Perineal Hernias

Question 1

What is a perineal Hernia

Answer 1

A perineal hernia is a hernia involving the perineum. It is associated with the degeneration of the muscles of the pelvic diaphragm.

Question 2

what organs are usually involved

Answer 2

The herniated organs include the rectum, fat, prostate, and occasionally the bladder

Question 3

What is a common complication ?

Answer 3

hernias is retroflexion and incarceration of the bladder and prostate.

Question 4

Clinical signs

Answer 4

Swelling on one or both sides of the perineum - common in entire dogs

Question 5

Pre op

Answer 5

The patient should have the bowels manually emptied to reduce faecal contamination at the surgical site. Enemas should be avoided because these soften the faeces and this may spill into the surgical site intraoperatively.

Question 6

Patient Prep

Answer 6

A purse string suture should be placed into the anus to prevent soiling at the operation site (remember to take this out once the procedure is completed).

Question 7

Patient prep - clipping

Answer 7

The entire perineum should be clipped, with the clip extending beyond the tail base about 10cm. The clip should also extend laterally beyond the ischial tuberosity and ventrally to include the scrotum.

Question 8

Patient Positioning

Answer 8

The patient is placed in sternal recumbency with the hind legs flexed to the side. A support bag/towel or sandbag is placed under the pelvis to elevate it slightly. The tail should be bandaged and elevated away from the surgical site.

Question 9

Instruments / Materials

Answer 9

A normal surgical kit is required, PDS and four quarter drapes.

Question 10

Surgical procedure

Answer 10

The most common technique used is making a vertical incision next to the anus to expose the hernia. The herniated contents are then inspected and reduced back into their normal anatomical location if they are viable. The two atrophied muscles are apposed using a monofilament absorbable suture. A suture of choice is Polydioxanone. PDS is a monofilament, has low capillarity, and is minimally absorbed at 90 days.

Question 11

Post op complications

Answer 11

Patients should be closely observed to ensure urination and defecation is normal. Some patients may require faecal modifiers or stool softeners for 1-2 months after the surgical procedure. Some common post-operative complications are: infection, wound dehiscence and rectal prolapse due to straining. Reoccurrence of this type of hernia is a common long term complication.