Simple hernias are the easiest to correct. An elliptical skin incision is made around the hernia, making sure that enough
skin is left to close. After dissecting down to the ring, the abdomen should be entered with a stab incision. Even if the
hernia was easily reducible, the abomasum or other parts of the gastrointestinal tract often are herniated and adhered to
the inside of the hernial sac, so care should be taken on entering the abdomen. A finger is placed into the stab incision
to palpate for herniated bowel or infected umbilical remnants. The skin and lining of the hernial sac are removed from the
ring. If the abomasum is adhered, it should be dissected away from the sac. Occasionally the abomasum will have to be incised
away from the sac and then closed. The edges of the hernial ring can be roughened by lightly cross-hatching it with a scalpel
blade. There are many ways described to close the abdomen, but I prefer a vest-over-pants suture pattern. Although a continuous
pattern can be used, I prefer to pre-place interrupted sutures, then tighten them down once all are placed. The edge of the
ring can then be over-sewn in a simple continuous pattern. The subcutaneous tissue and skin are then closed routinely.
Complicated hernias and umbilical infections require some caution during surgery. A strangulated bowel might need to be resected
if present. With infections, care should be taken when making skin incisions so as not to enter an abscess. And internal structures
should be carefully palpated and identified when entering the abdomen to avoid disruption and contamination. If the infection
only involves the external structures, the infected tissues can be removed en mass. If the arteries are infected, they should
be clamped and transected at a non-infected portion. The artery should be double ligated, and the end of the remaining stump
should be carefully over-sewn to avoid hemorrhage. The ends to be removed should be covered with gauze to avoid contaminating
the abdomen. If the urachus is involved, it should be removed along with the tip of the bladder and the bladder routinely
closed. If the umbilical vein is involved, it can be removed similarly to the arteries.
Occasionally the vein is infected all the way to the liver, and the liver is abscessed. Since the abscess cannot be resected
from the liver, the umbilical vein can be marsupialized to the outside skin through a stab incision separate from the original
incision. The vein is left open to drain to the outside. Controversy exists as to whether or not the vein and liver abscess
should be flushed. The marsupialized vein eventually will close. The abdomen is closed as described previously. Systemic antimicrobials
post-surgery are indicated.
Dr. Navarre is an extension veterinarian with Louisiana State University's Department of Veterinary Science.