# Diaphragmatic Herniorrhaphy in Veterinary Patients Diaphragmatic herniorrhaphy is the surgical closure of a defect in the diaphragm that allows abdominal organs to move into the thoracic cavity. The procedure restores the barrier between the abdomen and the chest, relieves lung compression, and returns herniated organs such as the liver, gallbladder, stomach, or intestines to their normal position. It is performed in two broad clinical settings. The first is a congenital pleuroperitoneal or peritoneopericardial diaphragmatic hernia, a birth defect in which the fetal communication between the abdomen and the pericardial sac or pleural space fails to close. The second is an acquired rupture after blunt trauma, most often a vehicular accident or a fall, in which a sudden rise in intra-abdominal pressure tears the muscle. The hands-on surgical time for a straightforward herniorrhaphy is typically 60 to 120 minutes. Complex cases with adhesions, organ resection, or a concurrent pericardial or hiatal defect can exceed three hours. Total elapsed time from induction to recovery includes anesthesia, patient positioning, aseptic preparation, the approach, reduction and closure, and a controlled recovery period. This article covers the diagnostic triad, anesthesia, the ventral midline celiotomy approach, suture technique, and a post-operative monitoring checklist. It is educational and is not a substitute for veterinary diagnosis or treatment. ## Clinical Presentations: Congenital Versus Acquired ### Congenital Peritoneopericardial Diaphragmatic Hernia A congenital peritoneopericardial diaphragmatic hernia (PPDH) is a developmental defect in which the diaphragm and the pericardial sac fail to separate during fetal life. Abdominal organs communicate directly with the pericardial space. This is the most common congenital diaphragmatic defect in dogs and cats. A retrospective study of 58 cases at two teaching hospitals found a prevalence of 0.025 percent, with cats affected more often than dogs (0.062 percent versus 0.015 percent) [1]. Many PPDH cases are discovered incidentally. In the same series, PPDH was an incidental finding in 13 of 28 dogs (46.4 percent) and 15 of 30 cats (50.0 percent) [1]. Other congenital abnormalities were found in 16 dogs (57.1 percent) and 7 cats (23.3 percent), most commonly umbilical hernias, abdominal wall hernias cranial to the umbilicus, or sternal anomalies [1]. When clinical signs do appear, they most often involve the respiratory or gastrointestinal tracts. Respiratory signs are more prevalent in cats, and gastrointestinal signs are more common in dogs [2]. The most frequently herniated organs are the liver, gallbladder, and small intestine [2]. A separate report described chylothorax, an accumulation of chyle in the pleural space, as a consequence of PPDH in a dog, and it resolved permanently after repair, pericardectomy, and cisterna chyli ablation [3]. ### Acquired Traumatic Diaphragmatic Rupture Traumatic diaphragmatic hernia results from blunt trauma that creates a tear in the diaphragmatic muscle. The most common cause is a vehicular accident. In an eleven-year retrospective analysis of 49 dogs and 48 cats with acquired diaphragmatic hernia, the predominant respiratory sign was dyspnea, and concurrent orthopedic or soft tissue injuries were identified in 48.45 percent of the animals [4]. The interval from trauma to the development of clinical signs did not influence survival, but animals treated surgically within 48 hours after diagnosis had a lower risk of death [4]. Concurrent injuries and intraoperative and postoperative complications were the main factors associated with a higher risk of death [4]. A hernia may be delayed. One case report described an 8-year-old dog that suffered vehicular trauma six months before presentation with a persistent cough [5]. Initial imaging and exploratory laparotomy at the time of trauma showed no significant damage. Contrast radiography with barium revealed tubular shadows in the thoracic cavity, confirming a delayed traumatic diaphragmatic hernia with both liver (hepatothorax) and intestine (enterothorax) in the chest [5]. This case shows why a negative initial evaluation does not rule out a diaphragmatic tear. Chronic hernias behave differently from acute ones. In a review of 34 dogs and 16 cats with hernias of more than two weeks' duration, the most common clinical signs were dyspnea and vomiting, but many animals presented only with nonspecific signs such as anorexia, lethargy, and weight loss [6]. Division of mature adhesions between the lungs or diaphragm and herniated organs was necessary in 14 animals to permit reduction [6]. ## The Diagnostic Triad A working diagnosis of diaphragmatic hernia rests on three findings that, taken together, are highly suggestive. 