Perineal hernia is a lengthy affair for us surgeons. Not only are we often dealing with a large dog, but the hernia is also of corresponding size. The operation can take time even in experienced hands, and before we get that far, we should castrate the dog first. Sometimes the bladder or other organs have herniated, or the dog is cryptorchid, requiring us to enter the abdomen during the same anesthesia. Traditionally, we have always repositioned these dogs after these procedures and turned them onto their stomachs to tackle the least aseptic procedure last: the herniorrhaphy. This feels like it takes forever and requires both assistance from other personnel as well as time and extra equipment. Additionally, repositioning can lead to increased risk of reflux problems and hypotension, and infection risk increases when the individual remains under anesthesia for long periods. Airway compliance can also be negatively affected by having the head down as dogs do in sternal recumbency.
Could it be possible to perform all necessary procedures without repositioning? Yes, according to Karen Tobias, a leader in small animal surgery. This April, she published a study in Veterinary Surgery with a colleague, examining the results of performing all procedures in one position – dorsal recumbency.
23 dogs with perineal hernia were operated on in dorsal recumbency. Of these, 22 were operated using internal obturator muscle transposition, while one received a polypropylene mesh implant. 18 of the dogs were castrated and/or required simultaneous abdominal surgery. The latter is often necessary if the bladder, prostate, or other organs have herniated and require a pexy, or if the dog is cryptorchid.
None of the dogs experienced intraoperative complications, but 14 had complications during their hospital stay, including perineal swelling (5), wound drainage (3), tenesmus (2), urinary leakage (2), urinary retention (1), wound redness (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 required antibiotic treatment for wound infection within two weeks after surgery. Four dogs experienced recurrence, but this appeared to be related to previous surgery; the risk of dehiscence increases if the dog has been operated on in the area before. It’s also worth noting that in 3 of the 4 dogs with regurgitation issues, the jejunum had herniated (!)
Although I must admit that I found the number of complications high, it is actually comparable with other literature in the field. This relates to many factors; older dogs often develop this problem, the procedure takes a long time, and we’re operating in a tricky area regarding infection risk. The authors acknowledge that the study is retrospective and not prospective, but conclude that dorsal recumbency for all procedures is achievable and associated with the same results as when repositioning.
I will definitely give it a try next time I get a dog with this problem!
(The image is borrowed from the article – and here is the link: https://doi.org/10.1111/vsu.13812)