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Marvel S, Monnet E. Laparoscopic Treatment of Sliding Hiatal Hernia. Vet Clin North Am Small Anim Pract 2024; 54:649-659. [PMID: 38503597 DOI: 10.1016/j.cvsm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Hiatal hernias result from a widening of the esophageal hiatus that leads to the displacement of the lower esophageal sphincter and stomach into the thoracic cavity. Clinical signs of regurgitation, gastroesophageal reflux, and esophagitis are managed medically, but surgery is considered in those that fail to respond to medical management. Surgical treatment of hiatal hernia can be performed laparoscopically. Treatment involves plication of the esophageal hiatus, as well as a pexy of the esophagus to the diaphragm and a left sided gastropexy. Outcomes with laparoscopic treatment are comparable to those performed via laparotomy.
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Affiliation(s)
- Sarah Marvel
- ACVS Fellow, Surgical Oncology and MIS (SA Soft Tissue), Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Eric Monnet
- ACVS Founding Fellow, MIS (SA Soft Tissue), Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Hosgood GL, Appelgrein C, Gelmi C. Circumferential esophageal hiatal rim reconstruction for treatment of persistent regurgitation in brachycephalic dogs: 29 cases (2016-2019). J Am Vet Med Assoc 2021; 258:1091-1097. [PMID: 33944588 DOI: 10.2460/javma.258.10.1091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe a technique for circumferential esophageal hiatal rim reconstruction and to report outcomes in brachycephalic dogs with persistent regurgitation treated with the technique. ANIMALS 29 client-owned brachycephalic dogs. PROCEDURES Dogs that had undergone circumferential esophageal hiatal rim reconstruction between January 1, 2016, and December 31, 2019, for treatment of persistent regurgitation were identified through a search of the medical record database of The Animal Hospital at Murdoch University. Circumferential esophageal hiatal rim reconstruction involved apposition of the medial margins of the left and right pars lumbalis dorsal to the esophagus (reconstructing the dorsal margin) and ventral to the esophagus (reducing the ventral hiatal aperture and completing the circumferential reconstruction). Data collection from the medical records included preoperative, intraoperative, and postoperative (short- and long-term outcomes [≤ 14 days and ≥ 6 months, respectively]) data. RESULTS In all dogs, substantial laxity of the left and right pars lumbalis and failure of dorsal coaxial alignment were observed, and circumferential esophageal hiatal rim reconstruction and esophagopexy were performed. Results of short-term follow-up indicated reduced regurgitation frequency; however, 7 of 29 dogs continued to have mild regurgitation, which was attributed to esophagitis and resolved with medical management. Long-term follow-up information was available for 19 dogs: regurgitation had resolved in 16 dogs and occurred once weekly in 3 dogs. No ongoing medication was required for any dog. CONCLUSIONS AND CLINICAL RELEVANCE Circumferential hiatal rim reconstruction combined with esophagopexy substantially reduced regurgitation frequency in dogs of the present study, and we recommend that this procedure be considered for brachycephalic dogs presented with a history of regurgitation unresponsive to medical management.
