Changes

If the hernia is acquired, the underlying cause should be treated.

If the hernia is acquired, the underlying cause should be treated.

'''Medical management''' should be initiated to reduce oesophagitis caused by regurgitation.  Medical management can be continued for cases with acquired hernias and may also achieve some success in cases with congenital hernias.  This approach involves the use of:

'''Medical management''' should be initiated to reduce oesophagitis caused by regurgitation.  Medical management can be continued for cases with acquired hernias and it may achieve success in some cases with congenital hernias.  This approach involves the use of:

*'''[[Gastroprotective Drugs]]''' including oral sucralfate suspensions and gastric acid secretory inhibitors such as cimetidine, ranitidine or omeprazole.

*'''[[Gastroprotective Drugs]]''' including oral sucralfate suspensions and gastric acid secretory inhibitors such as cimetidine, ranitidine or omeprazole.

*A '''low fat diet''' fed from a height will increase the tone of the lower oesophageal sphincter and increase the speed of gastric emptying, reducing the likelihood of regurgitation.

*A '''low fat diet''' fed from a height will increase the tone of the lower oesophageal sphincter and increase the speed of gastric emptying, reducing the likelihood of regurgitation.

*'''Antibiotics, nebulisation and coupage''' may be used to manage aspiration pneumonia.

*'''Antibiotics, nebulisation and coupage''' may be used to manage aspiration pneumonia.

'''Surgical management''' is usually attempted with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases.

'''Surgical management''' can be used with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases.

*'''Hernia repair''' is achieved via a cranial ventral coeliotomy.  The oesophageal hiatus is exposed by transection of left triangular ligament (between the liver and diaphragm) and retraction of the liver.  The phreno-oesophageal ligament is partially incised and the oesophagus is retracted into the abdomen until the lower oesopageal sphincter is identified.  Sutures are then passed to reduce the size of the oesophageal hiatus.  

*'''Hernia repair''' is achieved via a cranial ventral coeliotomy.  The oesophageal hiatus is exposed by transection of left triangular ligament (between the liver and diaphragm) and retraction of the liver.  The phreno-oesophageal ligament is partially incised and the oesophagus is retracted into the abdomen until the lower oesopageal sphincter is identified.  Sutures are then passed to reduce the size of the oesophageal hiatus.  

*An '''oesophagopexy''' may also be performed (tacking the oesophagus to the left body wall) or a '''fundic gastropexy'''.  A tube gastropexy has the added advantage of allowing cases to be fed if they are suffering from severe oesophagitis or oesophageal ulceration.

*An '''oesophagopexy''' may also be performed (tacking the oesophagus to the left body wall) or a '''fundic gastropexy'''.  A tube gastropexy has the added advantage of allowing cases to be fed if they are suffering from severe oesophagitis or oesophageal ulceration.