Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Veterinary and Animal Science: S. Guerios, K. Orms, M.A. Serrano T

Download as pdf or txt
Download as pdf or txt
You are on page 1of 7

Veterinary and Animal Science 9 (2020) 100122

Contents lists available at ScienceDirect

Veterinary and Animal Science


journal homepage: www.elsevier.com/locate/vas

Original Article

Autologous tunica vaginalis graft to repair perineal hernia in shelter dogs T


a,⁎ b b
S. Guerios , K. Orms , M.A. Serrano
a
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Univerity of Florida, 2015 SW 16th Avenue, Gainesville, FL 32608 USA
b
Miami-Dade County Animal Services Pet Adoption and Protection Center, 3599 NW 79th Avenue, Doral, FL, 33122 USA

A R T I C LE I N FO A B S T R A C T

Keywords: In an effort to reduce shelter intake, Miami-Dade Animal Services (MDAS) Pet Retention Program offers care-
Autograft takers with an opportunity to have animals treated for certain medical conditions, free of charge. Discovery of
Perineal hernia new, simple surgical techniques for low-cost procedures provides veterinarians with more surgical solutions,
Tunica vaginalis communis expands the capacity for services provided through low-cost veterinary clinics and other shelter programs, and
Pet-relinquishment
provides shelters with life-saving alternatives that will increase adoptability of homeless pets and reduce eu-
Shelter medicine
thanasia rates. The aim of this clinical trial was to describe and to evaluate the use of the autologous tunica
vaginalis communis as a free graft to repair perineal hernia (PH) in intact male dogs at an animal shelter facility.
In 2018, seven male intact dogs, diagnosed with perineal hernias (PH), were presented to MDAS. All dogs had
the surgical reconstruction of the pelvic diaphragm repaired by using the tunica vaginalis communis obtained at
the time of castration, prior to the perineal access, and sutured directly into the perineal defect. Clinical outcome
including postoperative complications and hernia recurrence were obtained via telephone communication. The
median follow-up time was 13 months. None of the dogs included in this study had recurrence of the PH. All dogs
were adopted, were transferred to animal rescue organizations or were returned to their owners after the surgical
procedure. The use of tunica vaginalis communis autograft is a simple, low-cost surgical technique that requires
less surgical expertise and training and can be used for perineal herniorrhaphy in dogs, without long-term
recurrence.

Introduction diaphragm results in lateral deviation of the rectum or protrusion of


abdominal or perineal viscera into the perineum (Biondo-Simoes et al.,
The efforts to reduce euthanasia and increase live release rates 2017). The underlying cause of the weakening is not completely de-
(LRR) in shelters have drastically increased (Griffin et al., 2016). The termined, although it is likely to be multifactorial (Merchav et al.,
ability to perform more advanced surgical procedures such as hernia 2005). Diagnosis is made based on clinical signs and through a rectal
repair on shelter patients, represents a critical component in improving examination. Clinical signs will depend on the hernia contents and may
live outcomes, by improving adoptability, and reducing euthanasia include perineal swelling lateral to the anus, tenesmus, dysquesia, fecal
rates in shelters. The ability to perform more advanced surgical pro- incontinence and dysuria (Hosgood et al., 1995).
cedures on shelter patients represents a critical component in im- Surgical reconstruction of the pelvic diaphragm is usually re-
proving live outcomes, by improving adoptability, and reducing eu- commended for PH repair. Surgical techniques including simple muscle
thanasia rates in shelters. The most common surgical procedures apposition, muscle flap transposition (internal obturator muscle, su-
performed at Miami-Dade Animal Services (MDAS) besides sterilization perficial gluteal muscle, semitendinosus muscle) (Mortari et al., 2005;
surgeries include enucleations, limb amputations, wound repairs, Morello et al., 2015) and the use of implants or graft techniques (syn-
hernia corrections, eyelid defects, skin grafts, mastectomies and other thetic mesh, porcine small intestinal submucosa, canine small intestinal
mass removals. These procedures are performed following basic sur- submucosa, autologous tunica vaginalis) have been described to treat
gical standards; however, an effort is made on minimizing costs and PH (Stoll et al., 2002; Tanaka et al., 2004; Szabo et al., 2007; Lee et al.,
targeting animals that are at most risk for relinquishment and eu- 2012; Pratummintra et al., 2013; Guerios, et al., 2017). Some reports
thanasia due to their presenting medical conditions. recommend a combination of colopexy, vasopexy and/or cystopexy,
A perineal hernia (PH) is a common disorder in mature male intact and perineal herniorrhaphy due to severe displacement of organs
dogs (Gill and Barstad, 2018). A structural weakness of the pelvic (Gilley et al., 2003; Brissot et al., 2004). Castration is recommended at


