Surgical correction of Perineal hernia

1. Welcome

2. Speaker:
Girjesh Upmanyu.
Perineal Hernia in
Dogs.

3. HERNIA AND ITS
CLASSIFICATION

4. Hernia
• Abnormal protrusion of contents of a body
cavity through normal or abnormal
opening
• Constituents of hernia –
 Hernial ring
 Hernial sac
 Hernial contents – Intestine, Omentum,
Urinary Bladder, etc.

5. Classification
Based on Location :
i) External hernia – Ventral H, Inguinal H,
Umbl. H, Perineal H
ii) Internal Hernia – Diaph. H
Based on functional alterations:
i) Reducible
ii) Irreducible – incarcerated H
strangulated H

6. Classification
III. Based on hernial contents
i) Enterocoele – intestines
ii) Epliplocoele – Omentum
iii) Reticulocoele – reticulum
iv) Vesiculocoele – urinary bladder
IV. Based on cause
i) Congenital – anatomical variations
ii) Acquired – trauma

7. Diff diagnosis

8. Treatment:
• Reduction of contents and application of
bandages for 2-3 weeks
• Local infiltration of irritants
• Herniorrhaphy – suturing of hernial ring
• Hernioplasty – covering the gap
with mesh and suturing it
• Kelotomy – enlarging the hernial ring

9. Perineal hernia
• It is abnormal protrusion/ displacement of pelvic or
abdominal viscera through the weakened/ruptured
pelvic diaphragm into the region around the anus called
the perineum.
• It occurs when the perineal muscles separate, allowing
the rectal, pelvic or abdominal contents to displace.
• It is common in dog and un common in ruminants but
has been recorded in cattle and buffaloes
• This condition occurs secondary to a weakening of the
muscles

10. Pelvic diaphragm is composed of:
• Coccygeus muscle
• Levator ani muscle
• External anal sphincter muscles.

11. Anatomy

12. Etiology
• Cause of pelvic diaphragm weakening is poorly
understood but is believed to be associated with male
hormones
• Straining
• Congenital or acquired muscle weakness-tenesmus
• Atrophy
• Trauma
• Breed disposition – welsh corgies, boxers, boston
terriers,coolies
• Sex
• Tail docking
• Prostatic enlargement

13. Classifications of Perineal Hernia
• Based on Location
1. Unilateral
2. Bilateral
• Based on Position
1. Dorsal
2. Ventral
3. Sciatic or Caudal
Hernias

14. Hernial Contents and Hernial Sac
• Contents are contained in perineal fascia as perineal
peritonium is usaully intact so it forms the true sac
• Contents may include
1. Pelvic or retroperitneal fat
2. Peritonial fluid
3. A deviation, dilation or sacculation of the rectum
4. A rectal diverticulum
5. Prostrate gland
6. Urinary bladder
7. Small intestines

15. Diagnosis
• History
– Affected animals usually are presented for treatment because of
difficulty in defecation or urination
– Some owners notice swelling lateral to the anus
• Clinical signs
– Perineal swelling
– Constipation
– Dyschezia
– Tenesmus
– Rectal prolapse
– Stranguria
– Anuria
– Vomition
– Fecal incontenance
– Digital palpation of hernial ring

16. Differential diagnosis
• Perineal neoplasia
• Perineal gland
hyperplasia
• Anal sacculitis
• Anal sac neoplasm
• Perineal fistula
• Anal sac abscess
• Rectal neoplasia
• Anal trauma
• Anal dermatitis

17. Biochemical analysis
• If urinary bladder is involved( stranguria,anurea)
1. Raised serum urea
2. Raised serum creatinine
3. Raised phosphate concentrations
4. Raised serum potassium concentrations- usually after
24 hrs. of obstruction.

18. Diagnostic Imaging
• Usually not required
• Ultrasonography can be done to ascertain the
presence of absence of small intestine, prostrate, U
bladder
• Positive contrast cytogram – U.B.

19. Surgico-medicinal management
• The goal of treatment is to relieve and prevent
constipation, dysuria and organ strangulation
1. Conservative management
• Causative factors should be corrected
• Normal defection sometimes can be maintained using
laxative , stool softeners , dietary changes , enema.
• High fibre diet
• Occasional enema or manual evacuation of faeces

20. Cont…..
2. Surgical management
• Herniorrhaphy should always be recommended.
• Castration is recommended during herniorrhaphy
because it has been reported to reduce recurrence
• Non castrated dogs have a recurrence rate 2.7
times greater than castrated dogs.

21. Surgical Management:- Techniques
• Internal obturator
transposition
herniorraphy
• Traditional
Herniorapphy

22. Schematics of the internal obturator muscle
transposition procedure

23. Suture placement for Internal Obturator Transposition
herniorrhaphy
(1, external anal sphincter; 2, coccygeus muscle; 3
superficial gluteal muscle; 4, ischial tuberosity; 5,
internal obturator muscle; 6, retractor penis muscle)

24. Post Operative Complications
• Tenesmus
• Neuropraxia
• Urinary incontinence
• Surgical wound infections

25. Prognosis after surgery
• Favourable- 15% reoccurance
• Antibiotics, stool softeners, high fibre diet shall be
given
• Elizabethan collar
• Dogs with bilateral hernia shall have one side
repaired at a time

26. CASE NO:- 1318
A Soft puffy swelling palpable of the left side in the perineal
region just below the base of tail

27. Case no_1318

28. • History;
– Constipation
– Swelling on lateral side of anus from last 2 months
– Loss of appetite
• Clinical signs
– Perineal swelling
– Constipation
– Dyschezia
– Tenesmus

29. Diagnosis
Palpation of the affected site revealed
hernial ring
Based on history and clinical signs the case
was diagnosed as perineal hernia and
surgical intervention was advised

30. Premedication & Anaesthesia
• Atropine sulphate @ 0.04mg /kg b wt. i/m
• Diazepam @ 0.5mg/kg b wt. i/v
• Xylazine @ 2 mg/kg b wt. i/m
• Ketamine Hydrochloride @ 10 mg./kg b wt. i/v

31. SURGICAL
PROCEDURE

32. Prepared site

33. Positioning of the animal

34. Temporary closure of anus

35. After closure

36. Incision on the swelling

37. Hernial ring

38. Suturing of hernial ring

39. After closure

40. Skin closure

41. Post operative care
• Ceftriaxone @ 20 mg/kg b wt. i/m for 3 days
• Melonex @ 0.5 mg/kg b wt. i/m for 3 days
• CPM @ 0.25mg/kg b wt i/m
for 3 days
• Liquid diet for 5 days

42. Post Operative Dressing of the Suture Line.

43. Hernial Contents:

44. Thank
you