Perineal hernia repair in the dog by transposition of the internal obturator muscle

Summary

A modified technique for transposition of the internal obturator muscle was used to repair perineal hernias in 100 dogs. Complications and long‐term results are described. The most important complications were wound infection (45%), faecal incontinence (15%), and perineal fistula (7%). These complications often occurred in combination. The recurrence rate of perineal hernia was 5%.

Nine of the 15 patients with faecal incontinence had paresis of the external anal sphincter or faecal incontinence before surgery. We suggest that in numerous patients, faecal incontinence is a complication of the condition rather than a complication of treatment. The owner's assessment of the surgical result was good in 71% and moderate in 18% of the cases.     

Perineal hernia in the dog

The case records and owners of seventy–two dogs with perineal hernia seen at the University of Pennsylvania Veterinary Hospital were surveyed. The condition was seen in older male dogs, most of which presented with perineal swelling and straining to defaecate. Most dogs were treated by perineal herniorrhaphy. The incidence of recurrence in those dogs treated surgically was 46%. Recurrence was more common when the surgery had been performed by inexperienced surgeons, in those dogs which had been treated surgically elsewhere, and in those dogs in which the time period from surgery to survey was more than 1 year. Other complications occurring were wound infection, faecalincontinence, urinary problems and lameness. Most owners of dogs which were alive at the time of the survey were satisfied with the results of treatment. Castration had no effect on the incidence of recurrence or development of a hernia on the opposite side to that repaired initially. Résumé. On a étudié les dossiers de soixante-douze chiens avec des nernies perinéales, vus à l'Hǒpital vétérinaire de l'Université de Pennsylvanie. On a observé la condition chez des chiens mǎles plus ǎgés dont la plupart souffraient d'enflure périnéale et devaient faire tous leurs efforts pour aller à la selle. La plupart des chiens ont été traités par suture de hernie périnéale. Le taux de récidive chez ces chiens traités par chirurgie, a été de 46%. Les récidives ont été plus communes quand la chirurgie a été pratiquée par des chirurgiens peu expérimentés, chez ces chiens traités par chirurgie ailleurs, et chez ceux pour lesauels le laps de temps d'une opération à une autre était de plus d'un an. Une infection de la plaie, une incontinence de fèces, des problèmes urinaires et un état de claudication se comptent parmi les complications survenues. La plupart des propriétaires dont les chiens étaient vivants au moment de cette étude ont été satisfaits des résultats. La castration n'a pas eu d'effet sur la récidive ou le développement d'une hernie du cǒté opposé de celle qui avait été réparée auparavant. Zusammenfassung. Eine Aufzeichnung von Fàllen mit perinealer Hernie in 72 Hunden, die man im Tierǎrztlichen Krankenhaus der Universitǎt von Pennsylvanien sah, wurde iiberblickt. Man fand den Zustand in àlteren mànnlichen Hunden, von denen die meisten périnéale Sch-wellung und Anstrengung beim Dafàzieren zeigten. Die neisten Hunde wurden durch périnéale Bruchnaht behandelt. Der Vorfall von erneutem Auftreten dieser Beschwerden in jenen Hunden die chirurgisch behandelt wurden, war 46%. Emeutes Auftreten war hàufiger, wenn die Opération von unerfahrenen Ghirurgen ausgefùhrt wurde, in den Hunden die anderswo chirurgisch behandelt waren und in Jenen Hunden, deren Zeitspanne von einer Opération zur anderen mehr als ein Jahr betrug. Andere Komplikationen die vorkamen ware Wundinfektion, Nichthalten-kǒnnen des Kotes, urinàre Problème und Lahmheit. Die meisten Besitzer der Hunde die zur Zeit des Uberlicks am Leben waren, zeigten sich mit dem Ergebnis der Behandlung zufrieden.     

Novel application of internal obturator and semitendinosus muscle flaps for rectal wall repair or reinforcement

Internal obturator and/or semitendinosus muscle flaps were used to reinforce primary appositional rectal wall repair in three dogs and one cat in this case series. All three dogs incurred rectal wall compromise during surgical excision of anal sac tumours. The cat sustained bite wounds to the perianal region resulting in abscessation and a rectal tear. Our results indicate that application of an internal obturator and/or semitendinosus muscle flap can reduce the risk of rectal wall dehiscence after primary repair, and consequently the risk of pararectal abscess or rectocutaneous fistula formation.     

Fibular head transposition for repair of cruciate-deficient stifle in the dog

Fibular head transposition (FHT) was introduced as a surgical technique to reconstruct the cruciate-deficient stifle in the dog. Surgically moving the fibular head into a cranial position alters the orientation of the lateral collateral ligament, thereby preventing cranial drawer motion and minimizing internal rotation of the tibia. The technique was found to be safe, mechanically sound, and clinically effective. Comparison of clinical results for this technique with those for the fascial strip technique (using a uniform grading system) demonstrated an overall superior performance of FHT. Factors found to adversely influence clinical results were heavy body weight and meniscal damage. The interval between stifle injury and reconstructive surgery or the presence of associated osteoarthritic disease bore no relationship to clinical outcome. It was concluded that the clinical performance after FHT was equal or superior to other surgical methods for reconstructing the cruciate-deficient stifle in the dog.     