Corresponding author.
E-mail address: sdguerios@ufl.edu (S. Guerios).

https://doi.org/10.1016/j.vas.2020.100122
Received 21 October 2019; Received in revised form 28 May 2020; Accepted 29 May 2020
Available online 31 May 2020
2451-943X/ Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).
S. Guerios, et al. Veterinary and Animal Science 9 (2020) 100122

the time of herniorrhaphy to reduce the incidence of recurrence the hernia, 1-2cm lateral to the anus, extending from the base of the tail
(Snell et al., 2015). Frequent complications observed after PH repair to the midpoint between the ischial tuberosity and the pubis. The
include wound infection and dehiscence, persistence of clinical signs subcutaneous tissues were bluntly dissected until identification of the
such as tenesmus and fecal incontinence, rectal prolapse and hernia hernial sac. The hernial sac was incised and the herniated organs were
recurrence (Hosgood et al., 1995). identified and manually returned to anatomic position (Figure 3).
The tunica vaginalis communis has been experimentally used for After the hernia was reduced, the perineal structures were identi-
reconstruction of abdominal wall defects, urethral defects, urinary fied: dorsolaterally, the coccygeous and levator ani muscles; laterally,
bladder defects and hernia repair (Hafeez et al., 2005; Leslie et al., the sacrotuberous ligament; medially, the rectum and external anal
2009; Wongsetthachai et al., 2011). The autologous tunica vaginalis sphincter; and ventrally, the internal obturator muscle. The prepared
communis was described by Pratummintra (2013) to repair PH in 9 tunica was placed into the hernial defect with 4 horizontal mattress
dogs. In this report, a success rate of 90.91% was achieved by har- sutures (2/0 - 3/0 monofilament nonabsorbable polypropylene),
vesting the tunica vaginalis communis via closed orchiectomy prior to starting from the graft to the coccygeous, sacrotuberous ligment, peri-
the herniorrhaphy (Pratummintra et al., 2013). The aim of this case osteum of the ischial border and internal obturator muscle. Simple
study was to describe the successful use of a low-cost surgical technique continuous sutures were placed between the simple interrupted sutures,
that requires low surgical training and expertise as an alternative for PH including the tunica and the diaphragm muscles to keep the draft under
repair in shelter dogs as well as reporting the outcome and recurrence tension, so as to keep the pelvic and abdominal viscera reduced and to
rate in dogs treated with an autologus tunica vaginalis communis. support the rectal wall (Figure 4).
The subcutaneous tissue was closed over the graft using a simple
Materials and Methods continuous pattern (3/0 absorbable polyglycolic acid), and the skin was
apposed with cruciate interrupted pattern (3/0 absorbable polyglycolic
During 2018, ten male dogs were diagnosed with PH at the MDAS acid). Purse string was removed.
shelter. All animals included in the study were intact male dogs that
had a perineal hernia confirmed by rectal examination and were sur- Postoperative evaluation
gically treated with an autologous tunica vaginalis communis. Cases
with a minimum 11 months follow up were included. Pre-surgical All dogs received buprenorphine (0.02mg/kg, IM, every 12 hours
evaluation included clinical signs and a complete physical examination. for 3 days) post-operatively for 3 days, carprofen (4.4mg/kg orally
Three days before surgery, patients were prescribed lactulose (0.3ml/ every 24 hours for 5 days) and lactulose (0.3ml/kg, PO, twice a day for
kg, PO, twice a day) as a stool softener. Administration of subcutaneous 5-10 days). An Elizabethan collar was placed until suture removal.
Ringer Lactate fluids (25ml/kg) and manual removal of the feces were Follow-up information was provided by phone call. Attention was fo-
performed on the surgery day when fecal impaction was present. cused on post-operative clinical signs including difficulty to defecate,
local pain, blood on the stools, diarrhea, surgical site dehiscence and
Anesthesia and Analgesia infection and hernia recurrence.

Anesthesia and pain management protocols were similar for all Tunica vaginalis measurement
dogs. Dogs were anesthetized with a combination of dexmedetomidine,
ketamine and butorphanol (DKT) mixed in equal proportions. A parallel study was performed to correlate the dogs’ weight with
Anesthesia was induced by an intramuscular (IM) injection of DKT at the tunica vaginalis size. Seventy-one random dogs from the shelter,
0.06ml/kg. Cefovecina (8 mg/kg, SQ) and carprofen (4.4mh/kg, SQ) that were presented for routine neuter, were included. Dogs were
were administered to all dogs preoperatively. An endotracheal tube was weighted prior to anesthesia induction. These patients followed the
placed, and anesthesia was maintained with isoflurane at 100% oxygen same anesthesia, analgesia and closed pre-scrotal orchiectomy proto-
(1-2 l/min). Anesthesia was monitored by pulse-oximeter for the cols as PH dogs. After the vaginal tunic was harvested from the testicle
duration of the procedure. and opened along the greater curvature, the rectangular shape was
measured in centimeter (length top, left bottom, width left and width
Surgical technique right).