1. **Tachypnea or dyspnea.** An increased respiratory rate or effort reflects lung compression by herniated organs. In one reported PPDH case, the dog had intermittent tachycardia, tachypnea with mildly increased respiratory effort, and bilateral ventral muffled lung sounds [7]. 2. **Muffled lung sounds on auscultation.** Muffled or absent lung sounds, especially ventrally, suggest that a solid or fluid-filled organ instead of aerated lung sits against the chest wall. Borborygmi, or bowel sounds, heard over the chest are an even stronger sign. In a 5-month-old Labrador Retriever with a congenital PPDH, clinical examination revealed borborygmi on auscultation of the chest [8]. 3. **Thoracic viscera on radiographs.** Thoracic radiographs may show abdominal organs within the chest, an indistinct or interrupted diaphragmatic line, or a large soft-tissue opacity in the pericardium. In the chylothorax case, chest radiographs showed significant pleural effusion and computed tomography revealed a PPDH with a large fat-attenuating mass within the pericardium [3]. Radiography alone is not always sufficient. In the chronic hernia series, thoracic radiographs revealed evidence of diaphragmatic hernia in only 66 percent of animals, and additional imaging was often needed to confirm the diagnosis [6]. Computed tomography can identify the exact location of the defect. A one-year-old German Shepherd with a delayed dorsal hernia of the pars lumborum, the dorsal muscular part of the diaphragm, was successfully repaired only after CT identified the exact location and allowed the surgeon to choose a lateral paracostal approach [9]. ### The Pitfall: Missing a Concurrent Defect A second defect can be present and easily missed. A peritoneopericardial hernia and a hiatal hernia may coexist, and either can be hidden by the more obvious lesion. In one reported case, a dog with a PPDH was taken for emergency laparotomy and median sternotomy, and the surgical team found right ventral PPDH with a herniated, necrosed quadrate liver lobe and gallbladder, plus two suspected right ventricular aneurysms and generalized mesenteric and portal lymphadenopathy [7]. The affected liver lobe and gallbladder were removed, and the suspected aneurysms were managed by placing two purse-string sutures around the lesions and anchoring a pericardial flap over them [7]. A hiatal hernia is a separate condition in which part of the stomach moves cranially through the esophageal hiatus. Clinical signs in four dogs and one cat included regurgitation, vomiting, hematemesis, hypersalivation, dysphagia, and dyspnea [10]. Thoracic radiographs, esophagram, and fluoroscopy demonstrated cranial displacement of the esophagogastric junction and part of the stomach through the esophageal hiatus [10]. Surgical repair involved reduction in the size of the esophageal hiatus, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and a left fundic gastropexy [10]. A more recent study of 41 dogs found that dogs that underwent gastropexy were significantly more likely to require further surgery related to the initial surgery or persistence of gastrointestinal signs compared with dogs that had no gastropexy [11]. This finding means the decision to add a gastropexy must be made case by case rather than by routine. The practical lesson is to inspect the entire diaphragm, the esophageal hiatus, and the pericardium before closing. A defect that is not seen at surgery can cause persistent signs after an otherwise successful repair. ## Anesthesia Considerations Anesthesia for diaphragmatic herniorrhaphy is complicated by the fact that the lungs are already compressed. Positive-pressure ventilation is required because the patient cannot maintain normal gas exchange with a reduced functional lung volume and a chest cavity partly filled by abdominal organs. Intermittent positive-pressure