Köpeklerde Perineal Fıtıkların Sağaltımında Dört Tekniğin Bir Arada Kullanılmasının Nüksleri Önlemedeki Etkinliği: Obturator Internus Kas Transpozisyonu, Kastrasyon, Sistopeksi ve Kolopeksi

Öz

Perineal fıtık, pelvik diyaframı oluşturan bileşenlerin güçsüzlüğü sonucu, idrar kesesi, bağırsaklar, retroperitoneal yağ doku veya prostat gibi intraabdominal yapı ve organların perineal bölgeye fıtıklaşmasıdır. Tedavisinde klasik herniorafi dışında farklı kasların transpozisyonu, çeşitli prostetik implantlar ve biomateryaller kullanılmaktadır. Çalışmamıza farklı ırk ve yaşta 11 adet erkek köpek dahil edildi. Hastalar, perineal bölgede şişlik, ağrılı defekasyon, dışkıda kan ve strangüri gibi şikayetlerle getirilmişlerdi. Perineal fıtık tanısı, klinik muayene ve rektal palpasyon bulgularına göre kondu. Perineal fıtık tanısı konan 11 hastadan 10 ‘u, obturator internus kas transpozisyonu, kastrasyon, sistopeksi ve kolopeksi işlemleri aynı seansta uygulanarak sağaltıldı ve hastalar kısa ve uzun dönem nüks ve diğer bazı komplikasyonlar açısından değerlendirildi. Bir hastada ise hasta sahibi yavru almak istediği için kastrasyon yapılamadı. Çalışmanın sonucunda 11 hastanın 10 ‘unda uzun dönem nüks şekillenmedi. Önemli sayılabilecek bir postoperatif komplikasyonla karşılaşılmadı. Sonuç olarak, postoperatif nüks oranları %36-48 lere kadar ulaşabilen perineal fıtıkların sağaltımında, obturator internus kas transpozisyonu, kastrasyon, sistopeksi ve kolopeksinin eş zamanlı uygulanmasının postoperatif uzun dönem nüksleri engellemede faydalı olabileceği kanısına varıldı.

Anahtar Kelimeler

• Kastrasyon
• Köpek
• Obturator internus kası
• Organopeksi
• Perineal fıtık

Prevention of Perineal Hernia Recurrences by Four-In-One Procedure in Dogs: Obturator Internus Muscle Transposition, Castration, Cystopexy and Colopexy

Öz

Perineal hernia is caudal dispacemet of intraabdominal structure and organs such as the urinary bladder, intestines, retroperitoneal fat or prostate to the perineal region because of weakness and deficiency of pelvic diaphragm. In treatment, different muscle transposition tecniques, various prosthetic implants and biomaterials are used beside of traditional herniography. Eleven male dog with different age and breed was included in this study. These patients were brought by the complaints of perineal swelling, blood in feces, painful defecation and stronguria. Perineal hernia diagnosis was made by clinical examination and rectal palpation. Perineal hernias was treated by obturator internus muscle transposition, castration, cystopexy and colopexy in the same session in 10 of 11 patient and the postoperative complications and short and long term recurrence was evaluated. In one patient, owner of the dog did not give permission to castration since he wanted to use his dog for breeding. At the end of the study, postoperative long term reccurrence was not determined in 10 of 11 patient. No significant postoperative complications were noted. As a result, in the treatment of perineal hernias that have postoperative recurrence rates up to 36-48%, it was concluded that simultaneous using of obturator internus muscle transposition, castration, cystopexy and colopexy can be useful in preventing postoperative long term recurrence in dogs.

Anahtar Kelimeler

• Castration
• Dog
• Obturator internus muscle
• Organopexy
• Perineal hernia

Kaynakça

1. 1. Al-Akraa AM., 2015. Standard Herniorrhaphy, Polypropylene Mesh and Tension Band for Repair of Perineal Hernia in Dogs. International Journal, 3(10), 174-181.
2. 2. Khatri-Chhetri N., Khatri-Chhetri R., Chung CS., Chern RS., Chien C. H., 2016. The spatial relationship and surface projection of canine sciatic nerve and sacrotuberous ligament: A perineal hernia repair perspective. PloS one, 11(3), 1-12.
3. 3. Shaughnessy M., Monnet E., 2015. Internal obturator muscle transposition for treatment of perineal hernia in dogs: 34 cases (1998–2012). Journal of the American Veterinary Medical Association, 246(3), 321-326.
4. 4. Villamil CS, Carrera AE., 2016. Perineal herniorrhaphy in a dog using a cone-shaped polypropylene mesh implant. Veterinary Record Case Reports, 4(1), 1-5.
5. 5. Sharma AK., Kumari Chandrakala LK., Singh S., Kumar S., Kumar P., 2016. Successful Surgical Management of Recurrent Perineal Hernia Using Colopexy and Cystopexy in a Dog. International Journal of Livestock Research, 6(4), 105-109.
6. 6. Saberi M., Akhtardanesh B., Shojaeepour S., 2014. Bilateral perineal hernia with urinary bladder retroflexion in a terrier dog. Online Journal of Veterinary Research, 18(4), 359-363.
7. 7. Morello E., Martano M., Zabarino S., Piras LA., Nicoli S., Bussadori R., Buracco P., 2015. Modified semitendinosus muscle transposition to repair ventral perineal hernia in 14 dogs. Journal of Small Animal Practice, 56(6), 370-376.
8. 8. Snell WL., Orsher RJ., Larenza-Menzies MP., Popovitch CA., 2015. Comparison of caudal and pre-scrotal castration for management of perineal hernia in dogs between 2004 and 2014. New Zealand Veterinary Journal, 63(5), 272-275.