The skin of the perineum, scrotum and caudal aspect of the hind Results
limbs were clipped and aseptically prepared. The rectum was digitally
emptied, a gauze sponge was placed in the rectum and a temporary A total of 10 dogs were diagnosed with PH in 2018 (12-month
purse-string suture was placed around the anus. The dogs were posi- period). Seven sexually intact male dogs were included in the study,
tioned in dorsal recumbence for closed pre-scrotal orchiectomy. A with a total of 8 perineal hernias repaired. Three dogs were excluded
midline pre-scrotal incision was made over the cranially displaced from the study, two of them were already neutered and one had com-
testicle, into the subcutaneous tissue and the spermatic fascia, to allow plications during anesthetic induction and surgery was not performed.
exposure of the parietal vaginal tunic. The scrotal fat and fascia were Median age was 9 years old (ranged from 8 to 12, average 9.57 ± 1.51).
stripped from the tunica, the spermatic cords were ligated, and the The median weight was 5kg (ranged from 3.6 to 34, average
testicles were removed. The pre-scrotal incision was closed in two 14.64 ± 16.74). Six dogs had unilateral (5 left side hernias, 1 right side)
layers: both subcutaneous and intradermal layers were closed by simple and one dog had a bilateral PH. Clinical signs included perineal swel-
continuous patterns (monofilament absorbable suture) and the skin was ling (7), straining to defecate (7), constipation (3) and fecal impaction
apposed with tissue glue. (3). Periprostatic fat and omentum (3), small intestine (2), and rectum
The vaginal tunic was harvested from the testicle and opened along deviation (4) were found in the hernias at the time of surgery. Dogs’
the greater curvature of the testis with Metzenbaum scissors (Figure 1). outcome after surgery included return to owner via retention program
The tunic was placed between sterile gauze sponges and soaked with (2), adoption (2) and rescue with further adoption (3).
sterile ringer lactate solution until use. All dogs left the shelter 12-24 hours after the surgical procedure. We
Immediately after castration, dogs were placed in ventral re- recommended soft food diet and lactulose for 5 to 10 days. Follow-up
cumbency with lightly elevated hindquarters, the hind limbs were time ranged from 9 to 17 months (average 12.14 ± 2.97). Clinical
hanging over the edge of the surgical table and the tail was secured in a findings, hernia content and outcome for the 7 dogs included in the
cranial position (Figure 2). A dorsoventral skin incision was made over present study are summarized in Table 1. All dogs had excellent

2
S. Guerios, et al. Veterinary and Animal Science 9 (2020) 100122

Fig. 1. After a closed castration (A), the tunica vaginalis communis was opened along the greater curvature of the testis with Metsenbaum scissors (B), it was
harvested from the testicle (C) and a rectangular like shape was obtained.

outcomes. Two dogs presented difficulty to defecate, that was resolved 50 kg). Average weight and tunica vaginalis measurement are pre-
a week after the surgery. The owners, rescue partners and adopters sented in Table 2.
were aware that their pet had a PH repaired and informed that no
surgical site complications and PH recurrence were observed.
Seventy-one dogs that had the tunica vaginalis harvest for mea- Discussion
surement, were grouped by body weight (2 - 10 kg, 11 - 25 kg and 26 -
Among the reasons for dog surrender or euthanasia at shelters are

Fig. 2. Dogs were placed in ventral recumbence with lightly elevated hindquarters, the hind limbs were hanging over the edge of the surgical table and the tail was
secured in a cranial position.

3
S. Guerios, et al. Veterinary and Animal Science 9 (2020) 100122

Fig. 3. Intraoperative view of the PH access. A dorsoventral skin incision was made over the hernia and the herniated organs were identified after the hernial sac was
incised (A). After the hernia reduction, perineal structures were identified (B).

