Top Surgery Cases

Read along with us as we share our exceptional surgery cases!


Lemon is a ranchu goldfish who was adopted with a slight oral deformity. Once day, when going after a large pellet, one side of her mouth luxated and obstructed her oral cavity. Dr. Sanders was able to correct the injury with a few well-placed sutures and Lemon was able to recover. Read more about her story here.


We don’t know why he did it, but Rocky, a shovelnose catfish, decided that the rocks at the bottom of his tank looked particularly tasty. He ended up eating almost a pound of them and they got stuck in his stomach. Dr. Sanders performed surgery to open the stomach and remove the rocks. Read more about Rocky here.


Our buddy Sparky presented with a HUGE tumor on his eye. Rather than trying to cut the tumor away from the delicate cornea, Dr. Sanders elected to remove the eye. Sparky healed up great and you can never even tell an eye was there to begin with. Read his full story here.

Want to watch some fun surgery videos? Check out our YouTube channel.

This koi had a coelomic tumor that required invasive surgery to remove.

Fish Surgery Diagnostics

How do fish veterinarians decide when it’s time for a fish to go under the knife? Surgery can be very beneficial for fish when it is warranted.

Water Quality Testing

Prior to any surgery, a veterinarian MUST test the water quality. If the water quality is off in any way, recovery after surgery will be hindered. Corrections to water quality must be made prior to any procedure.


In dealing with structures including and next to bones and the swim bladder, radiographs, commonly called “x-rays,” provide great diagnostic info. These are very handy to see if there is any air where it shouldn’t be and if any structures are not in the correct place. For soft tissue, we need…


This tool is one of the most beneficial to evaluate internal structures in fish. For koi, it is how we are able to see gonadal sarcomas and how extensive they are. A small tumor is much easier to operate on that a large one.


Unlike many other pet species, bloodwork is not very useful in many species of pet fish. Reference ranges have been established, but some are too wide, and vary based on water quality and genetics. For surgical procedures, a PCV (packed cell volume) is helpful to understand how much blood a fish loses during a procedure.

Fish Eyeball Removal Surgery

Yes, fish need surgery at times. Ever wonder what happens when a fish needs to have an eye removed? Check out this video!

How Do Fish Undergo Surgery?

How Do Fish Undergo Surgery?

One of the most common questions we get asked is how do fish undergo surgery? Yes, even surgical treatment is available to fish. It can be a simple lump removal all the way through to a full open abdomen procedure. It is simply amazing how well a fish improve from a simple corrective surgery.

Are they awake for the procedure?

Absolutely not! Just like people, cats and dogs are sedated for surgery, so are fish. Rather than using an aerosolized anesthetic, fish are sedated using a water-based anesthetic. Our office uses a compound called MS-222 or Tricaine-S (tricaine methanesulfonate). Other fish vets may use eugenol or clove oil. These compounds produce a safe plane of anesthesia to operate with the fish happily in dreamland. Recovery using clean water usually occurs within 10-30 minutes.

Surgery on the stomach of a shovelnose catfish

Are the fish underwater when you operate?

No again. For simple external procedures, the fish will lie on one side with the surgical site up in the air. Usually we have an assistant or net hold the fish partially submerged. For open abdomen procedures, we have a specially crafted, acrylic V-shape that fits over a 10-gallon aquarium. An aquarium pump moves water from the reservoir below, through a tube to the fish’s mouth, which then flows over their gills and back down. It is a very simple closed circulation system that works extremely well. (Modified through the amazing work of Drs. Harms & Lewbart). There is one person assigned to this job for the entire surgery and monitors the fish’s anesthetic depth through gill movement and heart rate.

Our specialized surgical rig

What is the craziest surgery you have ever done?

Well, we do a lot of procedures that are very odd for the general veterinary practitioner. Given the specialty of our service, we see nothing but “odd” cases. Some of our favorites include our fish friends Rocky, Lemon and Sparky. Read all about their cases here.

Watch some of our procedures on our YouTube site: Eyeball Removal, Abdominal Tumor Removal

Have more questions? Check out our Fish Surgery FAQ

DIY Fish Surgery: A How-To Guide

DIY Fish Surgery: A How-To Guide

Ever watched some videos about how to do fish surgery online? Looks easy, right? Well, we’ve decided to write up a step-by-step guide for you do-it-yourselfers who want to try their hand at fish surgery. No veterinary degree required!




Step 1: Call a veterinarian. There are plenty who specialize in fish, check here and here.

Tah dah! And your surgery is all taken care of by a legitimate professional who put themselves into massive amounts of debt and pain of 4 extra years of school on top of their regular college degree whose sole purpose in life is to take away pain and suffering in your pet. Don’t give me that “it’s just a fish” line. Fish can have pain and discomfort just the same as if your gym trainer decided to try their hand at foot surgery. They’re obviously qualified because they work with the human body? I don’t think so.

