Background: Perineal hernia is a serious disease characterized by weakening or atrophy and separation of the muscles and fasciae of the perineal musculature, followed by the caudal displacement of pelvic and abdominal organs to the perineum region. Treatment is invariably surgical and several approaches have been proposed, but complication and recurrence rates remain high. This study aimed to evaluate 120 cases of perineal hernia treated at the Veterinary Hospital of Uberaba (HVU) from 2005 to 2020, addressing the clinical and surgical aspects and the postoperative period, seeking to identify the most relevant factors to improve care and treatment of future patients affected by this disease.Materials, Methods & Results: The medical records of dogs with a definitive diagnosis of perineal hernia were collected. The prevalence of perineal hernia was calculated. Data were obtained regarding sex, being castrated or not, age, body mass, race, clinical signs, affected side, possibility of hernia reduction, treatments used, associated pathologies. Of the 120 cases, only 69 underwent surgery at the HVU and from these cases data were obtained regarding hernia content, surgical techniques, surgical wires used, recurrences and postoperative complications. Fisher's exact test was applied to assess the influence of the type of surgical treatment and surgical thread on the occurrence of complications and recurrences. Perineal hernia was the second most frequently observed hernia. Mixed breed, male, non-neutered and geriatric dogs were the most affected. The most frequently observed clinical signs were related to the digestive and urinary tract, consistent with the most commonly found hernia contents (bladder, prostate and rectum). The simple herniorrhaphy technique was the most used and showed a high number of complications. The second most used technique was the elevation of the internal shutter, which proved to be more efficient than the simple technique. Regardless of the technique used, the association of two or more techniques proved to be more efficient to reduce major complications. The use of the vaginal tunic stood out because it proved to be efficient in the treatment of perineal hernias regardless of whether it is associated with simple herniorrhaphy or obturator elevation. The surgical fixations of abdominal organs (Bladder, Ducto deferente and Colon) proved to be effective, since there were no recurrences or major complications associated with their use and the most used threads for herniorrhaphy were polyamide and catgut. Low recurrence rates were found in patients who received synthetic yarns. The most frequent complications were suture dehiscence and serous secretion.Discussion: Perineal hernia is a very important alteration due to difficulties in treatment, high rates of complications and recurrence, in addition to the large number of affected dogs. Several surgical techniques have already been proposed for the treatment of perineal hernia in dogs and are based on the reconstruction of the perineal musculature through sutures, muscle flaps, biological membranes, synthetic mesh and the reduction of pressure on the perineum through the surgical fixation of organs abdominals such as colon, vas deferens and bladder (in the musculature of the abdominal wall). It is concluded that the perineal hernia affects mainly male, non-neutered and geriatric dogs, being rare in females. Regardless of the techniques used, the association of two or more techniques is more efficient to reduce the rate of recurrences and complications. The autogenous vaginal tunic is a good option for muscle strengthening in perineal herniorraphies. The use of synthetic surgical wires leads to better results in the treatment of perineal hernia when compared to biological wires.
Background: Hernias are changes with the displacement of organs from their normal anatomical location to a newly formed cavity, which can cause pain and dysfunction of the affected organ. The diagnosis can be obtained by palpation or by ultrasound. The treatment of choice is surgical and vision to promote the return of the organ to its normal anatomical position and the closure of the hernial ring. When affixing the edges of the hernial ring is not possible, alternative techniques such as the use of biological or synthetic membranes should be sought. The aim of the present study is to report an atypical case of inguinal hernia with splenic incarceration, in which splenectomy and herniorrhaphy with a bovine phrenic center were performed. Case: An 8-year-old large mestizo male dog was referred to the Veterinary Hospital of Uberaba complaining of the appearance of a mass in the inguinal region that increased significantly in the last 15 days. On physical examination, there was an increase in volume in the left inguinal region, irreducible and great pain sensitivity in the region. The hemogram showed normochromic normocytic anemia, hyperproteinemia and thrombocytopenia. No changes were observed in the biochemical analyzes. Urinalysis revealed the presence of protein and traces of occult blood. Ultrasound showed an enlarged spleen inside the hernial sac, closing the diagnosis of inguinal hernia. The animal underwent a herniorrhaphy procedure associated with the use of a biological membrane from a bovine phrenic center and splenectomy. In addition, contralateral inguinal hernia was observed. The animal remained hospitalized and under observation for three days. On return, after five days, the guardian reported that the animal was urinating by dripping and had increased volume in the region of the surgery. Urethral catheterization was performed without difficulty and the region of swelling was punctured, obtaining a serosanguinous liquid. Ten days after surgery, stitches were removed and contralateral herniorrhaphy and orchiectomy were recommended. The animal showed complete healing of the surgical wound, but did not return for treatment of the contralateral inguinal hernia.Discussion: Inguinal hernia is considered rare in male dogs, especially in non-neutered animals, and few cases have been described, most of which are over the age of four years. In the present report, the dog is male, not neutered and is eight years old, in line with the findings of the highest occurrence in this species. Inguinal hernia can be hereditary, congenital or acquired from trauma or hormonal changes, and its etiology is poorly understood. The dog in this report acquired this condition in adulthood, and it was not possible to define the cause of the hernia, however it is believed that there is a possibility of muscle weakness associated with the patient's weight. Inguinal hernia in non-neutered dogs usually progresses to inguino-scrotal hernia, and cases in the Brazilian queue breed have been described. In this work, the herniated content was irreducible contrary to what is generally reported. In inguinal hernia, the most observed content is the intestinal loops, but the bladder and colon have already been seen. In the animal in this report, the spleen appeared as herniated content. The diagnosis can be made by palpation when the hernia is reducible, but it does not allow the definition of the hernia content. In cases of incarcerated hernias, it is necessary to perform an ultrasound which also allows the definition of the hernia content. The recommended treatment is surgical by herniorrhaphy, as was done in this patient. During surgery, muscle atrophy was observed in the inguinal region, but the tutor did not authorize the placement of polypropylene mesh for financial reasons. The alternative used and authorized by the tutor was the use of a biological membrane that achieved a satisfactory result, with few complications in the postoperative period.
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