Fig. 4. The tunica vaginalis communis auto-


graft was placed into the perineal defect by
placing interrupted sutures between the tunica
and the coccygeous and levator ani muscles
(dorsolaterally), the sacrotuberous ligament
(laterally) and the internal obturator muscle
ventrally (A). A continuous simple suture pat-
tern was placed between the interrupted su-
tures and would include the pelvic diaphragm
and the graft (B). Final aspect of the graft
under tension in a patient with a unilateral left
side hernia (C) and a dog with bilateral PH (D).

medical conditions that are considered “demanding” of veterinary Conditions requiring surgery are often the cause of pet relinquishment
treatment (Lund et al. 2010; Lambert et al., 2015). The implementation due to affordability of these procedures as well as the impact they have
of novel and attainable surgical techniques in the veterinary field re- on the pet's quality of life when not appropriately treated. The present
duces pet relinquishment and decreases euthanasia of dogs and cats. study demonstrates that by providing a reliable and affordable tech-
Some of these procedures often require a certain level of surgical nique that requires less surgical expertise, will broaden the availability
training and expertise that will result in services not available to the pet of this surgical procedure throughout veterinary practices, which might
caretakers seeking low-cost veterinary services. reduce pet relinquishment and euthanasia. In shelters, this technique
Perineal hernias are frequently observed in intact mature male dogs. will also increase the chances for a positive outcome and reduce the

4
S. Guerios, et al. Veterinary and Animal Science 9 (2020) 100122

Table 1
Clinical characteristics at presentation, intraoperative findings, patient outcome and follow up month of seven dogs repaired by autologous tunica vaginalis com-
munis.
Dog Age, Breed, Weight Perineal hernia Clinical signs at presentation Intraoperative findings (hernia Patient outcome Follow up (months)*
side contents)

1 8y, Rottweiler, 34kg Left Perineal swelling, dyschezia, constipation, Rectum deviation rescue 17
fecal impaction
2 11y, Terrier mix, 6.3kg Bilateral Perineal swelling, dyschezia Right side (Small intestines) retention 14
Left Side (omentum, fat)
3 12y, Terrier mix, 5.4kg Right Perineal swelling, dyschezia Rectum deviation retention 14
4 10y, Chihuahua, 4.5kg Left Perineal swelling, dyschezia Small intestines, omentum, fat rescue 11
5 9y, Yorkshire, 5kg Left Perineal swelling, dyschezia, constipation, Rectum deviation rescue 11
fecal impaction
6 8y, Chihuahua, 3.6kg Left Perineal swelling, dyschezia Omentum, fat, rectum deviation rescue 11
7 9y, Terrier mix, 5kg Left Perineal swelling, dyschezia, constipation, Rectum deviation rescue 11
Fecal impaction

Table 2
Dogs average weight ( ± standard deviation) and tunica vaginalis measurement (length and width; ± standard deviation) after pre-scrotal castration.
Weight Group (kg) Length top (cm) Length bottom (cm) Width left (cm) Width right (cm)

6.31 ( ± 5.56) 5.26 ( ± 1.03) 5.13 ( ± 1.2) 4.77 ( ± 1.32) 4.76 ( ± 1.42)
17.92( ± 6.55) 6.96 ( ± 1.96) 6.68 ( ± 1.91) 5.71 ( ± 1.41) 5.86 ( ± 1.01)
31.89( ± 12.2) 10.24 ( ± 2.3) 9.52 ( ± 1.87) 8.47 ( ± 1.50) 7.97 ( ± 1.34)

