THREE CASES OF PERINEAL HERNIAL REPAIR

THREE CASES OF PERINEAL HERNIAL REPAIR BY INTERNAL OBTURATOR TRANSPOSITION, POLYPROPYLENE MESH PLACEMENT, AND SPLIT SEMITENDINOSUS FLAP METHODS

Thursday, June 2, 2016, 2:30 PM – 3:00 PM

Rey B. Oronan­1, Ma. Rosario S. Racho2 and Anne Jasmine SM. Orillena1

1 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of the Philippines Los Baños, College, Laguna, Philippines

2 Veterinary Teaching Hospital, Diliman Station, College of Veterinary Medicine, University of the Philippines Los Baños, College, Laguna, Philippines

Correspondence: rboronan@up.edu.ph

The paired coccygeal muscles and levator ani muscles comprise the pelvic diaphragm. Failure of these muscles to support the rectal wall leads to the development of perineal hernia. The specific cause of the weakening of the perineal muscles is not yet fully understood but it is believed to be associated to male hormones, straining, or congenital or acquired muscle weakness or atrophy. This paper will report on three procedures that can be performed in perineal herniorrhaphy such as Internal obturator transposi on, Polypropylene mesh placement, and Split semitendinosus flap. The patients are prepared aseptically and are placed on sternal recumbency with the hindquarters slightly elevated than the rest of the body. A Purse-string suture is placed on the anal opening prior to surgery. Elliptical incision of the skin and subcutaneous tissues are made over the hernia. The hernial sac in penetrated and the hernial contents are carefully examined for any abnormality and are replaced into the pelvic or abdominal cavity. The following describes the different approaches to perineal herniorraphy: Internal Obturator Transposition: The internal obturator muscle is freed from its a􀂂achment on the caudal border of the ischium using a periosteal elevator. The dorsal defect of the perineal hernia is closed by suturing the external anal sphincter, and the combined coccygeus and levator ani muscles. The ventral defect is closed by suturing the combined external anal sphincter, levator ani and coccygeus muscle to the transposed internal obturator muscles. Preplacing the sutures will facilitate and easier closure. Mesh Placement: Polypropylene mesh can be used to close the perineal hernia. The associated perineal muscles are closed tradi onally or in combination with internal obturator transposi on. The mesh is placed over the perineal defect and apposed with preplaced sutures to reinforce the initial muscle closure. Split Semitendinosus Flap: The skin incision is extended distocaudally to the leg to expose the semitendinosus muscle. The muscle is divided or split longitudinally and transected at the distal third. The transected semitendinosus muscle is transposed and used as a flap to cover the caudoventral opening of the perineal hernia. The subcutaneous tissues are closed by simple continuous suture pattern and the skin by simple interrupted suture pattern. The purse-string sutures are removed. Male patients need to be castrated before or after the herniorrhaphy.

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