RU2727649C1 - Method for treating perineum hernia in dogs - Google Patents

Abstract

FIELD: veterinary science.SUBSTANCE: invention refers to veterinary science, particularly to a method for treating perineum hernia in dogs. Method is characterized by that dog is placed on Trendelenburg table in dorsal position with elongated pelvic limbs, general anesthesia is performed. Instrumental laparoscopic port is formed, an overview laparoscopy of the pelvis cavity is performed, hernia defect is detected by instrumental laparoscopic palpation and external palpation, which are performed towards each other. Size of hernia defect of pelvic floor is determined. Mesh implant made of polypropylene or titanium nickelide is cut out with a size larger than a hernia defect by 1–2 cm along the perimeter. Hernia defect is closed with an implant without isolating the hernial sac and the mesh implant is fixed with non-absorbable sutures and / or stapler staples to the peritoneum, to the muscular and fascial tissues of the pelvic floor surrounding the hernial defect.EFFECT: using the invention enables minimizing postoperative complications.1 cl, 2 dwg

Description

Technology area

The invention relates to veterinary medicine, in particular to minimally invasive surgical methods for treating perineal hernia in dogs.

State of the art

Perineal hernia in dogs is a caudal protrusion of the internal organs of the pelvis into the perineal region through the layer of muscles and connective tissues of the pelvic diaphragm. Perineal hernias, usually one-sided, are observed on the right side in males. However, there are also bilateral perineal hernias. Surgical methods are used to treat perineal hernia in animals.

There is a known method of suturing umbilical hernias in pigs (application for invention RU 97111889 from 08/07/1997), including the insertion of the hernial contents into the abdominal cavity and the closure of the hernial opening. In order to increase labor productivity, ease of implementation and reliability, a bypass ligature is carried out under the skin, along the edge of the umbilical opening, with a Kashin ligature needle, then the ligature is pulled together and tied.

This method is not applicable to the treatment of perineal hernia in dogs, in addition, such treatment has a high risk of recurrent hernia.

Various options for autoplasty with the movement of a muscle flap to replace the defect have been described, which is often associated with significant soft tissue trauma and surgical complications (https://books.google.ru/books/about/Textbook_of_Small_Animal_Surgery.html?id=B_nh6zSr4w=y&redir_esc).

There is a known method of hernioplasty in dogs (application for invention RU 2013108138 dated 08.27.2014), which includes plastic surgery of the abdominal wall defect with plastic material. Above the hernial protrusion, under anesthesia with a scalpel, an oval flap of skin is excised together with subcutaneous tissue. A fragment of the skin is cleaned of subcutaneous tissue, irrigated with hot (t = 95-98 ° C) saline, the epidermis is removed with a scalpel. Further, in a checkerboard pattern, through incisions with a length of 1.0-2.0 cm are applied to the skin flap at a distance of 2.0-3.5 cm from each other. Then the prepared autograft is placed with a dermal layer laterally over the hernial defect and single interrupted nylon sutures, at a distance of 2.0-3.5 cm from each other, tightly sutured to the edges of the external hernial defect. The operating wound is sewn up tightly, treated with a solution of terramycin and a postoperative blanket is applied for 3-4 days.

This method leads to additional trauma, since it requires an incision, excision of a skin flap together with subcutaneous tissue, in order to obtain an autotranspalant, necessary for plastic surgery of the abdominal wall defect.

The essence of the invention.

The objective of the invention is to expand the existing arsenal of minimally invasive surgical techniques used to treat perineal hernia in dogs. The technical result consists in solving the problem, and the technical solution allows to surgically eliminate the perineal hernia, close the hernial defect with an implant without isolating the hernial sac, with minimal trauma. The tissues are minimally injured, there are no incisions and sutures on the abdominal wall, there is no contact of the abdominal cavity with the external environment, which minimizes the risks of infection and the occurrence of postoperative complications. The implant is stably and firmly installed in the bed, the risk of recurrence is minimal.

The technical result is achieved by the fact that in the method of treating perineal hernia in dogs, hernioplasty is performed laparoscopically. The dog is placed on the Trendelenburg operating table, with the head end lowered, in the dorsal position with the pelvic limbs extended. General anesthesia is performed. An instrumental laparoscopic port is formed, an overview laparoscopy of the pelvic cavity is performed, a hernial defect is detected by instrumental laparoscopic palpation and external palpation, which are carried out towards each other. Determine the size of the hernial defect of the pelvic floor. Then cut out a mesh implant made of polypropylene or titanium nickelide, larger than the hernial defect by 1-2 cm around the perimeter, close the hernial defect with an implant without isolating the hernial sac, and fix the mesh implant with non-absorbable sutures and / or stapler staples to the peritoneum, to muscle and fascial tissues of the pelvic floor around the hernial defect.

