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Date:   04 March, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

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7 CASES OF UMBILICAL HERNIAS IN PUPPIES 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS.
First written: 18 March, 2003
Date:  04 March, 2010

 
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Be Kind To Pets
Veterinary Education
Project 2010-0129
SOLUTIONS AND ADVICES

HERNIA SURGERY IN THE SHIH TZU PUPPY

Hernias in the Shih Tzu Puppy - Sharing the experiences of Dr Sing's interesting cases with the community of pet lovers and dog breeders all over the world 

BREEDERS:  BE KIND TO PUPPIES  - A  puppy's life is precious. 
The puppy can't talk but it feels the pain of the intestinal loops and liver lobes scraping the skin which becomes thinner.  The puppy eats less and becomes a dwarf by week 12 and is unsellable.

In 99% of the surgical cases, the normal puppy does not die from the anaesthesia or surgery.  Large hernias over 1-2 cm are best repaired as some of them do split to become bigger.  There is the possibility of the intestines stuck inside the hernia being twisted and the puppy dying consequently, especially if the hernia is large.

Toa Payoh Vets - Dr Sing's advice to breeders - Recommended time to repair the large umbilical hernia is at 6 weeks of age.

Some puppies do not grow well if the hernia is not repaired. However, general anaesthesia in puppies younger than 12 weeks old is reported to be high risk.

Consult your vet for his or her advices as the anaesthesia is high risk. Work closely and happily with your own vet in the best interest of your pet. 

In 2007/2008 there are rarely any cases of umbilical hernias seen in the Shih Tzu as the breeder's get educated and don't breed from affected lines.

The pictures in this webpage and its links were taken during the years of 2003 - 2006 when Dr Sing's worked with some of the "biggest" professional dog breeders in Singapore.

It was a fun time but very interesting and educational. Altogether 7 cases of umbilical hernia repairs done by Dr Sing are recorded in this webpage and its links. 

Case 1.  
Shih Tzu umbilical hernia repaired at week 8

The breeder decided to repair the hernia as it would be difficult to sell the puppy with such a large umbilical hernia. The hernia extended to the rib cage. It was immense.  This gold and white Shih Tzu was operated at a young age as any puppy over 12 weeks old are harder to sell since most Singapore buyers seem to fall in love with young ones only and don't mind paying a premium for younger puppies.

Case 2.  
Shih Tzu spayed at 6 months, Toa Payoh Vets.

During the spay, the owner can request that the small umbilical hernia to be repaired. In the above Shih Tzu, the owner just wanted a spay and no repair was done. In any case, the hernia was a small one, less than 1 cm long and usually would not be a problem in the dog.

Case 3. Case 3.
Active Shih Tzu - occasional breathing difficulty- may be pain due to gut partially twisted inside large umbilical hernia. General anaesthesia under 4 months old is high risk. Toa Payoh Vets.
Occasional breathing difficulty in this Shih Tzu puppy might be due to the acute pain in the partially twisted intestinal loops which had dropped into the big umbilical hernia. It might be due to other reasons too. So, should the vet operate or not? 
If the operation was postponed and the puppy died of intestinal blood vessel twisting and strangulation, it would be the wrong decision. If the vet operated and the puppy died on the operating table, the vet might be sued or blamed for its demise. So, what would be your decision as an owner? 
Case 4. Case 4.
Plump and healthy Shih Tzu puppies for sale, Singapore. 6-week-old Shih Tzu with large umbilical hernia repaired, Singapore
The Shih Tzu has a large belly button

"It is only six weeks old!" I said. "It is too young to go under the operating table!"  I pulled up the Shih Tzu puppy and looked at his belly. A large circular belly popped out from inside his abdomen. Could I say "no" to Mr Formicelli?

Mr Formicelli wanted to me to repair the large umbilical hernia in his Shih Tzu puppy. I was not keen to operate such a young puppy as his liver was not mature enough to metabolise the anaesthetic drugs and he might then die.

Mr Formicelli knew the risk of death. He could delay the surgery later but the hernia was really large. There were more benefits of an early operation. The puppy had more time to recover and would still be attractive to buyers even two to four weeks later. If he was operated at the 12th week as recommended by most veterinarians, he would be much bigger and less attractive to buyers at the 14th - 16th week. It took about 2 - 4 weeks to recover.

Should I operate or not?  The breeder was willing to risk his puppy. Was I willing to risk my professional reputation?  The death of a puppy stinks the reputation and I was not willing to do the surgery.