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Mayhew PD, Balsa IM, Marks SL, Pollard RE, Case JB, Culp WTN, Giuffrida MA. Clinical and videofluoroscopic outcomes of laparoscopic treatment for sliding hiatal hernia and associated gastroesophageal reflux in brachycephalic dogs. Vet Surg 2021; 50 Suppl 1:O67-O77. [PMID: 33687078 DOI: 10.1111/vsu.13622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a laparoscopic technique for treatment of sliding hiatal hernia (SHH) and associated gastroesophageal reflux (GER) in brachycephalic dogs and document clinical and videofluoroscopic outcomes postoperatively. STUDY DESIGN Prospective clinical trial. ANIMALS Eighteen client-owned dogs. METHODS A three-port laparoscopic approach was used. Intracorporeal suturing was used for hiatal plication and esophagopexy, and left-sided laparoscopic or laparoscopic-assisted gastropexy was performed. A standardized canine dysphagia assessment tool (CDAT) questionnaire was completed by owners pre- and postoperatively. Videofluoroscopic swallow studies (VFSS) were used to evaluate esophageal function, and impedance planimetry was used to assess lower esophageal sphincter geometry preoperatively and in a subset of dogs postoperatively. RESULTS Median age was 27.5 (range 5-84) months. Conversion to open surgery was necessary in 1 (5.5%) of 18 dogs. Regurgitation after eating, and associated with activity/exercise, improved significantly when comparing pre- and postoperative CDAT assessments. Hiatal hernia and GER severity scores improved significantly between pre- and postoperative VFSS assessments, whereas SHH and GER frequency scores did not. One dog developed pneumothorax intraoperatively, underwent cardiopulmonary arrest, and died. Minor complications included splenic (n = 6) and hepatic lacerations (n = 3) that did not require specific therapy. CONCLUSION A laparoscopic approach to treatment of SHH and GER led to improvements in clinical and VFSS indices in the majority of brachycephalic dogs. However, a subset of dogs still demonstrated some clinical signs postoperatively. CLINICAL RELEVANCE In experienced hands, laparoscopic treatment of SHH and GER offers a minimally invasive alternative to open surgery.
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Affiliation(s)
- Philipp D Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Ingrid M Balsa
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Rachel E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - J Brad Case
- Department of Small Animal Clinical Sciences, Veterinary Medical Center, University of Florida, Gainseville, Florida, USA
| | - William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Rohwedder T, Hellmuth VC. Gastroesophageal intussusception with complete herniation of the spleen in a 12 months old dog with idiopathic megaoesophagus. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Monnet E. Laparoscopic correction of sliding hiatal hernia in eight dogs: Description of technique, complications, and short-term outcome. Vet Surg 2020; 50:230-237. [PMID: 33170546 DOI: 10.1111/vsu.13541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/16/2020] [Accepted: 10/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe a novel laparoscopic technique to treat sliding hiatal hernia in dogs. STUDY DESIGN Retrospective case series. ANIMALS Eight dogs with sliding hiatal hernia treated with laparoscopy. METHODS Surgery reports were reviewed for technique description and animal outcomes. RESULTS Six dogs were brachycephalic. Dogs were placed in right lateral oblique recumbency. Four dogs were placed in a reverse Trendelenburg position to visualize the esophageal hiatus. A single port was placed 2 cm caudal to the last rib on the left side. An extra cannula was added in four dogs. A large-bore orogastric tube was introduced in five dogs and used in four dogs to reduce the hernia. A unidirectional nonabsorbable barbed suture was used for the closure of the esophageal hiatus and the esophagopexy. A left-sided gastropexy was performed for all the cases. The gastropexy was performed with a gastrostomy tube to bypass the esophagus in four dogs. Intraoperative complications included pneumothorax in three dogs. Conversion was elective in three cases and emergent in one case. Clinical signs were recorded as improved in each dog. The median follow-up time was 16.5 days (range, 9-264). CONCLUSION Hiatal hernia repair was performed laparoscopically in this population. Repair included a combination of esophageal plication, esophagopexy, and left-sided gastropexy. Reverse Trendelenburg animal positioning and orogastric tube placement facilitated the reduction of the hernia. CLINICAL SIGNIFICANCE Laparoscopy is an option for the treatment of sliding hiatal hernia in dogs.
