title: The use of porcine small intestinal submucosa as a biomaterial for perineal herniorrhaphy in the dog.
abstract: OBJECTIVE
  To develop an in vivo perineal hernia model, to develop a technique for using small intestinal submucosa (SIS) in perineal hernia repair, to further elucidate the biological behavior of SIS, and to compare SIS herniorrhaphy with the internal obturator muscle transposition (IOT) technique.
  
  
  METHODS
  Prospective evaluation comparing SIS herniorrhaphy with IOT.
  
  
  METHODS
  Twelve adult castrated male, large-breed dogs.
  
  
  METHODS
  All dogs had bilateral pelvic diaphragm defects created by complete excision of the levator ani muscle. Each dog had one side repaired using SIS and the other by IOT. Pain and inflammation were subjectively scored. Dogs were killed 2 weeks (n = 4), 12 weeks (n = 4), or 16 weeks (n = 4) after surgery. Each pelvic diaphragm was biomechanically tested to failure. The pelvic diaphragms from 2 normal dogs (n = 4 sides) were also biomechanically tested. Failure site, maximum pressure, displacement at failure, and initial linear stiffness values were determined. Histologic assessment was performed. Statistical analysis was performed with significance set at P <.05
  
  
  RESULTS
  No significant postoperative complications were noted. There were no significant differences in maximum pressure to failure, displacement, or stiffness when comparing normal, SIS, and IOT at any time point. The SIS group had significantly less displacement (P =.004) at 2 weeks than at weeks 12 or 16. For all herniorrhaphy techniques, the failure site was central (n = 22) or at the suture line (n = 2). At 2 weeks, histologic evaluation of tissues from the IOT group showed inflammation, mineralization, and necrosis, which were not present in tissues from the SIS group. Histologic examination at 12 and 16 weeks showed no microscopic differences in cell population or tissue characteristics between the IOT and SIS groups.
  
  
  CONCLUSIONS
  SIS herniorrhaphy was successfully performed in this in vivo model of perineal hernia in the dog.
  
  
  CONCLUSIONS
  This study suggests that SIS can be used as a primary means of repair, as augmentation when the internal obturator muscle is thin and friable, or as a salvage procedure in cases of recurrence in dogs with perineal hernia.
authors.affiliation: Department of Veterinary Medicine and Surgery, the Comparative Orthopaedic Laboratory, the College of Engineering, University of Missouri, Columbia, MO, USA.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Stoll
authors.forename: James L
authors.initials: JL
authors.lastname: Cook
authors.forename: Eric R
authors.initials: ER
authors.lastname: Pope
authors.forename: William L
authors.initials: WL
authors.lastname: Carson
authors.forename: John M
authors.initials: JM
authors.lastname: Kreeger
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D006552:Hernia, Inguinal / Q000601:surgery / Q000662:veterinary*; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008422:Materials Testing; D008954:Models, Biological; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000662:veterinary; D011446:Prospective Studies
chemical_list: D001672:Biocompatible Materials