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Perineal hernia repair after abdominoperineal resection (APR) with the laparoscopic-peritoneal dual fixation technique. Hernia 2022; 26:1307-1314. [PMID: 35652965 DOI: 10.1007/s10029-022-02632-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Perineal hernia (PH) following abdominoperineal resection (APR) is a rare but challenging problem. Although different techniques have been described in literature, the recurrence rate is still remarkable, and there is no consensus regarding the optimal repair approach. In the present study, we reported our experience based on a consecutive series of ten cases. METHODS Ten symptomatic large perineal hernias were repaired exclusively with the same laparoscopic-perineal dual fixation technique. Key steps consist laparoscopic adhesiolysis, hernia contents reduction, open excess perineal hernia sac resection, and mesh placement and dual fixation. Frist, a coated mesh was fixed to the sacrum and pelvic sidewalls with the metallic tacks in the laparoscopic step, second, the mesh was fixed anteriorly to urogenital diaphragm and laterally to the sacrotuberous ligament with permanent sutures in the perineal step. RESULTS Ten symptomatic PHs were repaired by the same laparoscopic-perineal dual fixation technique, 6 males and 4 females, median age at the time of repair was 69.5 years (range 66-77 years), the BMI was 24 ± 1. Four concomitant procedures were performed, including bilateral inguinal hernia repair with the transabdominal preperitoneal repair (TAPP) in one case, and laparoscopic parastomal hernia repair in two patients. The average operative time was 171 ± 45 min; the postoperative average hospital stay was 14 ± 4 days. There was no perineal hernia recurrence during the follow-up period (the median follow-up was 42 months; range 1-63 months). CONCLUSION Perineal hernia after APR is a rare and challenging postoperative complication, although many different approaches have been described, the recurrence is still high and the best method cannot be drawn. The present laparoscopic-perineal dual fixation approach proved to be a reproducible, effective and durable technique, and gave excellent results during the medium-long-term follow-up.
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Kameyama A, Yoshifuku S, Sasahara K, Otagiri N, Miyamoto M, Tauchi K. Repair of a perineal hernia with a bladder patch after abdominoperineal resection: A case report and literature review. Asian J Endosc Surg 2022; 15:380-383. [PMID: 34751003 DOI: 10.1111/ases.13011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/29/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Perineal hernia is the protrusion of the intra-abdominal viscera through the pelvic floor. It rarely occurs after abdominoperineal resection but has increasingly occurred after surgical treatment for rectal cancer. A patient was diagnosed as having perineal hernia 10 days after laparoscopic abdominoperineal resection with preoperative radiotherapy and chemotherapy. He presented with epigastric discomfort and perineal wound dehiscence. Perineal hernia was confirmed by computed tomography scan and treated with a semi-emergency surgery. The surgical field was contaminated because of the perineal wound dehiscence. The levator muscle at the pelvic floor was not sufficient, so we used a bladder patch to cover the pelvic inlet. The surgery was performed without any adverse events. To our best knowledge, this is the first case report to present the usefulness of a bladder patch for the treatment of a perineal hernia using a laparoscopic transabdominal approach in emergency situations.
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Affiliation(s)
- Akira Kameyama
- Department of Gastrointestinal Surgery, Aizawa Hospital, Nagano, Japan
| | - Seiziro Yoshifuku
- Department of Gastrointestinal Surgery, Aizawa Hospital, Nagano, Japan
| | - Kotaro Sasahara
- Department of Gastrointestinal Surgery, Aizawa Hospital, Nagano, Japan
| | - Noriaki Otagiri
- Department of Gastrointestinal Surgery, Aizawa Hospital, Nagano, Japan
| | - Masatake Miyamoto
- Department of Gastrointestinal Surgery, Aizawa Hospital, Nagano, Japan
| | - Katsunori Tauchi
- Department of Gastrointestinal Surgery, Aizawa Hospital, Nagano, Japan
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Mjoli M, Sloothaak DAM, Buskens CJ, Bemelman WA, Tanis PJ. Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis 2012; 14:e400-6. [PMID: 22308975 DOI: 10.1111/j.1463-1318.2012.02970.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The purpose of this study was to determine treatment characteristics and clinical outcome for patients with perineal hernia after abdominoperineal excision (APE). METHOD A systematic search of the literature revealed 40 individually documented patients, published between 1944 and 2010. Three additional patients treated at our centre were added. Patient characteristics, type of repair and outcome were entered into a database and a pooled analysis of these 43 patients was performed. RESULTS The pooled analysis revealed a median time interval of 8 months between APE and surgical repair of perineal hernia. The surgical approaches were perineal in 22 patients, open abdominal in 11, open abdominoperineal in three, laparoscopic in five and laparoscopic-perineal in two patients. A primary recurrence was documented in 13 patients and a second recurrence in three. The recurrence rate was 5/25 for synthetic or biological mesh, 6/12 for primary closure and 2/6 for the remaining techniques. Recurrent perineal hernia was repaired using a synthetic or biological mesh (n = 6), primary closure (n = 5) or a muscle flap (gluteus or gracilis; n = 4). CONCLUSION From these limited and biased data based on published case descriptions, it appears that the recurrence rate of primary perineal hernia repair after APE is lower with the use of a mesh or other assisted closure than with primary suture repair.
