Lecture 19 2/25/25 Flashcards
What are important notes regarding rectal surgery?
-resection of 6 or more centimeters of rectum along the peritoneal reflection can result in fecal incontinence
-injuries with contamination concerns should have the skin and subcutis left open
What are the steps to rectal prolapse correction?
-lubricate and reduce
-place a 2-0 nylon purse string suture; tight over a finger or syringe case to get appropriate constriction
-give stool softeners
-remove purse string suture after 7 to 10 days
-treat inciting cause
-perform colopexy in recurrent cases
What are the characteristics of the colopexy procudere?
-colon is pulled cranially to straighten the rectum
-colon can be incised or a scarification technique can be used
-body wall peritoneum is incised
-incised/scarified colon is sutured to incised peritoneum using an appositional pattern
What is the most important thing regarding a “cut and sew” resection in nonreducible/necrotic rectal prolapse cases?
the technique is very difficult to correctly do; it is very possible to patient will die from complications
What are the steps to rectal polyp removal?
-prolapse the retum with stay sutures
-resect polyp with attached mucosa
-appose defect with 3-0 monocryl
What are the three potential causes of hernias?
-congenital
-acquired
-traumatic
What are the common types of hernias?
-umbilical
-inguinal
-perineal
-prepubic
-diaphragmatic
-body wall tears
-surgical dehiscence
How are hernias diagnosed?
-palpation
-radiographs
-ultrasound
-CT
If a patient has a traumatic hernia, what other conditions should be assessed for?
-fractures
-neurologic deficits
-pulmonary trauma
-arrhythmias
When do hernias require emergency surgery?
-strangulation
-irresolvable obstruction of urinary or GI tract
-abdominal perforation
What are the characteristics of hernia repair surgery?
-use patient’s own tissue whenever possible; muscle or fascia flaps are best
-use synthetic mesh or xenograft if patient’s own tissue cannot be used
-reduce contents and close with interrupted sutures
-use monofilament suture
When should a hernia be incised around?
-skin is damaged
-contents are inflamed or ischemic
How does the closure of a hernia vary based on tension?
-primary closure if there is no tension
-flap, mesh, or xenograft closure if there is tension
-potential to make releasing incisions and then close primarily if there is tension
What should be done if contents of a hernia are reducible?
-return contents to abdomen
-ligate and amputate the sac
What should be done if contents of a hernia are not reducible?
-open sac +/- abdomen
-extend ring as needed
-reduce/resect contents before closing ring
Why is a gap left during inguinal hernia repair?
provides an area for vessels and nerve to pass through
How can unhealthy muscle be supported following traumatic hernia?
-muscle flaps
-fascia
-omentum
-mesh
What are the characteristics of perineal hernias?
-failure of pelvic diaphragm with secondary rectal sacculation
-precipitated by tenesmus
-affected dogs often have cropped tails
-most dogs have constipation
-dogs can have bladder entrapment
What are the surgical options for perineal hernia?
-internal obturator muscle flap
-mesh or other muscle flap
-possible colopexy for added support
What is the prognosis for perineal hernia?
-between 10 and 46% of cases will have recurrence
-castration reduces chance of recurrence
-urinary incontinence seen in 25% of patients that had bladder entrapment
What are the characteristics of cervical sialoceles?
-nonpainful, soft, fluctuant swelling in the intermandibular space and rostral ventral neck
-usually unilateral
-dogs may present with pain, cellulitis, and/or firm swelling
What are the characteristics of ranulas?
-owners usually notice swelling or tongue deviation
-source is usually sublingual duct
What are the characteristics of pharyngeal mucoceles?
-source is typically mandibular/sublingual or parotid glands
-pharyngeal swelling obstructs the airway
-may require immediate stab incision and suctioning
How are sialoceles diagnosed?
-mucin seen on cytology
-aspirated fluid that is thick, mucoid, and blood tinged
What are the characteristics of sialadenectomY?
-removal of mandibular and sublingual glands
-may also be required to prevent recurrence of ranulas and pharyngeal mucoceles
