vet surgery

1. Alternative method for treatment
Diaphragmatic hernia in dogs
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2. Introduction
Diaphragmatic hernia is the
major pathological condition
that occur when the integrity
of the diaphragm is
compromised, Such a
condition allows
displacement of abdominal
organ into the thoracic cavity.
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3. 3

4. Type of diaphragmatic hernia
• Diaphragmatic hernia in small
animals can be congenital,
Congenital diaphragmatic
hernia maybe pleuroperitonial
or more frequently
peritoniopercardial, or
acquired as a result of direct
or indirect trauma to the
diaphragm.
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5. Types of diaphragmatic tear:
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6. Herniated organ of diaphragmatic hernia:-
A:Left side of diaphragmatic
hernia;
a. Stomach
b.Spleen
B:Right side of diaphragmatic
hernia;
a. Liver
b.Small intestine
c.Pancreace 6

7. Clinical signs
Vary from none to severe
respiratory compromise and
shock, dyspnea is the most
common clinical. Cardiac
arrhythmias are present in
approximately 12% of small
animals with diaphragmatic
hernia.
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8. Diagnosis:
Thoracic radiographs are
indicated in all cases with
history of trauma . Additional
imaging techniques such as,
contrast radiographs
,computed tomography (CT
scans or magnetic resonance
imaging (MRI) may be
necessary
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9. Anesthesia:
• Inhalation anesthetics should be
used for maintenance of
anesthesia in dogs with
diaphragmatic hernia.
• Ketamine-diazepam
combination has been used in
patients with respiratory disease.
Rapid induction should be
followed by tracheal intubation.
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10. Treatment:
• The defininitive treatment for any
hernias is surgical repair of the defect
in the diaphragm and replacement of
any abdominal viscera that was
herniated back into the thoracic
cavity.
• Patient with traumatic herniated are
first stabilized and rested before
proceeding with surgery unless life
threatening hypoventilation, caused
by abdominal viscera compressing the
lung occurs. 10

11. Alternative technique of diaphragmatic herniorrhaphy:
Ideal material for diaphragmatic
hernia repair:-
• 1-Safe.
• 2-Promot wound healing.
• 3-Resistanace to infection.
• 3-No restriction of chest wall
development.
• 5-No tissue reaction.
• 6-Easy to use.
• 7-Inexpensive. 11

12. Materials used for hernial repair:
1.Artificial graft. 2.Free graft.
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13. Surgical procedure:
• Dog positioned in dorsal
recumbency, a ventral midline
abdominal incision was made from
the xiphoid to the pubis, and
extended through skin and
subcutaneous tissues.
• The ventral fascia was sharply
dissected off either the right or left
rectus abdominis muscle to expose
the lateral margin of the muscle. 13

14. ventral midline abdominal incision from
the xiphoid to the pubis, and extended
through skin and subcutaneous tissues
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15. t
Traumatized diaphragm is located
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16. Continue……..’
• The right or left rectus abdominis
muscle was harvested depending
on the location of diaphragmatic
trauma, with the muscle on the
opposite side from most of the
injuries chosen. The dorsal fascia
together with peritoneum was
incised at the lateral extent of the
muscle.
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17. The muscle was transected
cranially, allowing a length of
approximately 15-cm to cover the
diaphragmatic defect, and rotated
into the recipient site. 17

18. Herniated viscera were inspected for damage, and
returned into the abdominal cavity. The rectus
abdominis flap was positioned across the
diaphragmatic defect 18

19. Rectus abdominis muscle used to close
diaphragmatic defect with 3-0 non-
absorbable monofilament suture) in a
combination of interrupted horizontal
mattress and cruciate sutures.
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20. Continue…….’
• The donor site was closed by apposing the remaining
ventral fascia to the contra lateral rectus fascia. A closed
suction drain was placed in the subcutaneous tissues.
The remainder of the abdominal incision was
closed routinely
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21. Result: The use of RAPF did not cause
ventral hernia
• diaphragmatic hernia recurrence &
respiratory difficulty were not
observed
• blood gases were in the normal
range
• radiographic&fluoroscopic
examinations, revealed a normal
appearance without paradoxical
motion of the diaphragm.
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22. Result:
• Use of rectus abdominis muscle
flap (RAF) will be an alternative
surgical treatment for
diaphragmatic hernia with large or
contracted defect which cannot be
repaired by conventional
herniorrhaphy
• RAF has the advantages of no
foreign body property and graft
cost, It is readily obtained from the
concurrent abdominal incision. 22

23. Prognosis:
• The prognosis for any patient
with diaphragmatic hernia is
always initially guarded. It
improves if the patient is able
to be stabilized and if the heart
rhythm is normal.
• The prognosis for young pets
with congenital diaphragmatic
hernia is guarded to good
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