Hernia In Dog Research Articles

Surgical findings and clinical outcome after bilateral repair of apparently unilateral perineal hernias in dogs.

To report the short- and long-term outcomes and recurrence rate in dogs treated for apparently unilateral perineal hernia with bilateral herniorrhaphy, castration, colopexy, vas deferens pexy with or without cystopexy in single-stage procedures. Thirty-one client-owned dogs with apparently unilateral perineal hernia were included. Perineal hernias were repaired bilaterally, incorporating internal obturator muscle transposition and the sacro-tuberal ligament, combined with colopexy, vas deferens pexy with or without cystopexy. Preoperative pattern of defaecation, pattern of micturition and rectal alignment were recorded. Surgical time, bilateral surgical perineal findings, postoperative complications, short-, middle- and long-term (>24 months) scores and recurrence rate were documented. A hernia with ectopic tissue and weakness of the pelvic diaphragm was identified bilaterally in all dogs despite the unilateral clinical presentation. The procedure combination was achieved uneventfully in all dogs in 56 to 113 minutes (mean 73 minutes). Complication rate was low, consisting mostly of urinary disorders, most of which resolved within a few days. In all, 93% of dogs were free of clinical signs related to perineal hernia at long-term follow-up (mean 27 months). Recurrence rate was 0%. Our surgical findings suggest that perineal hernia in dogs might be considered a bilateral disease, even when the presentation is of apparently unilateral signs. Recurrence is rare following bilateral herniorrhaphy combined with colopexy and deferens pexy with or without cystopexy.

A Review of the Surgical Management of Perineal Hernias in Dogs.

Perineal hernia refers to the failure of the muscular pelvic diaphragm to support the rectal wall, resulting in herniation of pelvic and, occasionally, abdominal viscera into the subcutaneous perineal region. The proposed causes of pelvic diaphragm weakness include tenesmus associated with chronic prostatic disease or constipation, myopathy, rectal abnormalities, and gonadal hormonal imbalances. The most common presentation of perineal hernia in dogs is a unilateral or bilateral nonpainful swelling of the perineum. Clinical signs do occur, but not always. Clinical signs may include constipation, obstipation, dyschezia, tenesmus, rectal prolapse, stranguria, or anuria. The definitive diagnosis of perineal hernia is based on clinical signs and findings of weak pelvic diaphragm musculature during a digital rectal examination. In dogs, perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes difficult to perform as the levator ani and coccygeus muscles are atrophied and unsuitable for use. Internal obturator muscle transposition is the most commonly used technique. Additional techniques include superficial gluteal and semitendinosus muscle transposition, in addition to the use of synthetic implants and biomaterials. Pexy techniques may be used to prevent rectal prolapse and bladder and prostate gland displacement. Postoperative care involves analgesics, antibiotics, a low-residue diet, and stool softeners.

Effects of manipulations to detect sliding hiatal hernia in dogs with brachycephalic airway obstructive syndrome.

To determine the influence of manipulations aimed at increasing the transdiaphragmatic pressure gradient on the gastro-esophageal junction (GEJ) of dogs with brachycephalic airway obstructive syndrome (BAOS), and to identify the manipulation that most improves the detection of GEJ abnormalities and sliding hiatal hernia (SHH) in dogs with BAOS. In vivo experimental pilot study and prospective clinical study. Five purpose-bred Beagles and 20 dogs diagnosed with BAOS. Respiratory and digestive clinical signs as well as respiratory and GEJ abnormalities were scored. The presence of SHH was investigated using radiography and endoscopy in standard conditions. Endoscopic investigation was repeated after manipulations including manual pressure on the cranial abdomen (MP), Trendelenburg position (30°), or temporary complete endotracheal tube obstruction (ETO). No SHH was detected in any normal dog under any condition. Sixty-five percent of dogs with BAOS presented with digestive clinical signs, including vomiting and/or regurgitation. SHH was observed in only one dog via radiography and was not detected via endoscopy. Manipulations during endoscopy influenced GEJ abnormalities and allowed the detection of SHH in 2 (30°), 4 (ETO), and 5 (MP) dogs, respectively. Digestive clinical signs correlated with GEJ abnormalities observed only in dogs with ETO (P = .02). Manipulations aimed at increasing the transdiaphragmatic pressure gradient during endoscopy in BAOS dogs allowed the detection of GEJ abnormalities and SHH that were not detected under standard conditions. Although MP allowed detection of SHH in more dogs than ETO, scores under MP did not correlate with digestive clinical signs. Therefore, ETO may be more accurate manipulation for the detection of GEJ abnormalities in BAOS dogs.

