Herniorrhaphy (Proceedings)

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Herniorrhaphy (Proceedings)

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Oct 01, 2008

Treatment

In hernias of traumatic origin, the animal should be examined for evidence of shock. if shock is associated with hemorrhage as a result of hepatic, renal or splenic rupture, immediate surgery may be necessary. The usual treatment of shock should be instituted and surgery should be delayed until the risks attending anesthesia are minimized. During the course of this treatment, strangulation may be prevented by reducing the hernia while the patient is under the influence of a tranquilizer or narcotic and the abdomen bandaged to prevent recurrence.

Surgical Repair of Ventral Hernia

When multiple hernias exist an attempt should be made to reach them with as few incisions as possible. After entering the abdominal cavity, the organs should be inspected and repaired if necessary. The rent in the abdominal wall is closed in layers. This may be simple with recent hernias because the various muscles are easily identified. In older hernias identification and apposition is more challenging. The sheath of the deepest muscle layer is sutured first; this is the transversus, which is identified. by its dorsoventral fibers and the fact that the transverse fascia and peritoneum adhere to its deepest surface, The internal abdominal oblique is sutured next, its fibers run cranioventrally. The external abdominal oblique with caudoventral fibers is sutured last.

Stainless steel or non-absorbable suture material may be used for closing a ventral hernia. When identification of the torn muscle edges is not possible, they are apposed as well as possible with a series of interrupted sutures. With large defects, when apposition is impossible or great tension will be exerted on the suture line, the wound may be reinforced with plastic* or wire mesh. Synthetic absorbable suture is used for placing the mesh. Mesh is cut to extend 3 - 5 cm beyond the wound edges and sutured using simple interrupted pattern.

Post-Operative Care

Complication can include peritonitis, evisceration and recurrence. Antibiotics are indicated to prevent infection; Evisceration is best prevented by confining the patient to a cage or otherwise limiting activity for one week post-operatively. Dressing of the wound with Telfa Wet Pruf Pad over the suture line and drain opening, followed by a support bandage around the abdomen, aids in the healing process. Careful client education regarding signs of wounds dehiscence, evisceration and infection are of primary importance.

Inguinal Hernias

These hernias are characterized by protrusion of intestine or other viscera through the inguinal canal. They are fairly common in the dog and occur more frequently in birches. Inguinal hernias are not common in the cat. In the birch inguinal hernias are found most often in the pregnant or old animal and the hernial sac may contain a gravid or diseased uterus. Inguinal hernias are rare in the neutered male dog. when present it may extend to become an inguinoscrotal hernia, Inguinal hernias in puppies may disappear spontaneously, Predisposition to inguinal hernia has been suggested and it may have a hereditary basis. A structural weakness can be present in the inguinal area of the bitch; The frequency of inguinal hernia in a pregnant birch may be attributed to increased abdominal pressure. Obesity can be a predisposing factor. The resistance of the mammalian inguinal region to herniation of viscera may depend on the neuromuscular reflex mechanism of the lower abdominal wall rather than on the resistance of the inguinal rings. Whether the lesion is congenital or acquired, there seems to be a structural defect in the region. The internal and external rings are almost superimposed and there is no intervening canal; thus a gap is present in the abdominal floor,

Clinical Signs

Inguinal hernia is manifested by a protrusion of abdominal contents near the inguinal canal. Although most inguinal hernias are unilateral, careful examination may reveal the condition to be bilateral, The hernial contents are soft, doughy, and painless on palpation; this varies, however, depending on the contents and length of rime that the hernia has been present. The swelling may be so small as to be obscured by the caudal mammary glands or fat pads. The swelling might be large enough to contain a gravid uterus or one with pyometra. When the hernia extends beyond the external ring in a caudal direction (labial hernia) it may be lateral to the vulva and may resemble a perineal hernia.