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Affiliation(s)
- M Mjoli
- Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu Natal, Durban, South Africa
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Abstract
BACKGROUND A perineal hernia can severely disable everyday activities. Its repair is a surgical challenge, and guidance by the literature is limited. The series described so far are small or encompass a long period in which even nonmesh techniques were used. OBJECTIVE The aim of this study was to review recent results of a perineal mesh-based repair. PATIENTS Medical charts of patients with a symptomatic perineal hernia after abdominoperineal resection due to rectal cancer were reviewed. MAIN OUTCOME MEASURES Data included patients' characteristics, operative details, recurrence, and complications. RESULTS In total, 29 patients underwent repair of a symptomatic perineal hernia after an abdominoperineal resection due to rectal cancer. The majority was male (66%), and the median age was 59 years (range, 41-83). All patients received neoadjuvant treatment.From 2003 until 2006, polytetrafluoroethylene or Vypro mesh and Prolene 2.0 sutures were used for perineal hernia repair. All 8 repairs failed; repeated repair using various methods was successful in 63%. After 2006, the surgical technique was changed into a high-tension repair with the use of a nonabsorbable mesh. This technique was successful for 20 of 21 patients (95%). Complications encountered in the entire group of 29 patients were urinary retention (n = 2), wound infection, seroma, and fistula (n = 1 each). LIMITATIONS Even though this is the largest group described in the literature, the results are limited because of the small number of patients. CONCLUSION Repair of perineal hernia remains challenging and only a few reports offer advice on how to manage this unusual problem. However, superior results have been shown with the new mesh-based technique through perineal approach with only 5% recurrence.
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Ong SL, Miller AS. A transperineal approach to perineal hernia repair using suture anchors and acellular porcine dermal mesh. Tech Coloproctol 2011; 17:605-7. [PMID: 22108954 DOI: 10.1007/s10151-011-0774-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 10/08/2011] [Indexed: 11/26/2022]
Abstract
Perineal hernia following major pelvic surgery is a rare but recognised complication. Various surgical approaches to the repair of a symptomatic perineal hernia have been described. We describe the first reported use of the Mitek suture anchors to secure an acellular porcine dermal graft to the ischia during the transperineal repair of a large perineal hernia.
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Affiliation(s)
- S L Ong
- University Hospitals of Leicester, Leicester, United Kingdom,
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Affiliation(s)
- M Beck
- Clinique Ambroise-Paré, 21, route de Guentrange, 57100 Thionville, France.
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Kathju S, Lasko LA, Medich DS. Perineal hernia repair with acellular dermal graft and suture anchor fixation. Hernia 2010; 15:357-60. [DOI: 10.1007/s10029-010-0664-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 04/09/2010] [Indexed: 12/27/2022]
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Wang JK, Wolff BG. Postoperative Perineal Hernia. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2009.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Morcos BB, Al-Masri M, Baker B. Perineal hernia, another incisional hernia? Indian J Surg 2009; 71:112-6. [PMID: 23133132 PMCID: PMC3452485 DOI: 10.1007/s12262-009-0033-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 03/04/2009] [Indexed: 10/20/2022] Open
Abstract
A secondary perineal hernia is a type of incisional hernia of the pelvic floor, occurring after pelvic surgery such as abdominoperineal excision of the rectum and pelvic exenteration. Our aim is to review the available literature on the subject. This report reviews a recently repaired case, followed by a review of the available literature on the presenting condition, concentrating on approaches and methods of repair. Perineal hernias are uncommon, and not many surgeons face them. It is not known if and how these hernias could be prevented. The method and approach of repair should probably be individualized, but we believe that the use of a mesh is important in the repair of such hernias because of the significant tissue defect prevailing in most of the cases, in addition to the unhealthy tissues related to the use of radiotherapy. The laparoscopic approach has been recently utilized and its use is expected to increase.
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Affiliation(s)
- Basem B. Morcos
- Department of Surgery and Surgical Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, Amman, 11941 Jordan
| | - Mahmoud Al-Masri
- Department of Surgery and Surgical Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, Amman, 11941 Jordan
| | - Bilal Baker
- Department of Surgery and Surgical Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, Amman, 11941 Jordan
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Akatsu T, Murai S, Kamiya S, Kojima K, Mizuhashi Y, Hasegawa H, Kitagawa Y. Perineal hernia as a rare complication after laparoscopic abdominoperineal resection: Report of a case. Surg Today 2009; 39:340-3. [DOI: 10.1007/s00595-008-3851-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 09/02/2008] [Indexed: 01/30/2023]
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Miranda EP, Anderson AL, Dosanjh AS, Lee CK. Successful management of recurrent coccygeal hernia with the de-epithelialised rectus abdominis musculocutaneous flap. J Plast Reconstr Aesthet Surg 2007; 62:98-101. [PMID: 17889632 DOI: 10.1016/j.bjps.2007.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 10/30/2006] [Accepted: 08/07/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little data exist about the optimal management of the rare coccygeal hernia. A novel method of repair is reported. METHODS A 46-year-old woman presented with a symptomatic coccygeal hernia after resection of the coccyx for a tumour. She had previously been reconstructed with an on-lay polytetrafluorethylene (PTFE) mesh but subsequently developed a hernia. A de-epithelialised vertical rectus abdominis musculocutaneous flap was elevated and passed through the hernia defect. The de-epithelialised dermis was secured to the levator ani and to the periosteum of the sacrum via access through a posterior approach. The gluteal skin was closed primarily over the inset flap. RESULTS The de-epithelialised rectus abdominis musculocutaneous flap is a viable option for the treatment of coccygeal hernia. RELEVANCE The de-epithelialised rectus abdominis flap has several advantages over other techniques including mesh repair and anterior or posterior flap repairs of the coccygeal hernia. The transposed muscle blocks herniation through the pelvic floor and does not create the dead space that is associated with posterior flap repairs such as the bilateral gluteal advancements. It also has the advantages of the posterior approach mesh repair, as the de-epithelialised dermis provides significant strength when secured like mesh to healthy local tissue.