Perineal Hernia in Dogs: Which Technique Should We Use?

Background: Perineal hernia may be unilateral or bilateral and results from weakening and separation of the pelvic diaphragm muscles, favoring the abdominal viscera herniation into the perineal subcutaneous. The factors described as possible etiology of this affection are prostate hyperplasia, senile muscular atrophy, myopathy and hormonal imbalances. Several herniorrhaphy techniques are available in literature presenting different rates of success leaving the question whether there is any technique that is predominantly better than others are. This case report aims to describe five cases of perineal hernia treated with four different techniques performed by four experienced surgeons.Cases: Case 1. Semitendinous muscle transposition: A 8-year-old intact male Shitzu (6 kg) was referred for the evaluation of a swelling in the right perineal region. The mass was soft and regressed into de pelvic cavity during palpation. Abdominal ultrasound and radiography were taken, which reveled perineal hernia and a mild prostate enlargement. The patient was prepared for hernia repair with semitendinous muscle transposition and orchiectomy. Case 2. Internal obturator muscle transposition: A 9-year-old intact male mixed breed dog (18kg) presenting a two-week long unilateral (right-side) perineral hernia. Ultrasound exam revealed a cystic prostate and adipose tissue as the hernia content. After clinical and image examination the patient was submitted to surgical repair using the internal obturator muscle transposition technique and orchiectomy. Case 3. Internal obturator muscle transposition associated to correction of rectal sacculation: A 12-year-old intact male mixed breed presenting swelling on the right side of the perianal region. The owner reported a 4-day long aquesia, emesis and increased volume in perineum for 6 months. During the rectal palpation, resected fecal content was present and rectal sacculation was suspected. Enema, simple abdominal radiography, contrast radiography and ultrasonography were performed. The exams showed perineal hernia with bowel content and presence of rectal sacculation. The patient was submitted to surgery in order to correct the perineal hernia and rectal sacculation, and to performe orchiectomy. Case 4. Polypropylene mesh: A 13-year-old intact male dachshund dog (8.6 kg) was referred to clinical examination due to a 1-year-history complaint of a mass in the right perineal area. The owner also reported rectal prolapse and stranguria noted two days prior the consultation. Ultrasound and radiography showed bladder, prostate and bowel contained in hernia sac. The patient underwent to hernia repair with polypropylene mesh and castration. Case 5. Bovine pericardium preserved in 4% formaldehyde: A 7-year-old intact male mixed breed dog (14 kg) was presented to clinical evaluation with swelling lateral to the anus and dyschezia. Abdominal radiography and ultrasound revealed images suggestive of perineal hernia with urinary bladder, prostate and bowl content. The patient was referred to surgery.Discussion: Perineal herniations are commonly related to weakness of pelvic diaphragm muscles. However, the etiology involved in this process is undetermined. Success rate of perineal hernia repair techniques vary in literature. It can be speculated that local factors may influence these results, such as the surgeon ability to perform the technique or to recognize components that adversely affects the surgery. The results were considered satisfactory in all cases, which may answer the question: the better technique is the one we perform better.

Laparoscopic repair of congenital pleuroperitoneal hernia using a polypropylene mesh in a dog

ABSTRACT Pleuroperitoneal hernias are the most uncommon type of diaphragmatic hernias in dogs and cats. The treatment of choice is surgery and may involve the use of prosthetic implant through celiotomy. In the current report, laparoscopic repair of a congenital pleuroperitoneal hernia using polypropylene mesh in a dog is described. The surgery was feasible. Appropriate reduction of the hernia was carried out and no complications were noted.