Don’t ever attempt surgery on your fish unless you are a trained veterinary professional. It’ll save you from the embarrassing phone call to the vet who told you specifically not to attempt your own surgery when your fish is barely surviving and in a whole lot of extra pain. I wish I was kidding, but we got this phone call yesterday.

Yes, the world of YouTube has certainly opened up the medical profession. Did you see that open heart surgery video? Great. That makes you a qualified professional. Go ahead and open your practice!

I don’t know what else to say other than, “DON’T DO YOUR OWN SURGERY ON YOUR FISH.” Let me do it. Yes, I charge money for it, but you get more than you pay for. Go ahead and ask your trainer to do your coronary bypass next time you want to save money.

Rocky: The Rock-Eating Catfish

Rocky: The Rock-Eating Catfish

Meet Rocky…

As you can plainly see, Rocky has been a naughty little catfish and decided to eat something he wasn’t supposed to. In this case, the rocky substrate on the bottom of his tank. The only way to get them out? Open our shovelnose catfish friend up and take them out surgically.

Here we have the whole team working together to get the rocks out of Rocky. Sara (at top) was in charge on monitoring Rocky’s anesthetic level. We learned during this surgery that catfish go much deeper than koi or goldfish with our usual anesthetic levels. After a few adjustments with fresh water, Rocky was good for the rest of surgery.

Here, Dr. Sanders sutures closed Rocky’s stomach after all the rocks are removed. A few actually fell out of his mouth while we were manipulating the stomach.

Here’s a small portion of the rocks we removed. Look familiar to you fish tank owners?

And here Rocky is, post-surgery, in his recovery tank. He floats a lot better now! In total we took out 2/3 lbs of rocks. Rocky’s sutures will be in for 10-14 days and then they will be removed.

UPDATE: Unfortunately, Rocky’s home recovery did not go well. His tank mates thought that his sutures looked like tasty treats and tried to nibble his incision open! Rocky returned to our hospital for a re-suturing and will complete his recovery away from his obnoxious tankmates.

Fancy Goldfish Float Backpack

Fancy Goldfish Float Backpack

Some fancy goldfish can lead long, healthy, normal lives. Others, like their over-bred cat and dog compatriots, can develop genetic disorders that have no ideal treatment. Meet our little buddy, Rusty (top):


Back when he was little, he had no issues. Swimming and eating normally, being a happy little fish with his tankmates, Cupcake (bottom right) and Zhen Zhen (bottom left). However, a few months ago, we noted that Rusty was having trouble getting to the top of his tank. This progressed to where he started to lie on his side on the bottom for long periods of time. He was able to swim up to the top for meals, and eventually graduated to hand feeding.


In order to better see what was going on inside Rusty, we set up an appointment for x-rays. What we found was that his swim bladder had shifted to one side of his body, and due to his increasing size and girth, made it impossible for the swim bladder to inflate enough.


So, for a long-term solution, we needed to figure out a way to help Rusty swim. We have rigged temporary suspension systems for goldfish before, but never as a potential long-term treatment. The little guy pictured below had undergone neurologic damage secondary to a severe ammonia spike. A couple of weeks on the float, and he was able to recover.


This guy was rigged up using a block of styrofoam and a length of suture through his back. However, this was only a temporary setup. Rusty’s would have to be more long-term. So, our vet team sprung into action!


A small strip of plastic was threaded through Rusty’s dorsal fin and tied behind his pectoral fins. Several attempts had to be made in order to find a place where the strap would stay on and not interfere with his swimming. Then, a small sytrofoam peanut, donated by UPS Store #6455 in the same plaza as Aquatic Veterinary Services, was tied onto the strap.


Obviously, one peanut is much to buoyant for this tiny fish, so the peanut was gradually trimmed down.


For right now, he is still a little too positively buoyant, but our vet staff wanted to give him some time to get used to his new apparatus before learning to swim again. You can come meet Rusty at our Scales & Tails event this Saturday from 5p-9p. For more information, please see our Event Page.

We will keep you updated on his progress!


Goldfish Oral Reconstructive Surgery UPDATE

Goldfish Oral Reconstructive Surgery UPDATE

For those of you who missed our post this weekend, our little goldfish friend, Lemon, who underwent oral surgery two weeks ago to fish a semi-prolapsed mouth, got her stitches out this Saturday. Here she is:


Congratulations to Lemon, her family and the veterinary staff at Aquatic Veterinary Services!

Goldfish Oral Reconstructive Surgery

Goldfish Oral Reconstructive Surgery

For those of you who have seen pictures of our little buddy, Lemon, here is some more about his story:

Lemon was rescued by his current owners from a poorly maintained system that was overcrowded with fancy goldfish. He has always had a slight malformation of his mouth.

Lemon prior to surgery

Since he has grown bigger, his mouth has become quite problematic, ultimately resulting in a collapse of his mouth on the right side:


In order to correct this problem, so Lemon could eat normally, surgical intervention was required. Lemon was brought into Aquatic Veterinary Services for surgery to correct his collapsed lips.

Lemon on the surgery table.
Lemon on the surgery table.

