Evaluation of Internal Obturator Muscle Transposition in Treatment of Perineal Hernia in Dogs

Abstract

A technique that utilizes transposition of the internal obturator muscle for repair of perineal hernias was evaluated. Forty-two male dogs were followed for at least one year after surgery. The repair failed in only one animal, a dog with previously operated bilateral hernias. Microangiography demonstrated an adequate blood supply to the transposed internal obturator muscles of two dogs examined at three weeks and three months after surgery. H E H I G H RECURRENCE RATE (15-46%y reportedT with conventional methods for repair of perineal hernias has led to the development of alternative techniques. Transplantation of the superficial gluteal muscle and transposition of the internal obturator muscle have been used."a4 Although the original report of superficial gluteal transplantation indicated a low recurrence rate,3 a recent study reported a higher recurrence rate than with conventional r e~a i r .~ Transposition of the internal obturator muscle has been used at the University of Georgia since 1978. A retrospective study was conducted to determine the efficacy of the internal obturator technique. Materials and MethodsSurgical repair consisted of transposition of the internal obturator muscle.5 The internal obturator muscle was elevated from the caudolateral ischium; the tendon of insertion was severed; and the muscle was transposed into the defect created by the hernia (Fig. 1). Sutures were placed between the internal obturator muscle, superficial gluteal muscle, and external anal sphincter (Fig. 2). If the levator ani muscle and coccygeus muscle were strong enough to hold sutures, these muscles were included in the repair. Some surgeons also placed sutures through the sacrotuberous ligament .Experienced surgeons performed the surgery on 36 dogs; interns or residents operated on six dogs. Monofilament nonabsorbable suture material was used in 20 operations. A combination of chromic catgut and monofilament nonabsorbable suture was used in 22 dogs. Unilateral surgery was used in the repair of 25 unilateral hernias. Three unilateral hernias had bilateral repairs because of weakness on the opposite side. All dogs but one with bilateral hernias were treated with bilateral surgical repair. In one dog, a large suture abscess from a previous surgery prevented repair of one side. Of the 42 dogs, 41 were castrated using a prescrotal or caudolateral approach.G Permission for castration was refused in one case.Owners were contacted by telephone a minimum of one year after surgery. They were asked questions concerning complications such as fecal incontinence, continued dyschezia, recurrence of the hernia, or other unrelated problems with the dog. Results were classified as follows: Excellent-no special management of the animal required, no evidence of tenesmus, and no recurrence of the operated hernia; Good-no recurrence of the operated hernia, but one or more problems related to the perineal hernia or its surgical repair developed or continued; and Poor-recurrence of the operated hernia, permanent fecal incontinence, or conti...

A modified salvage technique in surgical repair of perineal hernia in dogs using polypropylene mesh

“…Transposition of the internal obturator muscle reduced the recurrence rate of perineal hernia to under 10%. In one study only 2.4% of dogs had a recurrence (Hardie et al, 1983).…”

Surgical findings and clinical outcome after bilateral repair of apparently unilateral perineal hernias in dogs

“…Internal obturator muscle transposition (IOT) is currently the technique preferred by most surgeons (Hardie et al . , Orsher & Johnston , Van Sluijs & Sjollema , Bellenger & Canfield , Grand et al . , Shaughnessy & Monnet ).…”

“…Because hormonal‐induced changes are believed to play a major role in pathogenesis, it is widely accepted that concomitant castration is required to resolve any prostatic hyperplasia and reduce the recurrence rate after PH repair (Spreull & Frankland , Hardie et al . , Orsher & Johnston , Frankland , Chambers & Rawlings , Stoll et al . , Bongartz et al .…”

Perineal Hernia Repair Using an Autologous Tunica Vaginalis Communis in Nine Intact Male Dogs

“…The recurrence rates have been reported from zero to 18.75% after TIOM [11,19,24,27,28], and zero to 12.5% after the use of a polypropylene mesh [9,26,28]. Principally, a surgeon should avoid the technique using foreign material when one utilizing the patient's own tissue is possible [28].…”

“…Among the techniques attempted to avoid reherniation, transposition of the internal obturator muscle (TIOM) is the most reliable technique and considered now the conventional herniorrhaphy. The transposed muscle increases strength of the ventral perineum where most hernias occur [11,19,24,27,28]. The reports on the herniorrhaphy utilizing other patient's own tissues for closing the defect include transposition of the superficial gluteal muscle [22,29], semitendinosus muscle [8] and fascia lata [5].…”