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Repair Right Sided Diaphragmatic Hernia Using Autogenous Jejunal Graft In Dogs

By: Miss Rasha | Prof.Dr.Muhammad Arif Khan.
Contributor(s): Dr.Asim Aslam | Dr.Asim Khalid Mehmood | Faculty of Veterinary Sciences.
Material type: materialTypeLabelBookPublisher: 2008Subject(s): Department of Clinical Medicine & SurgeryDDC classification: 1006,T Dissertation note: The present study was conducted to evaluate the viability and healing process of the perfused jejunal graft as an implant for the repair of canine diaphragmatic hernia. Diaphragmatic defect was created in 12 healthy mongral dogs irrespective of age and sex. A window was established through obliqus externus and obliqus internus muscles to have an access to the diaphragmatic crus. The jejunum was identified through the same window and a part of required dimension was ressected with intact blood supply. After resection the integrity of jejunum was restored by end to end anastamosis. After making the window identifies the jejunum. And ressect the selected part according to the diaphragmatic defect along with its blood supply. Then the jejunal graft was sutured on the diaphragmatic defect. A diaphragmatic defect of 4X4cm in size was created experimentally on right muscular portion of diaphragm through subcostal/paracostal approach. Experimental dogs were evaluated individually at 20th, 40th and 90th day post operatively .The defect was later on grafted using autogenous perfused jejunum. The size of jejunal graft was sufficient enough to cover the defect 4X4cm created in diaphragm. Clinical examination of the experimental animals was conducted in respect of dyspnea, signs of shock, cynosis and pain. The observations, with respect to the given parameter varied significantly. Physical examination of experimental animals was undertaken with respect to body temperature, pulse rate, respiration rate during post-surgical period. All the dogs showed good post-surgical recovery with minor complication only in the first week after surgery. Diaphragmatic outline was found intact when examined through plain chest radiography. Post-mortem examination revealed no evidence of discoloration, necrosis, injuries and bleeding but the adipose tissue deposit were found at the site of diaphragmatic repair. Histopathological examination of repaired site of diaphragmatic defect revealed fibrous tissue deposits. CONCLUSION The results of present study clearly indicated that the use of perfused jejunal graft with intact blood supply was a viable option and a better choice for the repair of diaphragmatic defect through right paracostal/ subcostal approach in dogs. The use of perfused jejunal graft resulted in lower chances of infection in comparison with synthetic! mesh material reported in literature and was also an economical procedure for the repair of diaphragmatic hernia. RECOMMENDATION Based on the findings of the present study use of autogenous perfused jejunal graft with intact blood supply is recommended as first choice of surgical treatment for the repair of diaphragmatic hernia.
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The present study was conducted to evaluate the viability and healing process of the perfused jejunal graft as an implant for the repair of canine diaphragmatic hernia. Diaphragmatic defect was created in 12 healthy mongral dogs irrespective of age and sex. A window was established through obliqus externus and obliqus internus muscles to have
an access to the diaphragmatic crus. The jejunum was identified through the same window and a part of required dimension was ressected with intact blood supply. After resection the integrity of jejunum was restored by end to end anastamosis. After making the window identifies the jejunum. And ressect the selected part according to the diaphragmatic defect along with its blood supply. Then the jejunal graft was sutured on the diaphragmatic defect. A diaphragmatic defect of 4X4cm in size was created experimentally on right muscular portion of diaphragm through subcostal/paracostal approach. Experimental dogs were evaluated individually at 20th, 40th and 90th day post operatively .The defect was later on grafted using autogenous perfused jejunum. The size of jejunal graft was sufficient enough to cover the defect 4X4cm created in diaphragm. Clinical examination of the experimental animals was conducted in respect of dyspnea, signs of shock, cynosis and pain. The observations, with respect to the given parameter varied significantly. Physical examination of experimental animals was undertaken with respect to body temperature, pulse rate, respiration rate during post-surgical period. All the dogs showed good post-surgical recovery with minor complication only in the first week after surgery. Diaphragmatic outline was found intact when examined through plain chest radiography. Post-mortem examination revealed no evidence of discoloration, necrosis, injuries and bleeding but the adipose tissue deposit were found at the site of diaphragmatic repair.

Histopathological examination of repaired site of diaphragmatic defect revealed fibrous tissue deposits.

CONCLUSION
The results of present study clearly indicated that the use of perfused jejunal graft with intact blood supply was a viable option and a better choice for the repair of diaphragmatic defect through right paracostal/ subcostal approach in dogs. The use of perfused jejunal graft resulted in lower chances of infection in comparison with synthetic! mesh material reported in literature and was also an economical procedure for the repair of diaphragmatic hernia.
RECOMMENDATION
Based on the findings of the present study use of autogenous perfused jejunal graft with intact blood supply is recommended as first choice of surgical treatment for the repair of diaphragmatic hernia.

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