length of stay (LOS) for shelter dogs. All dogs included in the study tissue (Wrobel, 1998). It has no antigenic properties
were adopted or returned to their owner via retention program. (Pratummintra et al., 2013), thus has been experimentally used for
The use of the autologous tunica vaginalis communis is an alter- reconstruction of urethral defects in rabbits (Atalan et al., 2005;
native in cases in which the internal obturator muscle is atrophied and Bongartz et al., 2005), abdominal wall defects in rats (Hafeez et al.,
is not viable to repair the perineal diaphragm, because it appears to 2005), umbilical hernias in sheep (Abass, 2008) and urinary bladder
have less postoperative complications such as infection rates than those wall defects in dogs (Wongsetthachai et al., 2011). After implantation,
reported with the use of synthetic mesh (Szabo et al., 2007). This neo capillaries and fibrous connective tissue from adjacent muscles will
technique also proved to be a technique that requires less surgeon ex- fill the graft (Pratummintra et al., 2013) thus strengthening the pelvic
pertise and is a suitable and low-cost alternative for PH repair in dogs. diaphragm.
These characteristics make this technique a feasible alternative for use There are few sources describing the use of tunica vaginalis com-
in low-cost settings such as shelters and nonprofit organizations, as well munis to repair PH. One study reported the use of pedicle flap with the
as private clinics and specialty practices. By using this technique, the tunica in one dog (Tanaka et al., 2004), and a second study successfully
pelvic diaphragm was strengthened, and the hernias were repaired reported the application of a free graft in 9 dogs (Pratummintra et al.,
without recurrence or major complications within 11-18 months. 2013). Compared to the pedicle flap, the graft is less technical since the
Internal obturator muscle transposition is the conventional proce- flap requires implantation into the perineal region via the abdominal
dure for PH repair, although difficulties in restoring the pelvic dia- cavity (Tanaka et al., 2004). Compared to the fascia lata graft, the tu-
phragm due to muscle atrophy (Shaughnessy and Monnet, 2015), sur- nica vaginalis communis does not require an additional surgical site,
geon inexperience (Sjollema and Van Sluijs, 1989; Marretta and since routine castration is usually performed simultaneously with the
Matthiesen, 1989; Orsher, 1989), and recurrence have been reported PH repair (Pratummintra et al., 2013). Fascia lata grafts can be asso-
(Sjollema and Van Sluijs, 1989;Shaughnessy and Monnet, 2015). The ciated with donor site morbidity including seroma, hematoma, pain,
treatment for PH with a lateral rectal sacculation has been successfully wound dehiscence and lameness of the donor limb (Bongartz et al.,
achieved with the transposition of internal obturator muscle, while a 2005; Lambert et al., 2015). Castration performed at the time of the PH
rectal ventral support has been effectively achieved by the semi- repair causes the prostate gland to atrophy within 2-3 weeks. Increased
tendinous muscle transposition. The combination of both techniques prostate size is related to constipation, which may result in rectal sac-
can be used to provide lateral and ventral support with lower recur- culation/diverticulum and PH recurrence (Hosgood et al., 1995;
rence rate (Morello et al., 2015). The combination of these two tech- Snell et al., 2015; Hayashi et al., 2016).
niques to repair the pelvic diaphragm is a complex and advanced sur- Minor modifications of the technique previous described by
gical procedure that cannot be learned easily without proper surgical Patrummintra (2013), were made to allow a faster and easier surgical
training and expertise, which creates a challenge to non-certified ve- procedure. The tunica was harvested and cut along the greatest cur-
terinary surgeons. vature, achieving a rectangle shape. The longest side of the tunica was
In this study, a free graft of the autologous tunica vaginalis com- oriented dorsal to ventral to the pelvic diaphragm muscles and sutured.
munis was used to fill in the pelvic diaphragm. Various biomaterials The decision was made not to cut the tunica in a triangle shape to ac-
have been used to repair PH, including fascia lata, canine small intes- count for the possibility of intense muscle atrophy and ensure coverage
tine submucosa and tunica vaginalis communis (Lee et al., 2012; of the entire defect in every case. The graft was placed at the pelvic area
Pratummintra et al., 2013; Guerios et al., 2017). Biomaterials are pre- with four (4) simple interrupted sutures. Subsequently, simple con-
ferable over synthetic mesh materials, since fewer postoperative com- tinuous sutures were placed between the previous interrupted sutures.
plications have been reported (Gill and Barstad, 2018). Advantages of The continuous sutures were intended to provide tension on the graft
the use of autologous tissue when reconstructing the pelvic diaphragm and to close any gaps between the sutures. These modifications allowed
includes a reduction of foreign body reactions, postoperative seromas us to obtain a steady pelvic diaphragm and optimized surgical time. A
and wound infections. The tunica vaginalis communis originates from polypropylene monofilament nonabsorbable suture material, was used
the peritoneum, and it is composed of mesothelium and connective for suturing, because it is relatively inert and provides strength for a