9. 9. Reddan S., 2014. Herniorrhaphy of a unilateral perineal hernia and castration. Veterinary Nursing Journal, 29(1), 14-16.
10. 10. Pirker A., Brandt S., Seltenhammer M., Skalizcky M., Dupre G., 2009. Relaxin expression in the testes of dogs with and without perineal hernia. Veterinar Medicine Austria, 96, 34–38.
11. 11. Seim HB., 2009. Surgical management of perineal hernia. Proceedings of North America Veterinar Conference, 1571–1573.
12. 12. Spreull JSA., Frankland AL., 1980. Transplanting the superficial gluteal muscle in the treatment of perineal hernia and flexure of the rectum in the dog. Journal of Small Animal Practice, 21, 265–278.
13. 13. Walker RG., 1965. Perineal hernia in the dog. Veterinary Record, 77, 93–94.
14. 14. Hosgood G., Hedlund CS., Pechman RD., Dean PW., 1995. Perineal herniorrhaphy: perioperative data from 100 dogs. Journal of American Animal Hospital Association, 31, 331–342.
15. 15. Aronson LR., 2012. Rectum, Anus, and Perineum. In: “Veterinary Surgery Small Animal”, Eds., KM Tobias, SA Johnston, 1564-1600, Elsevier Saunders, Missouri.
16. 16. Harvey CE., 1977. Treatment of perineal hernia in the dog—a reassessment. Journal of Small Animal Practice, 18, 505–511.
17. 17. Farquharson J., 1947. Surgical treatment of perineal hernias. Proceeding of American Animal Hospital Association. Tulsa, OKLAHAMA.
18. 18. Hardie EM., Kolota RJ., Earley TD., Rawlings CA., Gorgacz EJ., 1983. Evaluation of internal obturator muscle transposition in treatment of perineal hernia in dogs. Veterinary Surgery, 12, 69–72.
19. 19. Doust R., 2003. Semitendinosus muscle transfer flap for external anal sphincter incompetence in a dog. Journal of American Veterinary Medical Association, 222, 1385–1387.
20. 20. Clarke RE., 1989. Perineal herniorrhaphy in the dog using polypropylene mesh. Australian Veterinary Practitioner, 19, 8–14.
21. 21. Frankland AL., 1986. Use of porcine dermal collagen in the repair of perineal hernia in dogs—a preliminary report. Veterinary Record, 119, 13–14.
22. 22. Kang EH., Chang HS., Yang HT., Chung DJ., Lee JH., Yang WJ., Choi CB., Kim HY., 2006. The use of polyprolene mesh for perineal herniorrhaphy in the dog. Journal of Veterinary Clinics, 23, 461–464.
23. 23. Stoll MR., Cook JL., Pope ER., Carson WL., Kreeger JM., 2002. The use of porcine mall intestine submucosa as a biomaterial for perineal herniorrhaphy in the dog. Veterinary Surgery, 31, 379-390.
24. 24. Vnuk D., Maticic D., Kreszinger M., Radisic B., Kos J., Lipar M., Babic T., 2006. A modified salvage technique in surgical repair of perineal hernia in dogs using polypropylene mesh. Veterinarni Medicina, 51, 111–117.
25. 25. Bellenger CR., 1980. Perineal hernia in dogs. Australian Veterinary Journal, 56, 434–438.
26. 26. Hayes HM., Wilson GP., Tarone RE., 1978. The epidemiologic feature of perineal hernias in 771 dogs. Journal of American Animal Hospital Association, 14, 703–707.
27. 27. Towle HA., 2012. Testes and Scrotum. In “Veterinary Surgery Small Animal”, Eds., KM Tobias, SA Johnston, 1913-1916, Elsevier Saunders, Missouri.
28. 28. Canfield RB., 1985. Perineal hernia. In “Textbook of Small Animal Surgery”, Ed., D Slatter, 487-498, Saunders, Philadelphia.
29. 29. Matteeuws D., Comhaire FH., 1989. Concentrations of oestradiol and testosterone in peripheral and spermatic venous blood of dogs with unilateral cryptorchidism. Domestic animal endocrinology, 6(3), 203-209.
30. 30. Snow LA., 2016. Perineal Herniorrhaphy. In “Complications in Small Animal Surgery”, Eds., D Griffon, A Hamaide, 388-395, Wiley Blackwell, Singapore.