Congenital Peritoneopericardial Diaphragmatic Hernia in a Dog: Ventral Advancement Diaphragmatic Technique for Repair

Peritoneopericardial diaphragmatic hernia (PPDH) is a rare congenital anomaly that requires surgical treatment. Its clinical presentation varies and can affect one or more abdominal organs. This case report refers to a recently described surgical technique called ventral advancement of the diaphragm (VADT). Previously, a complete diagnostic approach was made in a 4-month-old, 6 kg (13.22 lbs.), uncastrated, mixed breed dog, with a history of cough from the time of adoption, with no known record of trauma. Physical examination revealed tachycardia, tachypnea, body condition score of 5/9, positivity to tracheal sensitivity tests, and attenuation of heart sounds in the left hemithorax, with no other relevant alterations. A PPDH was diagnosed and surgical correction was recommended. VADT was performed by incising the diaphragm ventrally with scissors, following the costal arch, about 3 cm on each side, avoiding excessive tension on the wound and possible postoperative dehiscence. Nonabsorbable monofilament material was used, with an interrupted horizontal suture pattern, without intraoperative or postoperative complications. The results showed that VADT is an easy surgical procedure to perform, being its approach beneficial for the patient, when compared with other techniques, providing an effective clinical resolution; generating little tension on the sutures that correct the diaphragmatic defect, with low rate of complications, dehiscence or recurrences, as reported in the literature and observed in this case. It is concluded that VADT is a surgical technique that is not very demanding for the surgical team and allows the defect to be corrected effectively, confirming its efficacy; however, further clinical evidence is recommended to validate its reproducibility.