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Affiliation(s)
- Eric Monnet
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Hernon T, Chanoit G, Meakin LB. Intrathoracic gastric torsion following surgical management of a type IV hiatal hernia. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tom Hernon
- School of Veterinary SciencesUniversity of BristolLangfordUK
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Ferrero C, Borland K. Anaesthetic complications and management of a great dane presenting with acute respiratory distress. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Camilla Ferrero
- Anaesthesia DepartmentAnderson Moores Veterinary SpecialistsWinchesterUK
| | - Karla Borland
- Anaesthesia DepartmentAnderson Moores Veterinary SpecialistsWinchesterUK
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Phillips H, Corrie J, Engel DM, Duffy DJ, Holt DE, Kendall AR, Schmiedt CW, Vetter A, Meren IL, Follette C, Schaeffer DJ, Mayhew PD, Marks SL. Clinical findings, diagnostic test results, and treatment outcome in cats with hiatal hernia: 31 cases (1995-2018). J Vet Intern Med 2019; 33:1970-1976. [PMID: 31397500 PMCID: PMC6766504 DOI: 10.1111/jvim.15583] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Information regarding clinical signs, assessment, treatment, and outcome in cats with hiatal hernia (HH) is limited. Objectives To characterize the clinical presentation of HH and medical and surgical outcomes in a cohort of affected cats. Animals Thirty‐one client‐owned cats with HH. Methods Medical records of cats with HH were retrospectively reviewed for signalment, history, results of diagnostic tests, details of surgical and medical treatments, complications, and outcome. Long‐term follow‐up data were obtained by telephone communication. Relationships between clinical variables and outcome were evaluated by regression analysis. Results Type I HH was present in 85.7% (24/28) of cats, and 64.5% (20/31) were >3 years of age at diagnosis. Twenty‐one of 31 (67.7%) cats underwent surgical repair including phrenoplasty, esophagopexy, and left‐sided gastropexy, and 10 of 31 cats were treated medically without surgery. Concurrent illness was common, and 77.4% cats had comorbidities. All cats survived to discharge, and median time to death or follow‐up was 959 days (range, 3‐4015 days). Cats treated medically survived longer than cats treated surgically, with median time to death or follow‐up of 2559 and 771 days, respectively. Conclusions and Clinical Importance Type I HH is the most common type of HH in cats. A congenital etiology is possible, but many cats with HH were >3 years of age at diagnosis and suffered from comorbidities, including upper airway obstruction. Case selection and the presence of comorbidities likely influenced the outcome. Cats with HH may not be diagnosed until disease is advanced or concurrent illness draws attention to clinical signs.
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Affiliation(s)
- Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Jessica Corrie
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Danielle M Engel
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Daniel J Duffy
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - David E Holt
- Section of Surgery, Matthew J. Ryan Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allison R Kendall
- Department of Internal Medicine, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Chad W Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Autumn Vetter
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Ilyssa L Meren
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Christelle Follette
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Philipp D Mayhew
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California
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Eivers C, Chicon Rueda R, Liuti T, Salavati Schmitz S. Retrospective analysis of esophageal imaging features in brachycephalic versus non-brachycephalic dogs based on videofluoroscopic swallowing studies. J Vet Intern Med 2019; 33:1740-1746. [PMID: 31218762 PMCID: PMC6639489 DOI: 10.1111/jvim.15547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/29/2019] [Indexed: 01/30/2023] Open
Abstract
Background Idiopathic esophageal dysmotility (ED) is increasingly recognized in young dogs of brachycephalic breeds. Few studies have objectively associated specific videofluoroscopic swallowing study (VFSS) features with brachycephaly, leading to under‐recognition of ED in brachycephalic breeds. Hypothesis/objectives To describe and compare VFSS in brachycephalic dogs versus non‐brachycephalic dogs presented for dysphagia or regurgitation, and to investigate associations between these imaging findings and patient signalment. Methods Retrospective analysis of VFSS of dogs presented for dysphagia or regurgitation (not megaesophagus) from 2006 to 2017. Cases were divided into brachycephalic and mesaticephalic breeds. The VFSS were reviewed using a standardized protocol by 2 examiners. Esophageal motility was assessed using specific criteria, and particular imaging features were noted and graded. Fisher's exact test was used to determine associations among signalment (including brachycephaly), final diagnosis, outcomes, and ED features. Results Thirty‐six dogs were included (n = 10 normal, n = 26 presumed ED). Twenty dogs (77%) with presumed ED were brachycephalic with a median age of 1 year (range, 0.2‐10.5 years). Most common were prolonged esophageal transit time (ETT; n = 21/26), decreased propagation of secondary peristaltic waves (n = 20/26), and gastroesophageal reflux (GER; n = 18/28). Eight dogs (all brachycephalic) had hiatal herniation (HH). Morphological esophageal variations were only observed in brachycephalic dogs. Brachycephaly was significantly associated with ED (P = .005), prolonged ETT (P = .41), GER (P = .02), and HH (P = .03). Conclusions and Clinical Importance The majority of dogs with presumed ED was young and brachycephalic and had specific abnormalities that were less frequent in mesaticephalic dogs with regurgitation or dysphagia.
