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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References
So JB, Palmer MT, Shellito PC (1997) Postoperative perineal hernia. Dis Colon Rectum 40:954–957
Mjoli M, Sloothaak DAM, Buskens CJ, Bemelman WA, Tanis PJ (2012) Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis 14:e400–e406
Hullsiek HE (1956) Perineal hernia following abdominoperineal resection. Am J Surg 92:735–738
Bertrand K, Lefevre JH, Creavin B, Luong M, Debove C, Voron T, Chafai N, Tiret E, Parc Y (2020) The management of perineal hernia following abdomino-perineal excision for cancer. Hernia 24(2):279–286
Portilla AG, Martín E, de Lecea CM, Gómez C, Magrach L, Cendoya I, Uzquiza E (2010) Recurrent postoperative perineal hernia: laparoscopic redo mesh repair. Hernia 14(5):535–537
Berendzen J, Copas P Jr (2013) Recurrent perineal hernia repair: a novel approach. Hernia 17(1):141–144
Hassan L, Beunis A, Ruppert M, Dhooghe V, Van den Broeck S, Hubens G, Komen N (2019) Perineal hernia mesh repair: a fixation with glue, sutures and tacks. How to do it. Acta Chir Belg 119(6):406–410
Li J, Zhang W (2017) How we do it: repair of large perineal hernia after abdominoperineal resection. Hernia 21(6):957–961
Gregory JS, Muldoon JP (1969) Perineal herniation: a late complication of abdominoperineal resection of the rectum. Dis Colon Rectum 12:33–35
Brotschi E, Noe JM, Silen W (1985) Perineal hernias after proctectomy: a new approach to repair. Am J Surg 149(2):301–305
Delmore JE, Turner DA, Gershenson DM, Horbelt DV (1987) Perineal hernia repair using human dura. Obstet Gynecol 70:507–508
Eqo-Aquirre C, Spratt JS, Butcher HR et al (1964) Repair of perineal hernias developing subsequent to pelvic exenteration. Ann Surg 159(1):66
Berthoux L, Labib A, Clough KB, Girodet J, Salmon RJ (1992) Hernie perineale après amputation abdomino-perineale. Role de l’epiploooplastie et/ou de l’irradiation. J Chir 129:550–552
Ettienne JC, Bouillot JL, Alexandre JH (1988) Eventrations perineales après amputations du rectum. A propos de trois observations. J Chir 125:75–80
Remzi FH, Oncel M, Wu JS (2005) Meshless repair of perineal hernia after abdominoperineal resection. Tech Coloproctol 9:142–144
Aboian E, Winter DC, Metcalf DR, WolV BG (2006) Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum 49(10):1564–1568
Beck DE, Fazio VW, Jagelman DG, Lavery IC, McGonagle BA (1987) Postoperative perineal hernia. Dis Colon Rectum 30:21–24
McDonald KC, Borger P, Webman R, Kwon SY (2021) Combined perineal hernia repair and abdominal parastomal hernia with mesh for sequela of an abdominoperineal resection. Int J Abdom Wall Hernia Surg 4:76–78
Abdul Jabbar AS (2002) Postoperative perineal hernia. Hernia 6(4):188–190
Ruiz DE, Kaikin M, Vivas D, Newman M, Wexner SD (2007) Multimedia article. Recurrent postoperative perineal hernia: transperineal redo mesh repair. Dis Colon Rectum 50(7):1080–1081
Skipworth RJ, Smith GH, Anderson DN (2007) Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature. Hernia 11(6):541–545
Martijnse IS, Holman F, Nieuwenhuijzen GA, Rutten HJ, Nienhuijs SW (2012) Perineal hernia repair after abdominoperineal rectal excision. Dis Colon Rectum 55(1):90–95
Goedhart-de Haan AM, Langenhoff BS, Petersen D, Verheijen PM (2016) Laparoscopic repair of perineal hernia after abdominoperineal excision. Hernia 20(5):741–746
McKenna NP, Habermann EB, Larson DW, Kelley SR, Mathis KL (2020) A 25 year experience of perineal hernia repair. Hernia 24(2):273–278
Morcos BB, Al-Masri M, Baker B (2009) Perineal hernia, another incisional hernia? Indian J Surg 71(3):112–116
Osorio Capitán M, Otaegui LG, Allende IA, Perez AL, Rodriguez LC, Ponce IA et al (2020) Anterior component separation external retrofascial approach: is that an option? Int J Abdom Wall Hernia Surg 3:100–104
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Li, J., Shao, X. & Cheng, T. Perineal hernia repair after abdominoperineal resection (APR) with the laparoscopic-peritoneal dual fixation technique. Hernia 26, 1307–1314 (2022). https://doi.org/10.1007/s10029-022-02632-8
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DOI: https://doi.org/10.1007/s10029-022-02632-8