Laparoscopic and perineal approaches to perineal hernia repair

Abstract

Perineal hernias after abdominoperineal resection (APER) of the rectum appear to be becoming more common, but there only a small number of reported cases, with very few reports discussing more than one or two. There is little consensus as to the optimal method of repair. We report the successful management of 7 cases of postoperative perineal hernia, including a hernia around a gluteal rotation flap that has not previously been reported, and discuss the operative approaches. We performed a single-centre hospital database review over 6years. Seven perineal hernias occurred after APER and were repaired. Six were treated with a transabdominal approach (5 laparoscopic and 1 laparoscopic converted to open) and one perineal approach. In 4 cases, a synthetic composite mesh was used, in 2 a biological mesh and in one direct suture repair. There have been no recurrences during a median follow-up of 25months. Laparoscopic mesh repair of symptomatic perineal hernia is the method of choice in most cases. Herniation may still occur despite inset of a gluteal rotation flap at initial APER and laparoscopic repair in that instance is difficult.