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Affiliation(s)
- E P Miranda
- Department of Surgery, University of California San Francisco, CA 94143, USA.
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Skipworth RJE, Smith GHM, Anderson DN. Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature. Hernia 2007; 11:541-5. [PMID: 17503160 DOI: 10.1007/s10029-007-0234-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
This is a case report of a 46-year-old man who presented with a painful perineal lump four months after abdominoperineal excision of the rectum (APER) with pre-operative radiotherapy and adjuvant chemotherapy. Perineal hernia (suspected clinically) was confirmed by magnetic resonance imaging, and the patient underwent open Permacol mesh repair via a perineal approach. Symptomatic perineal herniation after surgical resection is a rare phenomenon, and the approach to management remains challenging. Several different surgical approaches and techniques of repair have been described. In this report, we review the literature surrounding the presentation, aetiology and repair of this unusual post-operative complication. Furthermore, our case confirms that closure of the hernial orifice with mesh via a perineal approach is a satisfactory technique.
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Affiliation(s)
- R J E Skipworth
- Department of Surgery, NHS Lothian, University Hospitals Division, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
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Aboian E, Winter DC, Metcalf DR, Wolff BG. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum 2006; 49:1564-8. [PMID: 16946992 DOI: 10.1007/s10350-006-0669-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Perineal hernias are infrequent complications of abdominoperineal operations with estimated historic prevalences (from the era where the perineal wound was left open) ranging from 0.6 to 7 percent. The purpose of this study was to identify the modern prevalence of postoperative perineal hernias, factors that may contribute to their development, and examine the methods of repair. METHODS The Mayo Clinic patient database (1990-2000) was interrogated for the following data identifiers: incisional hernia, perineal hernia, abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. All surviving patients were followed up to December 2005. The retrieved patient data was retrospectively analyzed. RESULTS Of a total of 3,761 patients who underwent abdominoperineal resection (including nonrestorative proctocolectomy and pelvic exenteration) during the study period, 8 developed a perineal hernia (5 females). The median age at hernia presentation was 76 (range, 69-84) years, representing a median interval of 22 (range, 1-60) months from the original operation. All were smokers (> or =15 pack years) and five had received chemoradiotherapy for their original diagnosis. The commonest prevalence was found in patients who had undergone abdominoperineal resection (5/1,266) or pelvic exenteration (2/1,334). Only 1 of 1,161 patients developed a perineal hernia after proctocolectomy despite most being on perioperative immunosuppression for inflammatory bowel disease. Abdominal exploration and repair was performed in four patients whereas four underwent perineal repair (2 of each with mesh). None have recurred with a median follow-up of 36 (range, 6-60) months. CONCLUSIONS Perineal hernias are rare complications of abdominoperineal surgery with a more common prevalence after cancer operations. Smoking and chemoradiotherapy, but not corticosteroid immunosuppression, may be factors. The abdominal approach has advantages over the perineal approach, but both are suitable with good medium-term results.
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Affiliation(s)
- E Aboian
- Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Preiss A, Herbig B, Dörner A. Primary perineal hernia: a case report and review of the literature. Hernia 2006; 10:430-3. [PMID: 16858521 DOI: 10.1007/s10029-006-0114-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Accepted: 06/26/2006] [Indexed: 12/25/2022]
Abstract
UNLABELLED Pelvic floor hernias are extremely rare. This study presents a successfully treated case of primary perineal hernia and takes a look at the existing literature. CASE The case of a 75-year-old female patient with a great perineal hernia is presented. Diagnosis was secured by magnetic resonance tomography. The pelvic defect was successfully treated by primary suture with Prolene. DISCUSSION The literature shows many different approaches for treatment of perineal hernia, such as open or laparoscopic mesh repair, and perineal, abdominal or combined access. Our case confirms that primary closure of the hernial orifice through an abdominal approach is also feasible.
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Affiliation(s)
- A Preiss
- Department of Surgery, Diakonie Hospital Alten Eichen, Jütländer Alle 48, 22527, Hamburg, Germany.
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