ventilation through an endotracheal tube is standard. Nitrous oxide must be avoided. Nitrous oxide diffuses into air-filled spaces faster than nitrogen diffuses out, so it expands any closed gas space. In a patient with a pneumothorax, a herniated gas-filled bowel loop, or a pericardial gas pocket, nitrous oxide can enlarge that space and worsen compression of the heart and lungs. Use an inhalant such as isoflurane or sevoflurane in oxygen, with a balanced intravenous opioid and, where appropriate, a local or regional block. Re-expansion pulmonary edema is a risk when a chronically collapsed lung is re-expanded too quickly after the herniated organs are reduced. The mechanism is a sudden increase in pulmonary capillary permeability after rapid re-expansion. The prevention is gradual, controlled re-inflation, avoiding high airway pressures, and monitoring oxygenation and compliance as the lung re-expands. A sudden fall in oxygen saturation or a rise in airway pressure during reduction should prompt the anesthetist to slow or pause inflation. Monitoring during the procedure should include pulse oximetry, capnography, electrocardiography, direct or oscillometric blood pressure, and body temperature. Capnography is particularly useful because end-tidal carbon dioxide reflects ventilation and can signal a fall in cardiac output. A sudden drop in end-tidal carbon dioxide with hypotension may indicate reduced venous return from compression of the vena cava or from pneumothorax. ## Materials and Instrumentation | Item | Working details and purpose | |--|--| | Suture for diaphragm closure | Non-absorbable monofilament or long-lasting absorbable suture, sized to the patient. A simple interrupted or horizontal mattress pattern using 2-0 to 3-0 suture is typical in medium dogs, with smaller sizes in cats. | | Barbed suture | Used for laparoscopic closure in one reported case of an incidentally found diaphragmatic defect [12]. Allows continuous closure without knot tying. | | Chest drain | A thoracostomy tube placed for evacuation of residual air and fluid. Not required in every case. | | Suction and thoracentesis equipment | For intraoperative transdiaphragmatic thoracentesis to remove residual air. | | Mesh or muscle flap | For large defects that cannot be closed primarily. Polypropylene mesh [13] or a rectus abdominis muscle pedicle flap [14] are reported options. | | Pericardial flap | Used for repair of large ventral PPDH defects [8] and for covering lesions in one complex case [7]. | | Self-retaining abdominal retractors | For exposure through the ventral midline celiotomy. | Suture material selection balances tensile strength against the risk of the suture cutting through the diaphragm. A monofilament suture glides through tissue and resists bacterial colonization better than a braided suture. Absorbable sutures that retain strength for several weeks are acceptable, and non-absorbable sutures are used when long-term strength is desired. ## Surgical Approach: Step by Step The following steps describe the standard ventral midline celiotomy approach for a traumatic or congenital diaphragmatic hernia. 1. **Position the patient in dorsal recumbency.** The ventral midline provides access to both the abdomen and the ventral diaphragm. Clip and aseptically prepare the entire ventral abdomen from the xiphoid to the pubis. 2. **Make a ventral midline celiotomy.** Extend the incision from the xiphoid far enough caudal to allow full exploration of the abdomen and the diaphragm. The ventral midline is the most common approach, and 36 of 50 hernias in one chronic series were repaired through a midline laparotomy [6]. 3. **Explore the abdomen first.** Before reducing the hernia, inspect the herniated organs and the abdominal contents. Look for gastric dilation, bowel devitalization, or hemorrhage. In one case, the liver biochemical indexes were monitored after surgery to prevent endotoxemia related to hepatic compromise [5]. 4. **Break down adhesions if present.** In chronic hernias, mature adhesions form between the lungs or diaphragm and the herniated organs. Division of these adhesions was necessary in 14 of 50 animals in the chronic series to permit reduction of the hernia [6]. Use careful sharp and blunt dissection to avoid tearing the lung or liver. 5. **Reduce the herniated organs.