cut-and-sew had significantly higher odds of major complications compared with CO₂ laser (OR 2.9, 95% CI 1.2–7.4).

Why ALSC members may want to read it

This paper is a useful reference for:

• Surgeon-to-surgeon discussion of technique selection in BOAS staphylectomy
• Communicating risk in a more structured way using a clear definition of “major complications”
• Reviewing how different tools may relate to early post-op outcomes in a large dataset

Read the full JAVMA article