5
S. Guerios, et al. Veterinary and Animal Science 9 (2020) 100122

sustained period (Aronson, 2018). may interfere with the veterinary doctors’ decision to not treat this
The incorporation of the sacrotuberous ligament was considered disorder. This decision may have variable impacts on the animal out-
primordial to achieve surgical success. The sacrotubeous ligament has a come, leading to animal relinquishment and in some cases euthanasia.
persistent stiffness and has the ability to replace the coccygeal muscle The most suitable technique to prevent or treat PH will rely on sur-
that in many of these cases is atrophied. Sciatic nerve entrapment has geon's ability and experience. We demonstrated that the surgical
been described on PH repairs that include the sacrotuberous ligament treatment of PH with autologous tunica vaginalis communis graft is a
(Khatri-Chhetri et al., 2016). In the present study, the ligament was low-cost procedure, that requires minimal surgical training and ex-
penetrated instead of being encircled. Care was taken to place the pertise which allows adequate filling of the pelvic diaphragm defect,
needle close to the ischiatic attachment in order to avoid sciatic nerve providing sufficient perineal strength to avoid recurrence.
damage. No patient presented sciatic nerve dysfunction during the
follow up time. Declaration of Competing Interest
An abdominal approach combined with the perineal repair had been
recommended to treat bilateral and complicated PH. Colopexy, cysto- None of the authors has any financial or personal relationships that
pexy and vas deferens pexy performed prior to the PH repair can reduce could inappropriately influence or bias the content of the paper.
the risk of recurrence and facilitates herniorrhaphy (Brissot et al.,
2004). In the present study, these techniques were not performed, since References
the anatomical reposition of the hernia contents were easily obtained
during the PH repair and post operatory recurrence was not observed. Abass, B. T. (2008). Bovine Tunica Vaginalis: A New Material for Umbilical Hernioplasty
To investigate the coverage capacity of the tunica vaginalis auto- in Sheep. Iraqui Journal of Veterinary Science, 22(2), 69–76.
graft we measured the size of the graft, after harvesting it from healthy Aronson, L. A. (2018). Rectum, anus, and perineum. In K. M. Tobias, & S. A. Johnston
(Vol. Eds.), Veterinary Surgery: Small Animal: 2 vols, (pp. 1591–1598). St. Louis, MO:
dogs that were presented for neuter. We hypothesized that the size of Elsevier Inc.
the tunica is proportional to the dog weight and that would be adequate Atalan, G., Sozmen, M., & Ozaydin, I. (2005). Repair of Urethral Defects Using Fascia Lata
to cover the perineal defect. The observation that larger dogs (21 – 50 Autografts in Dogs. Veterinary Surgery, 34(5), 514–518. 10.1111/j.1532-950X.2005.
00077.x.
kg) presented with a considerably larger surface area when compared Bellenger, C. R. (1980). Perineal Hernia in Dogs. Australian Veterinary Journal, 56(9),
with smaller dogs (2 – 20 kg) did not affect surgical repair. The authors 434–438.
believe that the dogs’ size does not restrict the correction of the PH with Bernarde, A., Rochereau, P., Matres-Lorenzo, L., & Brissot, H. (2018). Surgical Findings
and Clinical Outcome after Bilateral Repair of Apparently Unilateral Perineal Hernias
the tunica vaginalis, since we were able to successfully cover the in Dogs. The Journal of Small Animal Practice, 59(12), 734–741. 0.1111/jsap.12920.
perineal defect in all patients. Biondo-Simoes, M., de, L. P., Carvalho, L. B., Conceicao, L. T., Dos Santos, K. B. P., Schiel,
The age, sex and neuter status of affected dogs were consistent with W. A., Arantes, M., da Silveira, T., Magri, J. C., & Gomes, F. F. (2017). Comparative
Study of Polypropylene versus Parietex Composite(R), Vicryl(R) and Ultrapro(R)
previously studied populations (Hosgood et al., 1995; Snell et al., 2015;
Meshes, Regarding the Formation of Intraperitoneal Adhesions. Acta Cirurgica
Aronson, 2018). In contrast with previous studies, most dogs were Brasileira, 32(2), 98–107. 10.1590/s0102-865020170202.
presented with left side PH (Bellenger, 1980; Brissot et al., 2004) and Bongartz, A., Carofiglio, F., Balligand, M., Heimann, M., & Hamaide, A. (2005). Use of
only one with bilateral PH. The proposed technique allowed the cor- Autogenous Fascia Lata Graft for Perineal Herniorrhaphy in Dogs. Veterinary Surgery,
34(4), 405–413. 10.1111/j.1532-950X.2005.00062.x.
rection of one dog with bilateral PH, since we are able to harvest tunica Brissot, H. N., Dupré, G. P., & Bouvy, B. N. (2004). Use of Laparotomy in a Staged
from both testicles during castration. The suggestion that PH may be Approach for Resolution of Bilateral or Complicated Perineal Hernia in 41 Dogs.