** Apply gentle traction to return the liver, gallbladder, stomach, intestine, or omentum to the abdomen. If an organ is necrotic or nonviable, resect it before reducing it. In the reported case, the quadrate liver lobe and gallbladder were removed because they were necrosed and nonviable [7]. Fourteen animals in the chronic series required resection of portions of the lungs, liver, or intestine [6]. 6. **Inspect the entire diaphragm and the esophageal hiatus.** Confirm the full extent of the tear or defect. Check the dorsal attachments, the pars lumborum, the esophageal hiatus, and the pericardial sac. This is the step that prevents a missed concurrent defect. 7. **Choose the closure technique.** For small defects, close the diaphragm primarily with sutures. For large defects that cannot be closed without tension, options include a polypropylene mesh, a rectus abdominis muscle pedicle flap, or a ventral diaphragmatic advancement. In the ventral advancement technique, the ventral attachments of the diaphragm are incised on either side of the defect and slid medially to allow tension-free closure, with the ventral aspect of the incised diaphragm reattached using circumcostal sutures [8]. A rectus abdominis muscle pedicle flap was successfully used in three dogs with combined radial and circumferential tears, with no reherniation over four months of follow-up [14]. 8. **Place sutures in the diaphragm.** Close the defect with a simple interrupted or horizontal mattress pattern for small defects, or a continuous pattern when appropriate. In an experimental gasless laparoscopic model, defect closure required 7.0 plus or minus 0.7 crossed mattress sutures in the suture group [13]. Tack the first and last sutures or use a tension-relieving pattern when closing a large defect under tension. 9. **Re-expand the lungs and evacuate residual air.** Coordinate with the anesthetist to re-expand the lungs gradually. Residual air can be removed by intraoperative transdiaphragmatic thoracentesis, intercostal thoracentesis, or a chest drain. In a study of 90 cats treated for traumatic diaphragmatic hernia, intraoperative transdiaphragmatic thoracentesis without a chest drain was associated with intraoperative and postoperative complication rates of 3.3 percent and 12.4 percent, respectively, and an overall survival rate of 93.3 percent [15]. Development of postoperative pneumothorax was associated with the presence of comorbidities [15]. 10. **Close the abdomen in layers.** Close the linea alba, subcutaneous tissue, and skin in standard fashion. 11. **Recover the patient with oxygen supplementation and close monitoring.** Extubate only when the patient is swallowing and has adequate spontaneous ventilation. Keep the head elevated slightly to aid respiration, and monitor respiratory rate and effort continuously. ## Reading the Results: What to Expect A successful repair produces a clear radiographic diaphragm border, aerated lung fields, and a return of herniated organs to the abdomen. In one reported case, postoperative radiographs revealed clear contours of thoracic and abdominal organs, and the dog moved, ate, and urinated normally within ten days of surgery [5]. In the chronic hernia series, 34 of 43 animals discharged from the hospital (79 percent) had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during follow-up [6]. Resolution of preoperative signs is the most meaningful outcome. In the PPDH case series, clinical signs associated with PPDH resolved in 29 of 34 surgically treated animals (85.3 percent) [1]. Short-term mortality for surgically treated animals was 8.8 percent (3 of 34) [1]. In another PPDH series, mortality was low in the first two weeks postoperatively, and prognosis for return to normal function was excellent, with most peri- and postoperative complications being minor and self-limiting [2]. Fluoroscopy can confirm normal diaphragm motion after surgery. In three dogs repaired with a rectus abdominis muscle pedicle flap, fluoroscopic examination revealed no paradoxical motion of the diaphragm [14]. ## Post-Operative Monitoring Checklist The following table lists the parameters to track after surgery, with typical frequency and the rationale for each. | Parameter | Frequency | What to watch for | |--|--|--| | Respiratory rate and effort | Every 15 to 30 