Comparison of caudal and pre-scrotal castration for management of perineal hernia in dogs between 2004 and 2014

AIMS: To compare peri- and post-operative complications associated with caudal scrotal castration (CSC) and perineal hernia repair with pre-scrotal castration (PSC) in conjunction with another surgical procedure.METHODS: Medical records were reviewed for 51 intact male dogs that were admitted to the Veterinary Emergency and Surgical Center, Levittown, PA, and underwent a CSC and perineal hernia repair using an internal obturator muscle flap (IOMF) between 2004 and 2014. Perioperative, and major and minor post-operative complications noted within the 2 week follow up period were reported and compared to 91 intact male dogs that underwent a PSC in conjunction with a second surgical procedure.RESULTS: There were no recorded perioperative or major post-operative complications in either group. There were 3/51 (6%) minor post-operative complications in the CSC group compared to 6/91 (7%) in the PSC group. There were 2/51 (4%) and 4/91 (4%) cases that developed heat, erythema and swelling associated with the incision site and 1/51 (2%) and 2/91 (2%) cases that developed scrotal swelling in the CSC and PSC groups, respectively. Overall, there was no difference in the prevalence of minor complications between the two groups (p=0.86).CONCLUSIONS AND CLINICAL RELEVANCE: Caudal scrotal castration was not associated with more perioperative or postoperative complications relative to PSC. Utilising the CSC approach eliminates the need to aseptically prepare and drape a second site when carrying out perineal hernia repair, as well as the need for patient repositioning. Thus, we recommend that CSC be the preferred surgical technique when performing orchiectomy in dogs concurrent with perineal hernia repair.

Internal obturator muscle transposition for treatment of perineal hernia in dogs: 34 cases (1998–2012)

To evaluate the outcome of dogs with perineal hernia treated with transposition of the internal obturator muscle. Retrospective case series. 34 dogs. Medical records of dogs with perineal hernia surgically treated from 1998 to 2012 were reviewed. Diagnostic methods and surgical techniques were recorded. Dogs were assigned preoperative and postoperative clinical sign scores. Complication and recurrence rates were evaluated over time. Risk factors were determined. Median follow-up time was 345 days (range, 22 to 1,423 days). Complications were observed in 10 dogs. Tenesmus (n = 9), dyschezia (7), fecal impaction (3), stranguria (4), hematochezia (2), urinary incontinence (2), diarrhea (1), urinary tract infection (1), and megacolon (1) occurred following surgery. Bladder retroflexion at the time of initial evaluation or surgery was not a risk factor for complication (hazard ratio, 1.72). One year after surgery, 51.2% dogs were free of complications. Three dogs developed a perineal hernia on the contralateral side between 35 and 95 days after surgery. The 1-year recurrence rate was 27.4%. Median time for recurrence was 28 days after surgery (range, 2 to 364 days). Postoperative tenesmus was a risk factor for the development of recurrence (hazard ratio, 2.29). Internal obturator muscle transposition was used for primary repair of perineal hernia in dogs. Recurrence was recorded as long as 1 year after surgery. Tenesmus was a risk factor for the development of recurrence after treatment of perineal hernia with internal obturator muscle transposition.

Extrahepatic Biliary Obstruction Secondary to Traumatic Diaphragmatic Hernia in Dog

A 3-year-old intact mixed hunting dog was referred to Gyeongsang Animal Medical Center with the clinical signs of vomiting, dyspnea, anorexia. The dogs had traumatic history that wounded at abdominal wall during the wild boar hunting 2 week ago. The dogs was diagnosed as extrahepatic biliary tract obstruction (EHBO) secondary to traumatic hernia. Diagnosis was based on radiographic features of a diaphragmatic hernia on survey radiography, dilated bile duct in abdominal ultrasonography and complete recovery due to the return of displaced organs into the peritoneal cavity and repair of the diaphragmatic rent. Diagnostic imaging and surgical intervention may result in a favorable outcome in dog with post hepatic obstruction secondary to diaphragmatic hernia. This case emphasizes the strangulation of bile duct by diaphragmatic rupture could be the cause of EHBO.