unilateral during physical exam should always be questioned, con- Veterinary Surgery, 33(4), 412–421. 10.1111/j.1532-950X.2004.04060.x.
Gill, S. S., & Barstad, R. D. (2018). A Review of the Surgical Management of Perineal
sidering that the pelvic diaphragm weakness is generally bilateral. Hernias in Dogs. Journal of the American Animal Hospital Association Journal of the
Correction of both sides should be considered, even when at the pre- American Animal Hospital Association, 54(4), 179–187. 10.5326/JAAHA-MS-6490.
sentation clinical signs are apparently unilateral (Bernarde et al., 2018). Gilley, R. S., Caywood, D. D., Lulich, J. P., & Bowersox, T. S. (2003). Treatment with a
Combined Cystopexy-Colopexy for Dysuria and Rectal Prolapse after Bilateral
Even though we only treated one dog bilaterally, we do recommend Perineal Herniorrhaphy in a Dog. Journal of the American Veterinary Medical
that PH should be treated as a bilateral disease regardless of its clinical Association, 222(12), 1717–1721. 1706 10.2460/javma.2003.222.1717.
presentation. Patients will benefit from systematic bilateral repair, since Griffin, B., Bushby, P. A., McCobb, E., White, S. C., Rigdon-Brestle, K. Y., Appel, L. D.,
Makolinski, K. V., Wilford, C. L., Bohling, M. W., Eddlestone, S. M., Farrell, K. A.,
it may avoid further surgical procedures for PH repair.
Fergunson, N., Harrison, K., Howe, L. M., Isaza, N. M., Levy, J. K., Looney, A., Moyer,
Urinary disorders, tenesmus, persisting straining and rectal prolapse M. R., Roberttson, S. A., & Tyson, K. (2016). The Association of Shelter Veterinarians.
had been described as an early postoperative complication. Transient Veterinary Medical Care Guidelines for Spay-Neuter Programs. Journal of the
American Veterinary Medical Association, 249(2), 165–188. https://doi.org/10.2460/
urinary incontinence and transient stranguria may be observed post-
javma.249.2.165.
operatively, even in dogs that do not present dysuria before surgery Guerios, S. D., Monteiro, F. M., & Da Silva, D. M. (2017). Fascia Lata Flap to Repair
(Brissot et al., 2004). All dogs in this study left the shelter with a rescue Perineal Hernia in Dogs: A Preliminary Study. Turkish Journal of Veterinary and
group, adopters or were returned to their owners 12 to 24 hours after Animal Sciences, 41, 686–691. 10.3906/vet-1703-32.
Hafeez, Y. M, Bakar, A. Z., Mohamed, Y. L., Mohamed, M. N., & Norimah, Y. (2005).
the surgical procedure. Postoperatively, we were able to obtain clinical Comparative Evaluations of the Processed Bovine Tunica Vaginalis Implant in a Rat
information via phone call, which included questions about post- Model. Anatomical Science International, 80(4), 181–188. https://doi.org/10.1111/j.
operative complications, hernia recurrence and quality of life. A few 1447-073X.2005.00111.x.
Hayashi, A. M., Rosner, S. A., Assumpcao, T. C. A., Stopiglia, A. J., & Matera, J. M. (2016).
post-operatory complications were reported, mostly related with diffi- Retrospective Study (2009-2014): Perineal Hernias and Related Comorbidities in
culty to defecate that was resolved after 2-3 days. One of the limitations Bitches. Topics in Companion Animal Medicine, 31(4), 130–133. https://doi.org/10.
of this study was the inability to perform live post-operative physical 1053/j.tcam.2016.10.004.
Hosgood, G., Hedlund, C. S., Pechman, R. D., & Dean, P. W. (1995). Perineal
exams on the patients instead of via a telephone questionnaire 9-12 Herniorrhaphy: Perioperative Data from 100 Dogs. Journal of the American Animal
months after the procedure; thus, limiting the early postoperative Hospital Association, 31(4), 331–342. 10.5326/15473317-31-4-331.
follow up. Recurrence is a complication that can occur early or later (> Khatri-Chhetri, N., Khatri-Chhetri, R., Chung, C. S., Chern, R. S., & Chien, C. H. (2016).
The Spatial Relationship and Surface Projection of Canine Sciatic Nerve and
6 months after the initial surgical procedure) (Snell et al., 2015). The
Sacrotuberous Ligament: A Perineal Hernia Repair Perspective. PloS One, 11(3),
mean follow-up time of 12 months was adequate to demonstrate the e0152078. https://doi.org/10.1371/journal.pone.0152078.
long-term efficacy of the autologous tunica vaginalis communis graft Lambert, K., Coe, J., Niel, L., Dewey, C., & Sargeant, J. M. (2015). A Systematic Review
and Meta-Analysis of the Proportion of Dogs Surrendered for Dog-Related and
technique.
Owner-Related Reasons. Preventive Veterinary Medicine, 118(1), 148–160. https://doi.
org/10.1016/j.prevetmed.2014.11.002.
Conclusions Lee, A. J., Chung, W. H., Kim, D. H., Lee, K. P., Suh, H. J., Do, S. H., Eom, K. D., & Kim, H.
Y. (2012). Use of Canine Small Intestinal Submucosa Allograft for Treating Perineal
Hernias in Two Dogs. Journal of Veterinary Science, 13(3), 327–330. https://doi.org/
The seemly invasive nature of the surgical procedure to repair PH

