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Diaphragm: repair of diaphragmatic defects
Synonym(s): Ruptured diaphragm
Introduction
- To repair a ruptured diaphragm via a ventral midline approach.
Uses
- Traumatic ruptured diaphragm Diaphragm: hernia.
- Congenital diaphragmatic hernia (peritoneopericardial diaphragmatic hernia (PPDH Peritoneal-pericardial diaphragmatic hernia (PPDH)) Congenital hernia.
Advantages
- Ventral midline approach allows extension of incision cranially through sternum, paracostally, or caudally to improve exposure as required Laparotomy: midline.
- Entire abdominal viscera can be examined for damage.
Technical problems
- Intra-operative pulmonary hyperinflation or too rapid re-inflation of lungs post-operatively in chronic case can result in re-expansion pulmonary edema Lung: pulmonary edema.
Alternative techniques
- Extension of the laparotomy via caudal median sternotomy can be performed when necessary to gain better intra-thoracic access, for example in chronic cases with adhesions.
- Lateral thoracotomy is not recommended:
- Does not allow for examination of abdominal viscera.
- Requires pre-operative knowledge of location of hernia.
- Would be required to be performed bilaterally in cases of bilateral hernias.
- Painful post-operatively.
Decision taking
Criteria for choosing test
- Patient must be stabilized before anesthesia, ie cardiovascularly stable and following correction of pleural effusion Pleural effusion or pneumothorax Pneumothorax via thoracocentesis Drainage: thorax.
- Timing of surgery is important and thorough patient assessment and stabilization is essential. Whilst earlier literature advised that surgery within the first 24 hours has the highest mortality rate, more recent reports do not support this.
- Herniation of the stomach into the thoracic cavity, in particular with radiographic evidence of gaseous gastric distension, is an indication for more urgent surgical intervention.
Note that cats with PPDH may not require surgical intervention; decision to pursue surgery should be based upon the presence and severity of clinical signs.
Risk assessment
- Anesthesia for these cases requires special care Anesthesia: for ruptured diaphragm.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Gibson T W, Brisson B A, Sears W (2005) Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990-2002). JAVMA 227 (1), 105-9 PubMed.
- Minihan A C, Berg J, Evans K L (2004) Chronic diaphragmatic hernia in 34 dogs and 16 cats. JAAHA 40 (1), 51-63 PubMed.
- Reimer S B, Kyles A E, Filipowicz D E et al (2004) Long-term outcome of cats treated conservatively or surgically for peritoneopericardial diaphragmatic hernia: 66 cases (1987-2002). JAVMA 224 (5), 728-732 PubMed.
- Sullivan M & Reid J (1990) Management of 60 cases of diaphragmatic rupture. JSAP 31 (9), 425-430 VetMedResource.
- Sullivan M & Lee R (1989) Radiological features of 80 cases of diaphragmatic rupture. JSAP 30 (10), 561-566 VetMedResource.