Repairing a perineal hernia is a lengthy affair for surgeons. Not only are the dogs often large, but the hernia is also of a corresponding size. The surgery can take time even in experienced hands, and before we get as far as to operate on the hernia itself, the dog should be neutered first. Sometimes the bladder or other abdominal contents have moved into the hernia, or the dog is cryptorchid, necessitating an abdominal procedure in addition. Usually we reposition these dogs after performing the castration and/or abdominal procedure in dorsal recumbency, so that the hernia can be operated on with the dog in sternal recumbency, tail up. This adds to the anesthesia time and requires help from other personnel as well as additional drapes and other equipment. Repositioning can lead to an increased risk of reflux and hypotension, and the risk of infection increases with increased time under anesthesia. The compliance of the airways can also be negatively affected by lying head down as with this procedure.

Could it be that you could carry out all the necessary procedures without repositioning the dog? Yes, says Karen Tobias, a renowned small animal surgeon and author. In April this year, she published a study in Veterinary Surgery together with a colleague, where they looked at the results after performing all procedures in dorsal recumbency, with the hind limbs tied forward and to the side of the abdomen.

23 dogs with perineal hernia received surgery in dorsal recumbency only. Of these, 22 received a transposition of the internal obturator muscle, while only one dog had a polypropylene mesh inserted. 18 of the dogs were castrated and/or had to undergo an abdominal procedure at the same time. The latter is often done if the dog is cryptorchid or if bladder, prostate or other abdominal organs have entered the hernia, which necessitates a -pexy. None of the dogs suffered intraoperative complications, but a total of 14 developed. complications during their stay in hospital, consisting of perineal swelling (5), dribbling from the wound (3), tenesmus (2), urine leakage (2), urine retention (1), redness of the wound (1), decreased appetite (1) and anorexia (1), aspiration pneumonia (1) and regurgitation (1). Eleven dogs had similar complications at home, and a total of 4 had to be treated with antibiotics for a wound infection within two weeks of surgery. Four dogs relapsed, but this occurrence appeared to be related to previous surgery, meaning that the risk of dehiscence increased if the dog had previously had surgery in the area. It is also worth mentioning that of the 4 dogs which developed postoperative regurgitation , three of them had parts of the jejunum in the hernial sac (!)

Although I have to admit that the number of complications was high, it is actually comparable to other publication in this field. It happens for several reasons, amongst them the age of the dogs (often old!), the lengthy procedure, and the fact that this area of the body is not particularly sterile.

The authors mention the retrospective nature of the study as a limitation but conclude that dorsal recumbency for all required procedures is feasible and, moreover, associated with the same outcome as when the dog is repositioned.

Next time I perform surgery on a dog with this problem, I will definitely give this a try!

(The image is borrowed from the publication, and here is a link to the study: https://doi.org/10.1111/vsu.13812)