Einsatz von SIS^TM (Small Intestinal Submucosa) bei der Hernia perinealis des Hundes

Zusammenfassung

Gegenstand: Therapie der Hernia perinealis beim Hund mittels Einsatz von SIS^TM. Material und Methoden: Retrospektive Auswertung der prä-, intra-, und postoperativen Daten von 15 Hunden mit 21 Perinealhernien, die von Juli 2003 bis Januar 2005 im Klinikum Veterinärmedizin, Klinik für Kleintiere, Chirurgie der Justus-Liebig-Universität Gießen operativ mittels Einsatz von SIS^TM therapiert wurden. Ergebnisse: Bei 11 Hunden wurde die Ausprägung der Perinealhernie als hochgradig eingestuft, bei vier Patienten als mittelgradig. Das Körpergewicht der Hunde lag bei 5–51 kg (Ø 20 kg). Bei Vorstellung wiesen 86,7% der Patienten Kotabsatzbeschwerden auf, 40% der Hunde zeigten eine perineale Schwellung. Eine Retroflexio vesicae wurde bei vier Hunden diagnostiziert. Die durchschnittliche Operationszeit betrug 58,1 Minuten (50–70 Minuten). Intraoperative Komplikationen traten nicht auf. Post-operativ kam es nur zu geringfügigen Komplikationen (Serombildung: sechs Hunde, geringgradige Nahtdehiszenz: drei Tiere), die nur in drei Fällen eine lokale Therapie erforderlich machten. Langzeitergebnisse wurden mittels rektaler Kontrolluntersuchung sowie telefonischer Besitzerbefragung 6–36 Monate postoperativ (Ø 25,2 Monate) ermittelt. Bei 19 operierten Perinealhernien konnte das Ergebnis als sehr gut bis gut eingestuft werden. Die Rezidivrate klinischer Symptome einer Perinealhernie lag bei 9,5% (zwei von 21 Perinealhernien). Schlussfolge-rung und klinische Relevanz: Der Einsatz von SIS^TM zur Therapie der Perinealhernie beim Hund ist eine einfache und sichere Methode. Die Langzeitverträglichkeit des Implantats erscheint sehr gut, die Rezidiv-rate klinischer Symptome ist gering. In Fällen, in denen der Defekt durch körpereigenes atrophiertes Gewebe nicht verschlossen werden kann oder die Ausmaße der Perinealhernie diesen Verschluss nicht zulassen, kann die Verwendung des Implantats erwogen werden. Ein Nachteil sind die zusätzlich anfallenden Materialkosten für das Implantat.

Summary

Objective: Surgical therapy of perineal hernia in dogs by using Small Intestinal Submucosa (SIS^TM). Material and methods: Retrospective evaluation of pre-, intra-, and postoperative data of 15 dogs for which a total of 21 perineal hernias were surgically treated by implantation of SIS^TM between July 2003 to January 2005 at the Hospital for Small Animals, Surgery, Justus Liebig University of Giessen. Results: Eleven of the 15 dogs showed a large sized perineal hernia, whereas in four dogs the defect was of medium size. Preoperatively, 86.7% of the patients showed defecation problems and 40% had perineal swelling. Retroflexion of the bladder was observed in four dogs. Average operation time was 58.1 minutes (50–70 minutes). No intraoperative complications were observed. Postoperative complications were minor (seroma formation in six patients, minor wound dehiscence in three dogs), and only three cases required local therapy. Implant intolerance was not observed. Long-term results were obtained 6–36 months postoperatively (mean 25.2 months) by rectal examination and owner telephone questionnaire. The recurrence rate, based on clinical signs of perineal hernia, was 9.5% (two of 21 perineal hernias). Results were rated excellent to good in 19 of the 21 surgically treated perineal hernias. Conclusion and clinical relevance: Implantation of SIS^TM in the treatment of perineal hernia in dogs is an easy and safe treatment option. Long-term implant tolerance appears to be excellent. Recurrence rate of clinical signs is low. In cases where the defect can not be closed with endogenous tissue, either due to atrophic tissue or dimensions of peri-neal hernia do not allow such closure, the use of Small Intestinal Submucosa should be considered. The additional costs for the implant are however a disadvantage of this method.

Schlüsselwörter

Perinealhernie - SIS - Retroflexio vesicae - Herniorrhaphie

Key words

Perineal hernia - SIS - bladder retroflexion - herniorrhaphy

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