Hernia perineal caninareconstrucción del diafragma pélvico con malla de polipropileno a través de doble abordaje

Abstract

The perineal hernia is a condition that occurs in the male of the canine species almost exclusively, appearing only sporadically in the female and is not presented in other domestic species. It described in humans mainly associated with abdominal surgery aggressive flow and always related to pelvic floor disorders. In the dog perineal hernia is caused by a failure of the pelvic diaphragm, which atrophy and sometimes the total disappearance of Levator Ani Muscle in a uni- or bilateral way. Weakness, absence or athrophy of this muscle leads to a more caudal positioning of all the organs in the pelvic canal, bladder, prostate, post-prostatic urethra, periprostatic fat and rectum. It appears in a wide age range although its most common trend is about 7-8 years old. Clinical manifestations of hernia oscillate depending on the severity and length of the process. Constipation and deformation (swelling) of the ischial fossa are the most common symptom, but there are also described the paradoxical diarrhea, vomiting and even obstructive anuria. The etiology of perineal hernia is unclear, although there are different hypotheses concerning phenomena that cause constipation as prostatic hypertrophy, or the existence of prostate cysts and/or paraprostáticos. It has also been associated with sacculitis or the existence of inguinal hernias. Other theories have linked the hernia with hormonal disorders, imbalances between androgen receptor / estrogen; recently it has been linked to the production of relaxin in prostate cysts and the latter has been linked to neurological disorders pudendal plexus. But the fact is that the percentage of dogs with prostatic disease is very high especially from 7-8 years of age, and the incidence of hernia is very low. Nor all animals suffering from hernia have prostate cysts and there are many animals with large cysts do not develop. In short, this condition appears to be multifactorial but the injury is the same, the diaphragm progressive weakness and lack of functionalism does the rest. Regarding the surgery also presents difficulties, several techniques have been described and the best results offered are based on the elevation of the internal obturator muscles. But sometimes this is also atrophied muscle and restoration of anatomical plane is not all that solid would therefore added to lift the shutter, the use of polypropylene mesh, the overlap of m. gluteus flow semitendinosus muscle or intrabdominal fixing bladder, colon and vas deferens. Nevertheless all recurrences continue to occur, but increasingly smaller percentage as the techniques developed later.