Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment. Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present. Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.

Objective To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. Design Review article.Summary Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment.Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present.Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals. Aust Vet J 2002;80:48-53 HH Liatal hernia LOS (intrinsic) lower oesophageal sphincter

SummaryChronic Achilles mechanism injuries require aggressive treatment with excision of degenerate tissue. Following excision of degenerate tendon, the defect created may be too large to allow simple apposition of tendon to bone. Use of peroneus brevis and peroneus longus tendon transpositions (passing through bone tunnels drilled in the calcaneus), +/− lengthening of the gastrocnemius tendon, and reinforcement with a free fascial strip graft allows reconstruction of the area. Postoperative support should be provided using a type II transarticular external fixator for four weeks, followed by a splint or Robert Jones bandage for three weeks. Treatment, in all four of the dogs in this report, resulted in a good to excellent outcome. Based on the favourable results in this series, resection of all grossly abnormal tendon should be considered in cases of Achilles mechanism rupture, even though reconstruction of the area is more complex.Five Achilles mechanism reconstructions were performed in four dogs with chronic injury to the tendon. Following excision of degenerate tendon the area was reconstructed, in each case using peroneus brevis and peroneus longus tendon transpositions, lengthening of the gastrocnemius tendon and reinforcement with a free fascial strip graft. Post-operative support was provided in the form of a type II trans-articular external fixator for four to five weeks, followed by a splint or Robert Jones bandage for two to three weeks. The results in all of the dogs were good to excellent. One dog returned to full working capacity. Two dogs returned to unrestricted exercise without any observable lameness. One dog (bilateral injury) is sound but the owners have decided to limit the dog’s access to unrestricted activity.