Massari et al: Laparoscopic repair of peritoneopericardial hernias: Multicentric retrospective case series of 12 dogs and one cat
Veterinary Surgery 3, 2026

Laparoscopic repair of peritoneopericardial hernias: Multicentric retrospective case series of 12 dogs and one cat

🔍 Key Findings

  • Laparoscopic PPDH repair was successful in 92% (12/13) of cases, with only one conversion due to CO₂-induced pericardial tamponade
  • Low insufflation pressures (3–4 mmHg) were critical to minimize cardiopulmonary compromise while maintaining adequate visualization
  • No major (Grade ≥3) complications occurred, with only minor issues (15.5% delayed wound healing, 7.7% seroma)
  • All patients survived and had successful long-term outcomes, with imaging confirming repair at 6 months
  • Adhesions were the most common intraoperative challenge, especially involving liver or pericardium, occasionally requiring organ resection
  • Barbed sutures and endoscopic suturing devices improved efficiency, particularly for intracorporeal closure
  • Intraoperative decompression (needle or drain) helped prevent tension pneumopericardium, a key complication risk
  • PPDH-SDC grading system aids case selection, with Grades A–B ideal for laparoscopy, C case-dependent, and D–E unsuitable

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Massari et al: Laparoscopic repair of peritoneopericardial hernias: Multicentric retrospective case series of 12 dogs and one cat
Veterinary Surgery 3, 2026

🔍 Key Findings

  • Laparoscopic PPDH repair was successful in 92% (12/13) of cases, with only one conversion due to CO₂-induced pericardial tamponade
  • Low insufflation pressures (3–4 mmHg) were critical to minimize cardiopulmonary compromise while maintaining adequate visualization
  • No major (Grade ≥3) complications occurred, with only minor issues (15.5% delayed wound healing, 7.7% seroma)
  • All patients survived and had successful long-term outcomes, with imaging confirming repair at 6 months
  • Adhesions were the most common intraoperative challenge, especially involving liver or pericardium, occasionally requiring organ resection
  • Barbed sutures and endoscopic suturing devices improved efficiency, particularly for intracorporeal closure
  • Intraoperative decompression (needle or drain) helped prevent tension pneumopericardium, a key complication risk
  • PPDH-SDC grading system aids case selection, with Grades A–B ideal for laparoscopy, C case-dependent, and D–E unsuitable

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Multiple Choice Questions on this study

In Massari 2026 et al., on laparoscopic PPDH repair, what was the most common intraoperative challenge?

A. Bleeding from major vessels
B. Gastric perforation
C. Dense adhesions involving liver or pericardium
D. Instrument failure
E. Poor visualization due to obesity

Answer: Dense adhesions involving liver or pericardium

Explanation: Adhesions, particularly dense or vascular, were the most frequent surgical challenge and could complicate reduction.
In Massari 2026 et al., on laparoscopic PPDH repair, what was the primary reason for conversion to open surgery in one case?

A. Hypotension due to hemorrhage
B. CO₂-induced pericardial tamponade
C. Inability to reduce hernia contents
D. Equipment failure
E. Severe adhesions preventing visualization

Answer: CO₂-induced pericardial tamponade

Explanation: Conversion occurred due to tension pneumopericardium causing bradycardia and cardiovascular compromise.
In Massari 2026 et al., on laparoscopic PPDH repair, what insufflation pressure was recommended during surgery to minimize complications?

A. 6–8 mmHg
B. 8–10 mmHg
C. 3–4 mmHg
D. 10–12 mmHg
E. 1–2 mmHg

Answer: 3–4 mmHg

Explanation: Low-pressure insufflation (3–4 mmHg) reduces cardiovascular compromise and risk of pneumopericardium while maintaining visualization.
In Massari 2026 et al., on laparoscopic PPDH repair, what was the overall survival and long-term outcome?

A. High mortality with frequent recurrence
B. Survival in 75% with moderate complications
C. All patients survived with successful 6-month outcomes
D. Only symptomatic patients survived
E. Long-term recurrence in most cases

Answer: All patients survived with successful 6-month outcomes

Explanation: All 13 patients survived, and imaging confirmed successful repair at 6 months with no major complications.
In Massari 2026 et al., on laparoscopic PPDH repair, which PPDH-SDC grades are considered ideal candidates for laparoscopic repair?

A. Grades C and D only
B. Grades A and B
C. Grades D and E
D. Grades B and C only
E. All grades equally suitable

Answer: Grades A and B

Explanation: Grades A and B (simple/intermediate) are ideal; C is case-dependent, D–E are not suitable for laparoscopy.

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