I should focus on the welfare of this puppy. The intestinal loops were visible under the thinned skin of the hernia causing much pain to the puppy (picture, right). Not as serious as another of Mr Formicelli's case, but delays would lead to the same situation.

"Is the puppy active and eating well for the past two days?" I asked Mr Formicelli. The puppy looked as plump as his two mates.  Maybe slightly smaller but not much difference yet. In another four weeks, he would lose out in weight gain as he would eat less as he feels the pain of the intestinal loops and liver lobes rubbing against the skin.

The puppy looked healthy. It should be a good anaesthetic patient. Now, when should the puppy be operated on?  Should it be eating 6 hours before surgery?

His belly button was more than 8 cm wide and I could see the intestinal loops impinging on the side. There was no protective muscle layer under the skin as in normal puppies.  Somehow, the skin looked paper-thin when there are no muscle and subcutaneous fat layers below it.

Mr Formicelli wanted the surgery to be done. He was a most successful dog breeder of years of experience.  He was successful in this business of live animals because his puppies grew up plump and  healthy. They were marketable by week 8 and look much bigger than their contemporaries at week ten.  Puppies at 8 weeks old fetch a premium and would be sold first compared to older ones. He would make more money to sustain his high cost of operations.

If the surgery enabled him to increase his revenue, just get a vet whom he could trust to do a good job.  No more waiting till week 12 as recommended by the professionals.   

Shih Tzus with large umbilical hernias are rarely seen in Singapore and I estimated one is seen in 1,000 puppies. A few of them have small umbilical hernias of less than 2.5 cm diameter. This condition seemed to be common in Shih Tzus compared to other breeds. 

"Umbilical hernias are present in brachycephalic breeds only," Mr Formicelli stated. "Pugs and Pekinese have such hernias. You don't see them in Golden Retrievers and German Shepherds."

The Shih Tzu has a shorter nose and he considered it brachycephalic which means "short head".  Actually, umbilical hernias are inherited. 

I took the puppy back to the surgery at 10 am. I operated on him at 4 pm so that his food would no longer be in his stomach. His belly defect stretched up to the liver lobes area. I could see the chocolate brown liver lobes under the hole. A lot of omental fat oozed out of the hole. Mr Formicelli really knew how to rear his puppies to make them fatter than the average ones you see in the pet shop.  I pushed back the fat, looked for the right and left muscle layers far away from the midline. I stitched the layers together. Around ten stitches were placed.  

It was nearly six o'clock when the surgery was completed. It was a minimal anaesthetic routine. When the puppy was moving, he was given more anaesthetic gas. This took a longer time to operate but was safer for the patient. 

I rushed him back to Mr Formicelli's kennels. Mr Formicelli had left the kennels for dinner.

He returned when he saw my car going to his kennels. I made sure that the Shih Tzu was not sleeping in a cold windy kennel and that Mr Formicelli gave him some food. The puppy was a bit groggy. He had cried a few minutes in the car. It must be the pain.  But now, he was all right.

The next morning, he was eating.  Mr Formicelli felt that the wound would heal better without the bandage.  He had his magical special wound spray from Taiwan. This spray reduced inflammation and killed viruses and bacteria. And it seemed to work very well as you can see from the picture of the 6-day operation puppy below. 

Six days later, his wound healed well and he was as active as his two siblings. Mr Formicelli always recognised his puppies as he inspected them every day, 7 days a week. He fed them and nursed them when they fell sick.

The breeder looked at the 3 puppies. He really could not differentiate the affected sibling from the other two. The pup was now not thin or had poor weight gain. He picked up the puppy on the extreme left of the 3-puppy picture below for me to check on its wound. No, it was the wrong party! 

Where's the real McCoy?  The benefit of an early operation was that the puppy had not experienced the internal pain of the intestinal loops twisting and strangulating their blood supply. The puppy would not be able to complain, but it would eat less and lose out to its siblings in body weight gain.  It would become a runt as its growth rate dropped considerably. It would be very hard to sell it.

Case 5 & 6. Umbilical hernia repair in a 8-week-old Shih Tzu - 2 cases. Case 7.  2003 umbilical hernia repair: A stitch in time saves nine.
Shih Tzu umbilical hernia 11 weeks old - serious condition now
Update: In 2010, most Singapore Shih Tzu dog breeders do not sell any puppies with umbilical hernias as they learn not to breed from affected bloodlines.  
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