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(Perineal Surgeries--Continued from
page 4)
laterally affected
(one side only may be obvious, but exploration of the other side frequently demonstrates a
smaller hernia, or a very weakened pelvic diaphragm). If bilateral hernias are
present, I will usually operate on both, under one anesthetic procedure.
The earlier described method of passing sutures from the anal sphincter muscle to the
coccygeus/levator ani muscles, or the sacrotuberous ligament to close the hernia defect,
typically results in a tremendous amount of tissue tension, this raises major concerns
about dehiscence and hernia recurrence. The newer described method involves
elevating the internal obturator muscle off of the ischial floor, rotating it dorsally and
medially into the hernia defect, and then suturing it to the anal sphincter muscle and
coccygeus/levator ani. This substantially reduces tissue tension and results in a
much lower recurrence rate. If needed, additional tissue harvested from the
superficial gluteal muscle or semimembranosus muscle can be used to close very large
hernia defects. Although the role of testosterone in perineal hernia is not fully
understood, castration accompanying the herniorrhaphy is still recommended. Fecal
incompetence (NOT incontinence) is more common following repair of very large bilateral
hernias, but this is usually controllable with dietary management and usually resolves
after a period of weeks.
Perianal Fistulae
This can be, and frequently is a very frustrating condition to treat. It is commonly
seen in German shepherd dogs, but can be seen in any breed. The fistulae are
frequently associated with chronic anal sac disease, but there are many other factors
associated with the condition. There is also growing evidence that at least some of
these fistulae have an immune-mediated component contributing to their formation.
The previously prescribed treatment for fistulae was surgical obliteration. Simple
medical management (systemic and/or topical antibiotics and local cleansing) was
unrewarding. Described surgical procedures included surgical excision, saucerization
and fulguration, cryosurgery, and laser surgery. Surgery remains an important
consideration for treatment of perianal fistulae, but clinical outcome was not as
rewarding as desirable with surgery alone. Fistula recurrence was the most common
complication.
Currently, the recommended treatment for most perianal fistulae involves immunosuppressive
therapy
(Continued on page 11)
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