Dr. Sanders operating while hospital manager, Sara, administers anesthesia via a syringe.
Dr. Sanders operating while hospital manager, Sara, administers anesthesia via a syringe.

Dr. Sanders was able to correct the mouth deformity by placing two tiny sutures in the corner of his mouth.


Lemon stayed in the hospital for 4 days in order to monitor his recovery. By the end of his stay, he was eating very well and able to close his mouth for the first time in a very long time.


His sutures will stay in for two weeks and then be removed. We hope to give you an update when they he is all set!

Get well soon, Lemon!

Fish Surgery FAQ

Fish Surgery FAQ

Surgery? On a fish? As odd as that may sound, fish surgery is a common occurrence in our veterinary practice. From the simple “lump-ectomy” to a fully-invasive abdominal explore (ceolom explore for professionals), fish can undergo surgery just like you or your furry pets. We have some of these posted on YouTube for you to get a better idea of what they entail.

Abdominal Explore – Tumor Removal in a Koi

Wen Trim – Oranda (Goldfish) Haircut

Still want to know more? Here are some of our most frequently asked questions:

Our in-house surgical setup
Our in-house surgical setup

1. Is the fish anesthetized?

Absolutely! Even most of our routine physicals are performed under sedation. Unlike a cat or a dog, manually restraining a fish is a fruitless endeavor. They are very slippery and have no limbs to hold on to! For surgery, we want to make sure the fish hold perfectly still, so we anesthetize them to the point where they can still breathe on their own, but they can’t feel us cutting or stitching. I usually have my surgical assistant monitor the patient’s breathing while I mess around with the rest of the body. We use a drug called MS-222, also known as Tricaine or Finquel. It is commonly used in fish medicine and has a very rapid recovery rate.

2. Do you stitch them up after surgery?

It depends on the surgery, but in the case of a large abdominal incision, we absolutely stitch them back up! Before cutting them open, we remove the scales along our incision site, revealing their underlying skin. Trying to cut into the skin without removing the scales would dull a dozen scalpel blades before we were able to get in there! Upon completion of the procedure, we stitch them up using regular suture material through their skin. We can use absorbable or non-absorbable suture in fish, and it’s usually up to the veterinarian’s discretion. I prefer a non-absorbable suture material, therefore ensuring I have to check the fish about 10-14 days later to remove the sutures and check in his progress.

Me on surgery day
Making the incision

3. How long do they need to recover?

For most of our procedures, fish will fully recover from anesthesia within 10-15 minutes. Some fish are more sensitive than others and will need more time. Others wake right up as soon as they go back in their home tank/pond. If there is an incision that needs to heal, fish in warm water (>65 F) will heal within 10-14 days. Colder water leads to longer healing time, since a fish’s metabolism is directly correlated to the water temperature. Lower metabolism = lower immune function = slower healing.

4. How does fish surgery differ from cat/dog surgery?

Between the land and water, the actual procedures are remarkably similar. Anatomy, however, is a different story. They all have the basic structures, kidneys, spleen, liver, heart, intestines, etc., but they are in very different places and can look very odd. Specialized training is certainly required to recognize a cat kidney from a fish kidney. Anesthesia is another key difference for surgery. Dogs and cats require inhalant anesthesia for most procedures, that is taken into the blood through the lungs. Well, fish don’t have lungs and can’t breathe air, so we dissolve the anesthetic in the water that passes over their gills and into their blood.

Courtesy of Dr. J Sanders
Simple eyeball removal (with tumor!)

5. What is the most common surgical procedure you perform?

They most common aquatic veterinary surgery I perform are eye removals, or enucleations. When eyes get damaged or have large growths on them, treating the globe itself is very hard with the fish having to live underwater. Most of the time, the best course of action is to simply remove the eye. Removing the eye has very minimal impact on a fish’s quality of life. They can still sniff out their dinner and use their lateral line system to tell where they are swimming and where their friends are. Fish living in groups that have vision issues or an eye removal will sometimes form a close attachment with another fish in the pond. They follow their buddy constantly and use them as a “seeing eye fish.”

6. What is the cost for surgery?

For relatively simple procedures, such as a wen trim or eye removal, the total cost for a visit is approximately $280-320. This includes everything your fish may need during the procedure. A more complicated procedure, such as a abdominal tumor removal, can run $600-700.

One year post eyeball removal
One year post eyeball removal

7. Do you use any pre-operative or post-operative drugs or antibiotics?

Again, it depends on the type of surgery. For simple lump removals or fish haircuts, no additional drugs are needed. For an invasive tumor removal, we often administer an intramuscular antibiotics and NSAID pain medication.

8. Where does the fish recover?

If the home tank/pond water has good water quality, the fish can recover in their own water. We certainly prefer if they can go right back into an environment they are familiar with that has all their fish family. If the water quality is not great, we can bring the fish to our hospital facility to recover for a few weeks in our heated quarantine tanks.

If you have any additional questions, we are happy to answer them! Please email or call (831) 346-6151

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