minutes for the first 2 hours, then every 1 to 2 hours for 12 hours, then every 4 to 6 hours | Rising rate or effort suggests re-expansion pulmonary edema, pneumothorax, or pain. A sudden increase requires immediate assessment. | | SpO2 (pulse oximetry) | Continuously during recovery, then with each check | A falling SpO2 indicates impaired oxygenation. Supplement oxygen and investigate for pneumothorax or edema. | | Thoracic drain output | Every 1 to 2 hours if a drain is placed | Air or fluid accumulation. Record volume and character. Persistent air may indicate a missed defect or a leak. | | Analgesia assessment | Every 2 to 4 hours using a pain scale | Pain increases respiratory rate and effort. Use opioids and, where appropriate, local blocks. | | Body temperature | Every 30 to 60 minutes until stable | Hypothermia prolongs recovery and impairs coagulation. | | Heart rate and rhythm | With each check | Arrhythmias can occur after thoracic surgery. One reported case developed a ventricular arrhythmia postoperatively, and echocardiography revealed right and left ventricular systolic dysfunction [7]. | | Blood pressure | Every 1 to 2 hours | Hypotension may signal reduced venous return or hemorrhage. | | Mucous membrane color and capillary refill | With each check | Pale membranes suggest poor perfusion or hemorrhage. | | Incision site | Every 4 to 6 hours | Swelling, discharge, or dehiscence. | | Mentation and appetite | Each check | Lethargy and anorexia are early signs of complications. In a reported case, a dog was lethargic and anorexic at home for a week after PPDH repair, and radiographs revealed a pneumopericardium [16]. | A pneumopericardium is a rare but reported complication after PPDH repair. In one case, the dog was lethargic and anorexic for a week after surgical closure of a PPDH via ventral midline celiotomy, and thoracic radiographs revealed a pneumopericardium. Pericardiocentesis evacuated approximately 100 mL of air from the pericardial sac, and the dog recovered well [16]. This is the first reported case of a pneumopericardium after PPDH repair requiring pericardiocentesis, and clinicians should be aware of it in post-operative PPDH patients [16]. Pneumothorax was the most common transient complication in the chronic hernia series, occurring in 21 of 50 animals [6]. ## Variations in Technique ### Minimally Invasive Approaches Laparoscopic repair of diaphragmatic hernia is reported but remains uncommon. A pre-clinical study in dog cadavers tested gasless laparoscopy for diaphragmatic hernia repair, closing composite defects with intracorporeal suture or with a central suture and polypropylene mesh. Reconstruction time was shorter in the mesh group (23.24 plus or minus 5.25 minutes) than in the suture group (50.00 plus or minus 16.46 minutes), and total surgical time was 87.22 plus or minus 19.23 minutes in the suture group and 66.45 plus or minus 6.38 minutes in the mesh group [13]. In a clinical case, a diaphragmatic defect with herniation of perirenal fat was incidentally found during a laparoscopic nephrectomy and repaired using a barbed suture without conversion to open surgery [12]. The dog recovered favorably despite transient hypoglycemia-associated seizures and was discharged four days later [12]. ### Lateral Paracostal Approach A dorsal tear of the pars lumborum can be difficult to reach through a ventral midline celiotomy. In one reported case, a 1-year-old German Shepherd had a delayed traumatic dorsal hernia of the pars lumborum, and herniorrhaphy via a ventral midline celiotomy with and without a paracostal extension was unsuccessful and the hernia recurred [9]. The hernia was successfully repaired using a single lateral paracostal approach, which provided excellent exposure [9]. Preoperative CT imaging can identify the exact location of the hernia and allow the best surgical approach to be determined [9]. ### Large Defect Repairs When a defect is too large for primary closure, a patch or flap is needed. A rectus abdominis muscle pedicle flap was used in three dogs with combined radial and circumferential tears. The circumferential tear was repaired by suturing the wound edge to the edge at the abdominal wall, and the muscle flap repaired the radial tear. All three dogs recovered uneventfully with no evidence of reherniation over four