Publication: Hernia perineal canina: reconstrucción del diafragma pélvico con malla de polipropileno a través de doble abordaje
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2016-08-11
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Universidad Complutense de Madrid
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Abstract
La hernia perineal es una patología que se presenta en el macho de la especie canina de forma casi exclusiva, apareciendo de forma muy esporádica en la hembra y el gato, pero no se presenta en las otras especies domésticas. Se ha descrito en la especie humana sobre todo asociada a cirugías agresivas del abdomen caudal y siempre en relación a trastornos del suelo pélvico. En el perro la hernia perineal se produce por un fallo del diafragma pélvico, en el que destaca la atrofia y a veces la total desaparición del M. elevador de ano de forma uni- o bilateral. La debilidad-ausencia-desaparición de este músculo conduce a un posicionamiento más caudal de todos los órganos contenidos en el canal pélvico, vejiga, próstata, uretra post prostática, grasa periprostática y recto. Aparece en un rango muy amplio de edades aunque su tendencia más frecuente es alrededor de los 7-8 años de edad. Las manifestaciones clínicas de la hernia varían en función de la gravedad y antigüedad del proceso; el síntoma más frecuente es el estreñimiento y la deformación (tumefacción) de la fosa isquiática, pero se han descrito también la diarrea paradójica, vómitos y hasta la anuria obstructiva. La etiología de la hernia perineal esta poco clara, aunque existen diferentes hipótesis relacionadas con fenómenos que producen estreñimiento como hipertrofia prostática, o la existencia de quistes prostáticos y/o paraprostáticos. También se ha relacionado con saculitis o con la existencia de hernias inguinales. Otras teorías han relacionado la hernia con trastornos hormonales, desequilibrios entre receptores de andrógenos/estrógenos. Recientemente se la ha relacionado con la producción de relaxina en los quistes prostáticos y por último se la ha relacionado con alteraciones neurológicas del plexo pudendo. Pero lo cierto es que los porcentajes de perros con enfermedad prostática son muy altos sobre todo a partir de los 7- 8 años de edad y la incidencia de la hernia es muy baja. Tampoco todos los animales que padecen la hernia tienen quistes prostáticos y existen muchos animales con grandes quistes que no la desarrollan. En resumen, esta afección parece ser multifactorial aunque la lesión es siempre la misma, la debilidad progresiva del diafragma y la falta de funcionalismo hace el resto. Respecto a la cirugía ofrece también dificultades, se han descrito varias técnicas y las que mejores resultados ofrecen son las basadas en la elevación del obturador interno. No obstante en ocasiones este músculo también se encuentra atrofiado y la restauración del plano anatómico no es todo lo sólida que se desearía por lo cual se añade a la elevación del obturador, la utilización de mallas de polipropileno, la sobreposición del m. glúteo caudal, del músculo semitendinoso o la fijación intrabdominal de la vejiga, colon y conductos deferentes. A pesar de todo las recidivas siguen presentándose, aunque cada vez en menor porcentaje según las técnicas desarrolladas con posterioridad.
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.
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.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Veterinaria, Departamento de Medicina y Cirugía Animal, leída el 22/01/2016