Dorsal Recumbency in Canine Perineal Hernia Repair: Clinical Outcomes and Surgical Advantages

Perineal hernia in dogs occurs when pelvic diaphragm muscles weaken, allowing abdominal or retroperitoneal contents to protrude into the ischiorectal fossa^1,2. Common clinical signs include perineal swelling, tenesmus, constipation, dyschezia, and urinary difficulties^1,3. Surgical correction remains the treatment of choice, with techniques such as appositional suturing, implant placement, and internal obturator muscle transposition (IOMT) commonly used^1,4. 

Complicated cases may also involve rectal deviation, rectal sacculation, bladder retroflexion, or concurrent abdominal disease, requiring additional procedures such as colopexy, cystopexy, or vas deferens pexy. Traditionally, dogs undergoing both abdominal and perineal procedures are repositioned during surgery, moving from dorsal recumbency for laparotomy to sternal recumbency for hernia repair¹. 

Why Dorsal Recumbency Was Evaluated 

The study evaluated whether maintaining dogs in dorsal recumbency throughout surgery could simplify the procedure and reduce intraoperative challenges. Repositioning during anesthesia can¹: 

• Increase surgical and anesthesia time  

• Require additional technical assistance  

• Raise treatment costs  

• Increase the risk of gastroesophageal reflux and hypotension 

• Potentially reduce respiratory compliance  

In all 23 dogs included in the study, perineal hernia repair was successfully performed in dorsal recumbency without intraoperative complications. 

Surgical Findings and Advantages 

The dorsal positioning allowed sequential or simultaneous abdominal and perineal approaches. Hind limbs were positioned cranially or frog-legged to improve surgical access, and adjustments could be made during surgery to improve visualization of either the abdomen or perineum. 

One of the major advantages noted was simultaneous access to both surgical fields. In one dog, bladder retroflexion could not initially be corrected through an abdominal approach alone but was successfully reduced with concurrent perineal manipulation. The positioning also facilitated colopexy by allowing direct confirmation of hernia reduction during cranial traction of the colon. 

Clinical findings in the study were similar to previous reports¹. The most common presenting signs were: 

• Perineal swelling  

• Tenesmus  

• Urinary tract signs  

Concurrent inguinal or umbilical hernias were identified in 21.7% of dogs, supporting previous reports linking nontraumatic hernias with perineal hernia development^1,5. 

During IOMT, the internal obturator tendon was transected in all dogs to improve dorsal mobilization of the muscle flap and reduce tension at the repair site¹. 

Complications and Recurrence Rates¹ 

Postoperative complications occurred in 60.9% of dogs during hospitalization and in 47.8% shortly after discharge, consistent with previously reported complication rates of 41%–64%. Most early complications involved incision redness, swelling, or drainage. 

Suspected or confirmed incisional infections occurred in 17.4% of dogs, which falls within previously reported ranges of 3.3%–45%. Interestingly, none of the dogs receiving postoperative amoxicillin-clavulanate or cefpodoxime developed infection signs, although case numbers were too small for statistical significance. 

Recurrence rates after IOMT in previous studies range from 0% to 27.4%. In the current study: 

• Dogs undergoing first-time repair had a recurrence rate of 5.9%  

• Dogs with previous repairs on the same side had a recurrence rate of 50%  

The authors suggested that recurrence in previously repaired dogs may be associated with poor tissue integrity, persistence of straining, or limitations of earlier repair techniques. 

Clinical Takeaway 

The study demonstrated that perineal hernia repair in dorsal recumbency is feasible and provides complication and recurrence rates comparable to traditional approaches. The technique offers simultaneous abdominal and perineal access while eliminating the need for intraoperative repositioning, making it a practical option for managing both routine and complicated canine perineal hernias. 

Reference 

1. Tobias KM, Crombie K. Perineal hernia repair in dorsal recumbency in 23 dogs: Description of technique, complications, and outcome. Veterinary Surgery. 2022 Jul;51(5):772-80. https://www.arfcv.fr/wp-content/uploads/2022/10/Veterinary-Surgery-2022-Tobias-Perineal-hernia-repair-in-dorsal-recumbency-in-23-dogs-Description-of-technique-.pdf 

2. Bernardé A, Rochereau P, Matres‐Lorenzo L, Brissot H. Surgical findings and clinical outcome after bilateral repair of apparently unilateral perineal hernias in dogs. Journal of Small Animal Practice. 2018 Dec;59(12):734-41. https://doi.org/10.1111/jsap.12920 

3. Swieton N, Singh A, Lopez D, Oblak M, Hoddinott K. Retrospective evaluation on the outcome of perineal herniorrhaphy augmented with porcine small intestinal submucosa in dogs and cats. The Canadian Veterinary Journal. 2020 Jun;61(6):629. https://pmc.ncbi.nlm.nih.gov/articles/PMC7238463/pdf/cvj_06_629.pdf 

4. Swieton N, Singh A, Lopez D, Oblak M, Hoddinott K. Retrospective evaluation on the outcome of perineal herniorrhaphy augmented with porcine small intestinal submucosa in dogs and cats. The Canadian Veterinary Journal. 2020 Jun;61(6):629. https://pmc.ncbi.nlm.nih.gov/articles/PMC7238463/pdf/cvj_06_629.pdf 

5. Wallace ML, Grimes JA, Duffy DJ, Kindra C, MacIver M, Lin S, Scharf VF, Schmiedt CW. Evaluation of concurrent perineal hernia in adult male dogs presenting with nontraumatic, acquired inguinal hernias. The Canadian Veterinary Journal. 2021 Jun;62(6):617. https://pmc.ncbi.nlm.nih.gov/articles/PMC8118169/pdf/cvj_06_617.pdf