6
S. Guerios, et al. Veterinary and Animal Science 9 (2020) 100122

10.4142/jvs.2012.13.3.327. 1292/jvms.11-0478.
Leslie, B., Barboza, L. L., Souza, P. O., Silva, P. S., Delcelo, R., Ortiz, V., & Macedo, A. Jr Shaughnessy, M., & Monnet, E. (2015). Internal Obturator Muscle Transposition for
(2009). Dorsal Tunica Vaginalis Graft plus Onlay Preputial Island Flap Urethroplasty: Treatment of Perineal Hernia in Dogs: 34 Cases (1998-2012). Journal of the American
Experimental Study in Rabbits. Journal of Pediatric Urology, 5(2), 93–99. 10.1016/j. Veterinary Medical Association, 246(3), 321–326. https://doi.org/10.2460/javma.246.
jpurol.2008.09.003. 3.321.
Lund, H. S., Eggertsson, S., Grondahl, A. M., & Eggertsdottir, A. V. (2010). Views on Sjollema, B. E., & Van Sluijs, F. J. (1989). Perineal Hernia Repair in the Dog by
Euthanasia and the Rehoming of Dogs in Norway and Iceland. The Veterinary Record, Transposition of the Internal Obturator Muscle. II. Complications and Results in 100
166(24), 749–752. https://doi.org/10.1136/vr.b4856. Patients. The Veterinary Quarterly, 11(1), 18–23. https://doi.org/10.1080/01652176.
Marretta, S. M., & Matthiesen, D. T. (1989). Problems Associated with the Surgical 1989.9694191.
Treatment of Diseases Involving the Perineal Region. Problems in Veterinary Medicine, Snell, W. L., Orsher, R. J., Larenza-Menzies, M. P., & Popovitch, C. A. (2015). Comparison
1(2), 215–242. of Caudal and Pre-Scrotal Castration for Management of Perineal Hernia in Dogs
Merchav, R., Feuermann, Y., Shamay, A., Ranen, E., Stein, U., Johnston, D. E., & Shahar, between 2004 and 2014. New Zealand Veterinary Journal, 63(5), 272–275. https://
R. (2005). Expression of Relaxin Receptor LRG7, Canine Relaxin, and Relaxin-like doi.org/10.1080/00480169.2015.1023858.
Factor in the Pelvic Diaphragm Musculature of Dogs with and without Perineal Stoll, M. R., Cook, J. L., Pope, E. R., Carson, W. L., & Kreeger, J. M. (2002). The Use of
Hernia. Veterinary Surgery, 34(5), 476–481. https://doi.org/10.1111/j.1532-950X. Porcine Small Intestinal Submucosa as a Biomaterial for Perineal Herniorrhaphy in
2005.00072.x. the Dog. Veterinary Surgery, 31(4), 379–390. https://doi.org/10.1053/jvet.2002.
Morello, E., Martano, M., Zabarino, S., Piras, L. A., Nicoli, S., Bussadori, R., & Buracco, P. 33596.
(2015). Modified semitendinosus muscle transposition to repair ventral perineal Szabo, S., Wilkens, B., & Radasch, R. M. (2007). Use of Polypropylene Mesh in Addition to
hernia in 14 dogs. The Journal of Small Animal Practice, 56(6), 370–376. https://doi. Internal Obturator Transposition: A Review of 59 Cases (2000-2004). Journal of the
org/10.1111/jsap.12342. American Animal Hospital Association, 43(3), 136–142. https://doi.org/10.5326/
Mortari, A. C., Rahal, S. C., Resende, L. A., Dal-pai-silva, M., Mamprim, M. J., Correa, M. 0430136.
A., & Antunes, S. H. (2005). Electromyographical, Ultrasonographical and Tanaka, S., Asano, K., Yamaya, Y., Sato, T., Tsumagari, S., & Nagaoka, K. (2004).
Morphological Modifications in Semitendinous Muscle after Transposition as Ventral Reconstructive Surgery of the Pelvic Diaphragm Using the Tunica Vaginalis
Perineal Muscle Flap. Journal of Veterinary Medicine Series A, 52(7), 359–365. https:// Communis in a Dog with Perineal Hernia. Journal of Japan Veterinary Medical
doi.org/10.1111/j.1439-0442.2005.00739.x. Association, 57(7), 451–454. https://doi.org/10.12935/jvma.1951.57.451.
Orsher, R. J. (1989). Problems and Complications Associated with Colorectal Surgery. Wongsetthachai, P., Pramatwinai, C., Banlunara, W., & Kalpravidh, M. (2011). Urinary
Problems in Veterinary Medicine, 1(2), 243–253. Bladder Wall Substitution Using Autologous Tunica Vaginalis in Male Dogs. Research
Pratummintra, K., Chuthatep, S., Banlunara, W., & Kalpravidh, M. (2013). Perineal in Veterinary Science, 90(1), 156–159. https://doi.org/10.1016/j.rvsc.2010.05.015.
Hernia Repair Using an Autologous Tunica Vaginalis Communis in Nine Intact Male Wrobel, K. H. (1998). Conective and Supportive Tissues. H. D. Dellmann, & J. Eurell
Dogs. The Journal of Veterinary Medical Science, 75(3), 337–341. https://doi.org/10. (Eds.). Conective and Supportive Tissues, Textbook of Veterinary Histology, 61–79.

You might also like