months [14]. A ventral diaphragmatic advancement technique was used to repair a large congenital PPDH after an initial pericardial flap repair failed seven months later. The revision procedure incised the ventral attachments of the diaphragm and slid it medially for a tension-free closure, and the dog recovered rapidly without complication [8]. In an experimental model, small intestinal submucosa patches of 4-ply and 8-ply thickness were tested in growing puppies, and the thinner 4-ply patches showed thinning, multiple defects, and liver herniation in three animals at six months [17]. ## Mermaid Diagram: Decision Path for Diaphragmatic Hernia Repair ```mermaid flowchart TD A[Patient with tachypnea and muffled lung sounds] --> B[Thoracic radiographs] B --> C{Thoracic viscera seen} C -->|Yes| D[Confirm with CT or ultrasound] C -->|No| E[Further imaging with contrast or CT] D --> F{Congenital or traumatic} E --> F F -->|Congenital| G[Plan ventral midline celiotomy] F -->|Traumatic| H{Defect location known} H -->|Ventral or central| G H -->|Dorsal pars lumborum| I[Consider lateral paracostal approach] G --> J[Reduce organs and close defect] I --> J J --> K[Reexpand lungs gradually] K --> L[Monitor respiratory rate and SpO2] ``` ## Troubleshooting | Symptom | Likely cause | Fix | |--|--|--| | Rising respiratory rate and effort in recovery | Re-expansion pulmonary edema, pneumothorax, or pain | Increase oxygen, assess for pneumothorax with radiographs or ultrasound, provide analgesia, and slow any further lung inflation. | | Falling SpO2 | Atelectasis, pneumothorax, or edema | Supplement oxygen, check the chest drain, and consider thoracentesis. | | Persistent air from the chest drain | Missed defect or suture line leak | Re-inspect the diaphragm and consider reoperation. | | Lethargy and anorexia days after PPDH repair | Pneumopericardium or other post-operative complication | Obtain thoracic radiographs and perform pericardiocentesis if a pneumopericardium is found [16]. | | Post-operative arrhythmia | Myocardial irritation or underlying cardiac disease | Perform echocardiography and electrocardiography, and treat as indicated [7]. | | Recurrence of hernia | Inadequate exposure or closure under tension | Reassess the approach. A lateral paracostal approach may be needed for dorsal defects [9], and a flap or mesh may be needed for large defects [8][14]. | | Vomiting or regurgitation after repair | Concurrent hiatal hernia not addressed | Evaluate the esophageal hiatus and consider esophagopexy and phrenoplasty [10][11]. | ## Recovery and Prognosis Most animals recover well after a successful repair. In the PPDH series, prognosis for return to normal function was excellent, and complications were typically minor and self-limiting [2]. In the chronic hernia series, 79 percent of discharged animals had complete resolution of clinical signs [6]. The mortality rate was 14 percent in that series [6]. In the acquired hernia analysis, intraoperative death occurred in 6.2 percent and postoperative death in 8.3 percent, from one hour to ten days after surgery [4]. Factors that improve outcome include early surgery. Animals treated within 48 hours after diagnosis had a lower risk of death [4]. Factors that worsen outcome include concurrent injuries and intraoperative and postoperative complications [4]. In cats, long-term survival after traumatic diaphragmatic hernia repair had a significant association with the presence of comorbidities, whether the procedure was performed as an emergency, and older age [15]. ## Clinical Relevance, Limitations and Common Mistakes Diaphragmatic herniorrhaphy is a life-saving procedure when it is performed for the right indication and with attention to the entire diaphragm. The diagnostic triad of tachypnea, muffled lung sounds, and thoracic viscera on radiographs guides the clinician toward the diagnosis, but radiographs alone miss about a third of chronic hernias [6]. Advanced imaging with CT or ultrasound improves confidence and helps plan the approach, particularly for dorsal defects [9]. The most common mistakes are these. First, missing a concurrent pericardial or hiatal defect. Inspect the entire diaphragm and esophageal hiatus before closure. Second, closing a large defect under tension, which predisposes to recurrence. Use a flap, mesh, or