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Affiliation(s)
- Caroline Eivers
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Midlothian, UK
| | - Rocio Chicon Rueda
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Midlothian, UK
| | - Tiziana Liuti
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Midlothian, UK
| | - Silke Salavati Schmitz
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Midlothian, UK
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Mayhew PD, Marks SL, Pollard R, Culp WTN, Kass PH. Prospective evaluation of surgical management of sliding hiatal hernia and gastroesophageal reflux in dogs. Vet Surg 2017; 46:1098-1109. [DOI: 10.1111/vsu.12684] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/17/2017] [Accepted: 05/11/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Philipp D. Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - Stanley L. Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine; University of California-Davis; Davis California
| | - Rachel Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - Philip H. Kass
- Population Health and Reproduction, School of Veterinary Medicine; University of California-Davis; Davis California
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Mayhew PD, Pitt KA, Steffey MA, Culp WTN, Kass PH, Marks SL. Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe. Am J Vet Res 2016; 77:799-804. [PMID: 27463542 DOI: 10.2460/ajvr.77.8.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the effect of intra-abdominal pressure (IAP) on morphology and compliance of the lower esophageal sphincter (LES) by use of impedance planimetry in healthy dogs and to quantify the effect of changes in IAP. ANIMALS 7 healthy, purpose-bred sexually intact male hound-cross dogs. PROCEDURES Dogs were anesthetized, and cross-sectional area (CSA), minimal diameter (MD), LES length, LES volume, and distensibility index (DI) of the LES were evaluated by use of an endoscopic functional luminal imaging probe. For each dog, measurements were obtained before (baseline) and after creation of a pneumoperitoneum at an IAP of 4, 8, and 15 mm Hg. Order of the IAPs was determined by use of a randomization software program. RESULTS CSA and MD at 4 and 8 mm Hg were not significantly different from baseline measurements; however, CSA and MD at 15 mm Hg were both significantly greater than baseline measurements. The LES length and LES volume did not differ significantly from baseline measurements at any IAP. The DI differed inconsistently from the baseline measurement but was not substantially affected by IAP. CONCLUSIONS AND CLINICAL RELEVANCE Pneumoperitoneum created with an IAP of 4 or 8 mm Hg did not significantly alter LES morphology in healthy dogs. Pneumoperitoneum at an IAP of 15 mm Hg caused a significant increase in CSA and MD of the LES. Compliance of the LES as measured by the DI was not greatly altered by pneumoperitoneum at an IAP of up to 15 mm Hg.
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Boucher C, Coetzee GL. Hiatal hernia in a five‐month‐old Bulldog. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2015-000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Charles Boucher
- Companion Animal Clinical StudiesUniversity of PretoriaPretoriaGautengSouth Africa
| | - Gert Louis Coetzee
- Companion Animal Clinical StudiesUniversity of PretoriaPretoriaGautengSouth Africa
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Gambino JM, Sivacolundhu R, DeLucia M, Hiebert E. Repair of a sliding (type I) hiatal hernia in a cat via herniorrhaphy, esophagoplasty and floppy Nissen fundoplication. JFMS Open Rep 2015; 1:2055116915602498. [PMID: 28491383 PMCID: PMC5361999 DOI: 10.1177/2055116915602498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/24/2022] Open
Abstract
Case summary A 10-month-old domestic shorthair cat was evaluated for severe esophagitis and protracted vomiting and regurgitation secondary to a sliding (type I) hiatal hernia. The hernia and concurrent upper airway obstruction (nasopharyngeal polyp) were diagnosed with a multi-modality approach, including thoracic and abdominal radiographs, abdominal ultrasound, computed tomography and endoscopy. Following unsuccessful attempts at medical management, lower esophageal incompetence was successfully treated by employing a combination of surgical techniques, including herniorrhaphy, esophagopexy and modified (floppy) Nissen fundoplication. Relevance and novel information A multi-modality imaging approach was valuable in completely assessing the extent of this cat’s disease. Although an untraditional approach, the authors report herein the first clinical description of the use of combined surgical techniques with the floppy Nissen fundoplication technique (an antireflux procedure) in a cat. This procedure was used as a first-line surgical technique in this cat with severe lower esophageal incompetence, and may be a viable option for cases non-responsive to other therapeutic interventions. Further investigation of this surgical technique is warranted.