Liposarcoma with perineal hernia in dog

Liposarcoma is an uncommon malignant tumor originated in the lipoblasts that usually does not produce metastases, but is locally invasive. The final diagnosis is made by histopathology and wide surgical excision is the treatment. A four years old male Pinscher, weighing 2.8 kg, which was previously submitted to seven therapeutic procedures for hepatoid adenoma, was brought to us. On clinical examination a large, soft consistency and painless tumor on lumbodorsal area, besides perineal hernia, was observed. The CT scan revealed an image of an extensive paravertebral intramuscular tumor, embracing retroperitoneal, pelvic canal and ad-anal region. After surgical resection, the material was sent for histopathological examination which confirmed it was a liposarcoma. Thus, chemotherapy protocol with doxorubicin was established. 12 months after the last application of chemotherapy, the patient shows no signs of tumor recurrence nor metastases.

Correction of rectal sacculation through lateral resection in dogs with perineal hernia - technique description

The occurrence of perineal hernias in dogs during routine clinical surgery is frequent. The coexistence of rectal diseases that go undiagnosed or are not correctly treated can cause recurrence and postoperative complications. The objective of this report is to describe a surgical technique for treatment of rectal sacculation through lateral resection in dogs with perineal hernia, whereby restoring the rectal integrity.

Surgical and nonsurgical treatment of peritoneopericardial diaphragmatic hernia in dogs and cats: 58 cases (1999–2008)

To determine clinical findings and outcomes for cats and dogs with peritoneopericardial diaphragmatic hernia (PPDH) treated surgically or nonsurgically. Retrospective case series. 28 dogs and 30 cats. Medical records for cats and dogs evaluated at 1 of 2 veterinary teaching hospitals were reviewed, and data regarding clinical signs, diagnostic and surgical findings, and outcome were evaluated. Prevalence of PPDH in the 2 hospitals during the study period was 0.025% (0.062% and 0.015% for cats and dogs, respectively); PPDH was an incidental finding for 13 (46.4%) dogs and 15 (50.0%) cats. Other congenital abnormalities were identified in 16 (571%) dogs and 7 (23.3%) cats (most commonly umbilical hernias, abdominal wall hernias cranial to the umbilicus, or sternal anomalies). Thirty-four (58.6%) animals underwent surgical repair of PPDH; 27 (79.4%) of these animals had a primary diagnosis of PPDH. Detection of clinical signs of PPDH (primary diagnosis) and intestines in the pericardial sac were significantly associated with surgical treatment. Short-term mortality rate for surgically treated animals was 8.8% (3/34). Clinical signs associated with PPDH resolved in 29 (85.3%) of surgically treated animals. No significant differences were detected between dogs and cats or between surgically and nonsurgically treated animals regarding long-term survival rate. Results of this study indicated animals with clinical signs of PPDH were more likely to undergo surgery than were animals without such signs. Herniorrhaphy was typically effective for resolution of clinical signs. Long-term survival rates were similar regardless of treatment method. Surgical or nonsurgical treatment of PPDH may be appropriate for animals with or without clinical signs, respectively.

Perineal Hernia Repair Using an Autologous Tunica Vaginalis Communis in Nine Intact Male Dogs

Perineal hernia in dogs is very problematic and mostly requires surgical reconstruction of the weak pelvic diaphragm. Tissue or synthetic grafts have been used for the correction after failure of the conventional herniorrhaphy. Aim of this clinical trial was to assess the possible use of the autologous tunica vaginalis communis as a free graft for perineal hernia repair in intact male dogs. Seven unilateral and 2 bilateral perineal hernias in nine intact male dogs free from testicular and scrotal neoplasms were included in this study. The median surgical time for unilateral herniorrhaphy was 75 min. The median follow-up time was 13 months. The success of the autografting, based on no recurrence and comfort of the animals during urination and defecation, was found in ten of 11 hernias; giving a success rate of 90.91%. One hernia (9.09%) recurred 10 days after surgery. Histopathological examination of the apposing area between the graft and the adjacent tissue, taken during the repair of the recurred case at day 20, revealed neovascularization and connective tissue ingrowth. In conclusion, the tunica vaginalis autograft can be used for perineal herniorrhaphy in intact male dogs.

