CLINICAL COMMENTARY
fascial scar overlying the hernial sac is often too weak. The dissec- tion process for releasing this fascia to mobilise the hernial sac for inversion is similar to that of the simpler umbilical herniorrhaphy, but as ever scar does not yield with the satisfactory neatness of pristine umbilical hernial tissue. The body wall must be identified completely, around the periphery of the hernial ring for the her- niorrhaphy sutures to engage or there will be a risk of engaging scar tissue, tending to partial structural failure of the repair. Dissection aims to release/resect enough of the scar tissue to expose a hernial sac that is sufficiently free to be inverted and thereby not obstruct- ing, drawing together the edges of the hernial ring. Identification of the true pristine untouched body wall can be made by dissecting beyond the scar tissue laterally, caudally and cranially, but palpation of the thick edge of the hernial ring may suffice. The peritoneum at the hernial ring may be a 1– 2 mm thick, a white structure very similar to the vaginal tunic encountered during closed/cryptorchid castrations, rather than the diaphanous peritoneum found during initial midline ventral laparotomy. If mesh is used a suture pattern that will create a trampoline texture to the finished mesh implan- tation is a guide. The primary repair
results achieved by Whitfield- Cargile
et al. ( 2011 ) look attractive. They used 2 or 3 PDS/Polyglactin 910 with a cutting needle. They used SIS for regions under tension and continuous sutures elsewhere. Six millimetre polyamide tape (Ethicon W277) with a large
96- mm- curved needle (Barber of Sheffield) placed as stout mattress sutures has been described as noted above H. Neal (1997) . Adopting the principles described, this is a very adaptable technique which the author prefers/uses as first option. Specific indications could include large hernia possibly outsizing the functional length of the available meshes and those hernia that lie close to the external preputial ori- fice (Figure 2 ) with the associated heavy bacterial colonisation that
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FIGURE 3 Incisional herniorrhaphy utilising nylon tape repair. Cranial is to the right, caudal is to the left, right side of abdomen is to the top and left side of the abdomen is to the bottom. Final tightening of pre- placed tape sutures is shown.
FIGURE 2 Yearling with previous unsuccessful umbilical herniorrhaphies. Hernia adjacent to external preputial orifice increasing risk of SSI. Managed successfully (3- year follow- up) with nylon tape repair.
FIGURE 4 Foal with persistent annular attachment between glans penis and preputial ring (Photo courtesy of James Bosley MRCVS).
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