Diaphragmatic Hernia

Question 1

What is a diaphragmatic Hernia

Answer 1

A diaphragmatic hernia is a tear in the diaphragm, the muscular structure that separates the abdominal cavity from the thoracic cavity. This allows for the stomach, liver and other organs to herniate through the opening, resulting in a diaphragmatic hernia.

Question 2

Clinical signs of a diaphragmatic hernia

Answer 2

Patients will usually present with respiratory distress and other injuries such as fractures or lung haemorrhage, and they may be in shock.

Question 3

When is a heniorrhaphy performed

Answer 3

usually within 24 hours after the incident occured. UNLESS the patient is is severe respiratory distress or cyanotic

Question 4

Pre op

Answer 4

These patients should be kept in sternal recumbency or a position they are most comfortable in as long as this does not exacerbate their respiratory distress. Oxygen therapy must be administered pre-operatively. These patients should be handled gently and carefully to reduce stress. Appropriate analgesics should be administered to these patients, ones that will not further compromise respiration.

Question 5

What is the surgical procedure?

Answer 5

An incision is made into the ventral midline xiphoid to the caudal umbilicus. The herniated contents are inspected for vitality, they are then reduced back into the abdomen. At this point a chest drain should be placed, prior to suturing up the diaphragmatic tear. This allows the air to evacuate from the pleural space, preventing barotrauma. Once this has been completed, the diaphragmatic tear, muscle layer and skin layer is sutured closed using absorbable sutures, and a suture pattern of choice by the veterinarian.

Question 6

Patient Prep

Answer 6

During patient preparation, the patient should be placed in dorsal recumbency with a towel placed underneath the head/neck, this encourages the herniated contents to drop back into the abdomen, and this will reduce the pressure on the lungs
The surgical sites should be prepped aseptically.

Question 7

Patient clipping

Answer 7

The patient should be clipped from the mid thoracic region to caudal to the umbilicus along the ventral midline. The patient should also be clipped on the lateral wall (ribs 7-10) for chest tube insertion to evacuate air from the thoracic cavity post operatively. The clip should extend 5cm either side of the proposed incision to reduce hair from falling into the surgical site.

Question 8

Patient positioning for surgery

Answer 8

The patient is placed in dorsal recumbency with the forelimbs tied cranially and the hind limbs tied back caudally.

Question 9

Instruments / materials

Answer 9

Instrumentals and materials required for this procedure are: A general surgical kit, a self-retaining abdominal wall retractor (Gosset or Balfour), a malleable retractor, a chest drain, absorbable and non-absorbable sutures and either a large fenestrated drape or four quarter drapes.

Question 10

Post op

Answer 10

Close observations are required in the post-operative period. According to Burbidge (n.d.) 75% survival rates of these patients should be expected.