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Affiliation(s)
- Jennifer M Gambino
- Department of Diagnostic Imaging, Mississippi State University, College of Veterinary Medicine, Mississippi State, MS, USA
| | - Ramesh Sivacolundhu
- Balcatta Veterinary Hospital, Perth, Western Australia, University of Western Australia, Honorary Research Associate, Murdoch University
| | - Meghan DeLucia
- Department of Internal Medicine, VCA Katonah Bedford Veterinary Center, Bedford Hills, NY, USA
| | - Elizabeth Hiebert
- Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
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Abstract
A 3 mo old male domestic shorthair weighing 2 kg was presented for acute onset of anorexia, lethargy, paradoxical breathing, and a palpable mass effect in the cranial abdomen. Initial diagnostics and imaging suggested a pleuroperitoneal or hiatal hernia. Emergency abdominal exploration was performed, and a complex type II paraesophageal hiatal hernia was identified. The entire stomach, greater and lesser omenta, spleen, left limb of the pancreas, and the proximal segment of the descending duodenum were herniated through a discrete defect in the phrenicoesophageal ligament. After reduction of the herniated organs back into the abdomen, a phrenicoplasty, esophagopexy, and left-sided fundic gastropexy were performed. The cat recovered uneventfully from the procedure and was free of any signs of disease for at least 30 mo postoperatively. This is the first detailed report of the findings and successful surgical treatment of a complex congenital, type II paraesophageal hiatal hernia with complete herniation of the stomach, omenta, and spleen in a cat.
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Affiliation(s)
- Kim Tong
- From the Dallas Veterinary Surgical Center, Dallas, TX (K.T.); and Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, Michigan State University, East Lansing, MI (R.G.)
| | - Reunan Guillou
- From the Dallas Veterinary Surgical Center, Dallas, TX (K.T.); and Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, Michigan State University, East Lansing, MI (R.G.)
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Allman DA, Pastori MP. Duodenogastric intussusception with concurrent gastric foreign body in a dog: a case report and literature review. J Am Anim Hosp Assoc 2012; 49:64-9. [PMID: 23148141 DOI: 10.5326/jaaha-ms-5827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 3 yr old spayed female boxer weighing 22.8 kg was presented for severe, acute vomiting and tenesmus. Tachycardia, tachypnea, dehydration, and abdominal pain were present on physical examination. Abdominal radiographs showed a foreign object (golf ball) in the fundus of the stomach, and a larger, round, soft-tissue opacity mass in the region of the pylorus. Endoscopic removal of the foreign object was unsuccessful. A large soft-tissue mass (duodenogastric intussusception) was visualized with endoscopy, but was not correctly diagnosed until surgery. A midline exploratory celiotomy was performed and the duodenogastric intussusception was diagnosed and manually reduced. Severe pyloric wall edema and minimal bruising were present. A routine fundic gastrotomy was performed and the foreign object was removed. A right-sided incisional gastropexy and duodenopexy were performed in attempt to prevent recurrence of the intussusception. The dog was discharged from the hospital 38 hrs after surgery, and was normal on follow-up 1 yr after surgery. The dog in this report is the sixth documented case of duodenogastric/pylorogastric intussusception in the veterinary literature. This is the first reported case with a concurrent gastric foreign body and endoscopic visualization of the intussusception.
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Affiliation(s)
- David A Allman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
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