Surgical repair of a peritoneopericardial diaphragmatic hernia in a pregnant dog

Objective: To describe the surgical repair and pre‐ and postoperative management of a peritoneopericardial diaphragmatic hernia (PPDH) in a pregnant dog. Case summary: A pregnant dog was presented for vomiting, lethargy, and pale mucous membranes. Pulsus paradoxus was noted on physical examination. The dog was diagnosed with a PPDH via thoracic radiographs, abdominal ultrasound, and an echocardiogram. The hernia was surgically repaired and the dog received supportive medical care until the puppies were old enough to be delivered via cesarean section. The mother and all puppies survived. New or unique information provided: This is the first report that describes the surgical repair and postoperative management of a PPDH in a pregnant dog.     

Limb fractures in the dog and cat. VI. Complications of fractures in the dog

Abstract— A review is made of possible complications of fractures which may occur in the dog. The complications are classified and then the subject is dealt with under the headings of mal-union, delayed-union, non-union and prevention of complications. Emphasis is given to metallurgical problems and post operative care. Résumé— Un compte-rendu est établi sur les complications éventuelles des fractures qui pourraient arriver chez le chien. Les complications sont classifiées, le sujet est ensuite traîté sous le nom de mal-soudure, soudure-lente, non-soudure et prévention des complications. Les problème metallurgiques et les soins post-opérationnels sont soulignés. Zusammenfassung— Besprechung über mögliche Bruchkomplikationen, die bei Hunden und Katzen vorkommcn können. Die Komplikationen werden klassifiziert, wora ut die betreffenden Gegenstände unter den Titeln: schlech es Zusammenwachsen, verzögertes Zusammen wachsen, ausgebliebenes Zusammenwachsen und Komplikationsverhütung behandelt werden. Besonderes Gewicht wird auf metallurgische Probleme und postoperative Behandlung gelegt.     

Perineal hernia in the cat—a description of two cases

This paper describes two cases of perineal hernia in the cat, a condition so far unreported in this animal. One, a 10-year-old spayed female, had a history which could have explained the development of the condition. The other, a 15-month-oId male, had no apparent predisposing history. The surgical repair is described and aetiologies discussed.     

Transplanting the superficial gluteal muscle in the treatment of perineal hernia and flexure of the rectum in the dog

The authors distinguish between perineal hernia and flexure of the rectum. They describe in detail an operative procedure to treat these conditions using a transplanted superficial gluteal muscle to reinforce the ischio rectal fossa.     

Use of polypropylene mesh in addition to internal obturator transposition: a review of 59 cases (2000-2004)

Fifty-nine dogs with a total of 69 perineal hernias that were repaired by internal obturator transposition and polypropylene mesh reinforcement were reviewed. Thirty-six dogs were available for follow-up at a mean of 29.4 months postoperatively. Six dogs had complications within the first 60 days of surgery, such as perineal swelling, persistent tenesmus, and incisional infections. Twenty-two dogs had excellent outcomes; seven dogs needed continued medical treatment after surgery; and seven dogs had poor outcomes. Hernias recurred in five dogs. The incisional infection rate was 5.6%; the recurrence rate was 12.5%; and the overall success rate was 80.5% for the 36 dogs with long-term follow-up.     

Surgical treatment of perineal hernia in the dog

In a nine-year period 101 dogs which were available for subsequent follow-up studies, were subjected to perineal hernia surgery. In thirty-six dogs the hernia was bilateral and, therefore, 137 hernias were initially operated. In 111 operations the standard perineal technique was adopted. In twenty-six operations the superficial gluteal muscle was reflected and sutured into the hernial defect (‘gluteal flap’). Later, following recurrence of hernia or new development on the second side, a further sixteen operations were done, including three anal splitting procedures. In all cases the deep sutures were of monofilament nylon. A post-operative follow-up was carried out for a minimum period of 12 (average 39) months. The operative and post-operative complications included superficial and deep wound infection, partial or complete sciatic paralysis, rectal prolapse and recurrence of the hernia following breakdown of the repair, as well as occurrence of the hernia on the opposite side. The success rate (75 per cent excluding six immediate post-operative fatalities) judged by remission of signs and lack of recurrence was higher in the standard technique (81 per cent) than the gluteal flap method (64 per cent). Anal splitting was unsuccessful and resulted in faecal incontinence. The standard technique was slow, sometimes gave limited exposure but was rarely associated with wound breakdown (13 per cent of operations), though sciatic paralysis was only noted in this procedure. The gluteal flap method was longer, gave excellent exposure with no risk of sciatic nerve damage, but was often associated with wound breakdown (58 per cent). Both techniques led sometimes to rectal prolapse. Castration with hernial repair resulted in a lower recurrence rate (13 per cent v. 20 per cent). Castration should be carried out in all cases of perineal hernia.