advancement technique when primary closure is not tension-free [8][14]. Third, failing to control lung re-expansion. Re-expansion pulmonary edema is preventable with gradual inflation and close monitoring. Fourth, omitting nitrous oxide avoidance from the anesthetic plan, which can worsen gas-filled space expansion. Fifth, assuming a normal initial evaluation after trauma rules out a diaphragmatic tear, as delayed hernias can present months later [5]. Any individual case requires assessment by a licensed veterinarian. The information here is educational and does not replace examination, imaging, and a treatment plan tailored to the patient. ## Frequently Asked Questions ### What is the survival rate after diaphragmatic herniorrhaphy? Survival is generally good. Reported overall survival in cats after traumatic diaphragmatic hernia repair was 93.3 percent [15], and in a chronic hernia series 79 percent of discharged animals had complete resolution of signs [6]. ### Can a diaphragmatic hernia be repaired laparoscopically? Yes, in selected cases. Laparoscopic repair has been reported for an incidentally found defect using a barbed suture, with no conversion to open surgery [12], and a pre-clinical cadaver study evaluated gasless laparoscopic repair [13]. ### Why must nitrous oxide be avoided during anesthesia for this surgery? Nitrous oxide expands closed gas spaces. In a patient with pneumothorax or a gas-filled bowel loop in the chest, it can worsen compression of the heart and lungs. ### What is re-expansion pulmonary edema? It is a complication that occurs when a chronically collapsed lung re-expands too quickly, causing fluid to leak into the lung tissue. Gradual inflation and monitoring of oxygenation prevent it. ### How is the diaphragm closed? Small defects are closed with simple interrupted or horizontal mattress sutures. Large defects may need a synthetic mesh, a rectus abdominis muscle pedicle flap, or a ventral diaphragmatic advancement technique [13][8][14]. ### Why do some surgeons place a chest drain and others do not? Residual air and fluid can be removed by intraoperative transdiaphragmatic thoracentesis, intercostal thoracentesis, or a chest drain. A study of 90 cats using transdiaphragmatic thoracentesis without a drain reported a 93.3 percent survival rate [15]. ### Can a diaphragmatic hernia be missed on radiographs? Yes. In one series, thoracic radiographs revealed evidence of hernia in only 66 percent of animals, and additional imaging was often needed [6]. ### What is the most common post-operative complication? Pneumothorax was the most common transient complication in a chronic hernia series, occurring in 21 of 50 animals [6]. ## Related Articles - [Immunodeficiency Disorders in Veterinary Patients](/knowledge/veterinary-medicine/veterinary-pathology-microbiology/immunodeficiency-disorders-in-veterinary-patients) - [Complications of Oxygen Therapy in Veterinary Patients](/knowledge/veterinary-medicine/emergency-critical-care/complications-oxygen-therapy-veterinary-patients) - [Monitoring Sedation and Anesthesia Recovery in Veterinary Patients](/knowledge/veterinary-medicine/veterinary-pathology-microbiology/monitoring-sedation-anesthesia-recovery-veterinary) - [Monitoring Nutritional Support in Hospitalized Veterinary Patients](/knowledge/veterinary-medicine/veterinary-pathology-microbiology/monitoring-nutritional-support-hospitalized-veterinary) - [Monitoring Protocols for Chemotherapy in Veterinary Oncology Patients](/knowledge/veterinary-medicine/veterinary-pathology-microbiology/monitoring-protocols-chemotherapy-veterinary-oncology) - [Monitoring Immunosuppressive Therapy in Veterinary Patients](/knowledge/veterinary-medicine/veterinary-pathology-microbiology/monitoring-immunosuppressive-therapy-veterinary) - [Enucleation of the Eyeball: Veterinary Surgery Guide](/knowledge/veterinary-medicine/veterinary-surgery/enucleation-of-the-eyeball-veterinary-surgery-guide) - [Sand Fly: Biology, Diseases, and Veterinary Importance](/knowledge/veterinary-medicine/parasitic-diseases/sand-fly-biology-diseases-and-veterinary-importance) - [Ranitidine in Veterinary Medicine: Uses and Dosing](/knowledge/veterinary-medicine/clinical-pharmacology/ranitidine-in-veterinary-medicine-uses-and-dosing) ## Sources 1. 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