Sometimes, colono- or cystopexy is performed to the ventral abdominal wall. For the operation, endoscopic manipulators are used, a laparoscope equipped with a video camera lens, an LED light source, a channel for endoscopic manipulators is used.

The invention is accompanied by graphic materials:

Fig. 1 - Photo of a dog on an operating table, a laparoscopic instrument is inserted;

Figure 2 - Photo of the inside of the abdominal cavity, a mesh implant is inserted in the area of the hernial defect.

The method is carried out as follows.

In the method of treating perineal hernia in dogs, hernioplasty is performed laparoscopically (Fig. 1). The hernial defect is closed with a mesh implant (figure 2) without isolating the hernial sac. To do this, the dog is placed on the operating table in a dorsal position with slightly elongated pelvic limbs, thereby slightly raising the perineum. General anesthesia is performed, an instrumental laparoscopic port is formed. An overview laparoscopy of the pelvic cavity is performed, during which the internal organs of the pelvis, bladder, prostate, rectum are differentiated, and a hernial defect is detected. Moreover, visual laparoscopic control is complemented by bimanual palpation, instrumental laparoscopic palpation and external palpation are performed towards each other. Determine the size of the hernial defect of the pelvic floor. A mesh implant (made of polypropylene or titanium nickelide) is cut out 30% larger than the hernial defect, along the perimeter (1-2 cm more). The hernial defect is closed with an implant without isolating the hernial sac; for this, a mesh implant ("patch") is brought through the instrumental port, and the mesh implant is fixed to the peritoneum, to the muscle and fascial tissues of the pelvic floor (with non-absorbable sutures and / or stapling staples around the hernial defect).

The method allows to surgically eliminate the perineal hernia, close the hernial defect with a mesh implant without isolating the hernial sac, with minimal trauma. The tissues are minimally injured, there are no incisions and sutures on the abdominal wall, there is no contact of the abdominal cavity with the external environment, which minimizes the risks of infection and the occurrence of postoperative complications. The implant is stably and firmly installed in the bed, the risk of recurrence is minimal. The method can use a mesh implant made of polypropylene or titanium nickelide.

A mesh implant is cut out with a size larger than the hernial defect, around the perimeter by 30% (by 1-2 cm), this provides the necessary supply of implant material for fixation and allows it to be stably fixed.

The mesh implant is fixed to the peritoneum, to the muscle and fascial tissues of the pelvic floor with non-absorbable sutures and / or stapling staples.

The operation is completed by monitoring hemostasis and the integrity of the pelvic organs.

Laparoscopy greatly facilitates the control of the preparation of the pelvic floor muscles. The detection of a hernial defect is mutually complemented by visual laparoscopic control and bimanual palpation (instrumental and external palpation towards each other). In laparoscopic perineal hernia repair, the simplest technique is used to close the hernial defect with an implant without isolating the hernial sac.

Sometimes, depending on the side of the lesion or the size of the hernial defect, colono- or cystopexy is performed to the ventral abdominal wall.

For the operation, endoscopic manipulators are used, a laparoscope equipped with a video camera lens, an LED light source, a channel for endoscopic manipulators is used.

The method is used in a veterinary clinic for the treatment of perineal hernia in dogs. The method expands the existing arsenal of minimally invasive surgical techniques used to treat perineal hernia in dogs.

Claims (1)

A method of treating perineal hernia in dogs, characterized by the fact that the dog is placed on the Trendelenburg operating table in the dorsal position with extended pelvic limbs, general anesthesia is performed, an instrumental laparoscopic port is formed, an overview laparoscopy of the pelvic cavity is performed, a hernial defect is detected by instrumental laparoscopic palpation and external palpation , which are carried out towards each other, determine the size of the hernial defect of the pelvic floor, after which they cut out a mesh implant made of polypropylene or titanium nickelide, larger than the hernial defect by 1-2 cm around the perimeter, close the hernial defect with an implant without isolating the hernial sac and the mesh implant is fixed with non-absorbable sutures and / or stapling staples to the peritoneum, to the muscle and fascial tissues of the pelvic floor around the hernial defect.

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