OC-097 A THREE LAYERED REPAIR OF A LARGE PERINEAL HERNIA- CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

Abstract Background A symptomatic perineal hernia is an uncommon complication after abdominoperineal resection (APR). Repairs of such hernias can be achieved by usage of autologous flaps, synthetic mesh or biologic mesh. Studies have shown that prophylactic repair of the pelvic floor with biologic mesh, reduces the incidence of perineal hernia. Data of perineal hernia repair methods are scarce and of poor quality. Aim In this paper we aim to share our experience using a non-conventional technic for the repair of A perineal hernia, as it appears to be a surgical challenge without a clear evidence based recommended technique. Methods A 71-year-old woman, after extended APR with primary closure of pelvic floor with a biosynthetic absorbable mesh, presented to our clinic with a symptomatic, extensive perineal hernia. The patient underwent an open reconstruction of the pelvic floor using a synthetic composite mesh in an underlay intraperitoneal position and a bilateral gluteal muscle flap closure. Results In post-operative-day 11 the patient developed a pelvic fluid collection and surgical site infection. The collection was surgically drained showing clear fluid negative for bacteria and antibiotic treatment was initiated. 3 months after surgery the wound had completely healed and A CT scan showed no recurrence of the hernia. Conclusion Considering the increased incidence of perineal hernia after APR and the superiority of a synthetic mesh in minimizing recurrence rates- a primary closure of the pelvic floor with a synthetic mesh or autologous flap might be justified.