A New Surgical Technique Using Polypropylene Mesh for Repair of Perineal Hernia in Dogs

A New Surgical Technique Using Polypropylene Mesh for Repair of Perineal Hernia in Dogs

Clinical Anatomy and Surgical Repair of Prepubic Hernia in Dogs and Cats

Prepubic hernia is a traumatic hernia in small animals, most often associated with severe trauma to the caudal abdomen. Common causes include vehicular trauma, dog fights, and kicks by large animals. Rupture of the prepubic tendon in dogs and of its equivalent in cats results in a ventral abdominal hernia. Due to the traumatic nature of the injury, concurrent injuries are frequently seen. Clinical signs of herniation are often nonspecific, and the resultant hernia may not be readily apparent during routine physical examination. This being so, diagnosis is often based on a thorough physical examination in conjunction with abdominal radiography and, possibly, abdominal ultrasonography. Multiple methods of repair of prepubic hernia have been reported, and survival rates are quite good if concurrent injuries are not severe.

Clinical and Surgical Evaluation of Perineal Hernia in Dogs: 41 Cases

Summary The purpose of the study was to report the clinical and surgical records of perineal hernia and associated rectal pathology with epidural morphine analgesia in 41 dogs. Fourty one dogs suffered from perineal hernia were included into the study with the age varied from 4.5 to 16 years. Eleven dogs had bilateral while the other 30 had unilateral (17 right, 13 left) perineal hernia. The clinical signs were perianal swelling (n=41), severe tenesmus (n=19), dyschesia (n=9), proctitis (n=7), fecal incontinence (n=4), stranguria (n=2) and hematuria (n=1). Associated rectal pathologies were diverticulation (n=15), dilatation (n=4), deviation (n=3) and sacculation (n=1). The rectal diverticulum was corrected by extraluminal plication (n=12) or rectal resection (n=3). Internal obturator muscle flap transposition was used to repair the hernia in all cases. Postoperative pain was subjectively evaluated and scores were “no pain” in 10 cases, mild in 28 cases, moderate in 3 cases. Mean follow-up time was 27.3 months (range 4 months to 5 years) and the recurrence was observed only in three cases postoperatively. In conclusion, combined perineal herniorraphy with internal obturator muscle transposition and rectal wall repairment can be carried out at the same time and epidural morphine administration provide adequate analgesia for these operations.

A modified salvage technique in surgical repair of perineal hernia in dogs using polypropylene mesh

In 16 male dogs who suffered from perineal hernia, polypropylene mesh was used to close a defect in the pelvic diaphragm. Pelvic bone was drilled on the pelvic floor and mesh was sutured through holes by polypropylene suture. Strong pelvic diaphragm, good long-term results and time-sparing by this technique was achieved. Suture sinuses were developed in two dogs one month postoperatively. Objectives of this study were to describe a new alternative technique of perineal herniorraphy and postoperative possible complications. Weakness of internal obturator muscle flap is complication which can be observed during transposition of internal obturator muscle flap. This technique can be used when internal obturator muscle flap is weak like the operation of the first choice.

Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990–2002)

To determine the survival rates of dogs and cats that underwent surgical treatment for traumatic diaphragmatic hernia within 24 hours of admission and determine whether timing of surgery affected perioperative survival rate. Retrospective study. 63 dogs and 29 cats treated surgically for traumatic diaphragmatic hernia. Medical records were reviewed to evaluate associations between perioperative survival rates and variables including timing of surgery in relation to admission and acute versus chronic diaphragmatic hernia. Among the 92 animals, 82 (89.1%) were discharged alive after surgery. Sixty-four (69.6%) patients received surgical intervention within 12 hours of admission, and 84 (91.3%) received surgical intervention within 24 hours of admission. Median time from admission to discharge was 4 days (2 to 33 days). Data for acute cases (68 dogs and cats) were analyzed separately. Sixty-three (92.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of admission to the hospital, and 59 (93.7%) of these patients were discharged alive. Twenty-nine (42.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of trauma, and 26 of 29 (89.7%) patients were discharged alive. An overall acute and chronic perioperative survival rate of 89.7% was observed in dogs and cats that received surgical intervention within 24 hours of admission. Results in 68 dogs and cats that underwent surgery within 24 hours of admission suggested that early surgical intervention for acute diaphragmatic hernia was associated with good perioperative survival rates.

Laparoscopia nas hérnias diafragmáticas: estudo experimental em cães

A hérnia diafragmática traumática é a forma mais comum entre as hérnias diafragmáticas em cães e gatos e, por tratar-se de uma alteração anatômica, a terapêutica indicada é a sua correção cirúrgica. O presente estudo se propôs a avaliar a cirurgia videolaparoscópica no diagnóstico e tratamento dessa afecção em cães. Na primeira etapa do experimento, os animais foram submetidos à produção de um modelo de hérnia diafragmática. Após o período de uma semana, os cães foram submetidos à segunda etapa experimental por meio do acesso laparoscópico, tendo como finalidade o diagnóstico e a terapêutica cirúrgica. O acesso laparoscópico mostrou-se eficaz tanto na identificação das rupturas e dos deslocamentos como na correção cirúrgica de reposição visceral e rafia diafragmática nos oito cães do experimento.

Radiographic diagnosis of diaphragmatic hernia: review of 60 cases in dogs and cats

Sixty cases of diaphragmatic hernia in dogs and cats were radiologically reviewed and categorized by their characteristic radiographic signs. Any particular predilection for age, sex, or breed was not observed. Liver, stomach and small intestine were more commonly herniated. At least two radiographs, at different angles, were required for a valid diagnosis, because some radiographic signs were not visible in a single radiographic view and more clearly detectable in two radiographic views. In addition to previously reported radiographic signs for diaphragmatic hernia, we found that the location of the stomach axis and the displacement of tracheal and bronchial segments were also useful radiographic signs.

Long-term outcome of medical and surgical treatment of hiatal hernias in dogs and cats: 27 cases (1978-1996)

Objective To determine long-term outcome of medical and surgical treatment of hiatal hernia (HH) in dogs and cats. Design Retrospective case series. Animals 22 dogs and 5 cats. Procedure Medical records of dogs and cats with HH were reviewed. Outcomes of treatment were obtained from reexamination or owner questionnaires. Results The most common breeds affected were English Bulldog and domestic shorthair cat. Mean age of all dogs and cats was 4 years. Hiatal hernia was diagnosed by use of contrast radiography of the esophagus (n = 19), fluoroscopy (7), or esophagoscopy (1). Eight of 15 dogs and cats treated medically for 30 days had complete resolution of signs. Of the 7 in this group that did not respond, 1 died on the 10th day of medical treatment and the remaining 6 were treated surgically. Eight of 10 dogs that underwent hiatal plication, esophagopexy, and gastropexy responded favorably. Four of 7 dogs that underwent fundoplication did well. However, 3 of these dogs did not have clinical signs. Fundoplication was successful in only 1 of 4 dogs with clinical signs. Clinical Implications Dogs and cats with clinical signs of reflux esophagitis associated with HH should undergo conservative treatment for 30 days. Most will be managed successfully by use of drugs, dietary alterations, or both. Those that do not respond to conservative treatment will likely require surgery. The best prognosis after surgery appears to be associated with the esophagopexy technique. (J Am Vet Med Assoc 1998;213:381-384)