The Use of Porcine Small Intestinal Submucosa as a Biomaterial for Perineal Herniorrhaphy in the Dog

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Abstract
Objectives—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.Study design—Prospective evaluation comparing SIS herniorrhaphy with IOT.Animals—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 =4sides) 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 atP< .05Results—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.Clinical relevance—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.