Surgical repair of a hernia is called “herniorrhaphy”, so repair of a perineal hernia is called “perineal herniorrhaphy”. In addition to a herniorrhaphy, if there is organ entrapment or severe perineal hernia, a cystopexy or colopexy is follows in order to free the entrapped organs, remove unhealthy organ tissue, and tack the bladder and colon in place.
Goal of a Herniorrhaphy
Herniorrhaphy is the treatment of choice for perineal hernia to eliminate the risk of organ entrapment down the road. Unfortunately, the weakened muscles of the pelvic diaphragm are not robust enough to hold sutures for repair on their own, so neighboring muscles are used to patch the hole in the pelvic diaphragm. At the Veterinary Surgicenter, we use a technique called the “internal obturator muscle transposition” because of its high reported success and minimal patient discomfort. In the most severe cases of perineal hernia, other local muscles such as part of the glutes or hamstrings may be also used. If the patient is neutered at the time of hernia repair, the strong tissue layer surrounding the testicle can be separated and used as a tissue graft to further strengthen the hernia repair and maximize success. Studies have shown that these tissue grafts are replaced with normal perineal tissues over time.
Because the surgical site is close to the anus, infection is a possible complication after surgery. Dehiscence (suture break-down) is also a possible complication which may require additional surgery. If small areas of the incision open, they are often left to heal on their own to avoid entrapment of fecal bacteria with skin closure.
Goal of Castration (Neuter)
Neuter is performed in all intact males with perineal hernia in order to shrink the prostate size and eliminate the sex hormones responsible for causing the hernia. Additionally, the strong tissue layer surrounding the testicle can be used as a tissue graft to further strengthen the hernia repair and maximize success.
Goal of a Abdominal Explore +/- Cystopexy, Colopexy
In patients with organ entrapment or severe perineal hernia, abdominal surgery is also required to free the entrapped organs, remove unhealthy organ tissue, and tack the bladder and colon in place to prevent their re-herniation. The prefix “cysto-” means relating to the bladder, and “colo-” relating to the colon. The suffix “-pexy” means to fix in place or create a union between two things. The goal of the “cysto-pexy” and “colo-pexy” surgery is to permanently fix the bladder and the colon to the inner body wall to prevent them from sliding back into the hernia and putting pressure on the herniorrhaphy repair. Some animals may strain to urinate or defecate for 5-7 days after surgery.
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POST OPERATIVE CARE PLANNING
E-collar at all times for 2 weeks, until skin incision check.
Exercise restriction for 2 weeks: no off-leash activity allowed, no play, no jumping on/off furniture.
Monitor perineal and/or abdominal incisions for signs of swelling, pain, or discharge.
Only clean the incision if soiled, and gently use a warm washcloth.
Pain medication will be prescribed.
Antibiotics may be prescribed in more severe cases.
Stool softener will be prescribed for at least 4 weeks. Ideal stool consistency is that of soft-serve ice cream in order to reduce straining while defecating.
High fiber diet is recommended