Perineal Hernia Research Articles

Perineal hernia in a pregnant Angus heifer (Bos taurus)

AbstractThis case report details a perineal hernia in a 3‐year‐old Angus heifer in late gestation. The heifer had a gradually increasing swelling of the perineal region since 2 weeks. Upon palpation, the swelling was painless, hard and non‐reducible. Ultrasonographic examination revealed a hernial sac enclosing the non‐pregnant horn of the uterus, filled with homogenous hypoechoic fluid. Based on the anamnesis and clinical examination, a tentative diagnosis of perineal herniation was made. Considering the deteriorating clinical condition of the cow and the possible risk of dystocia, the viable calf was delivered by Caesarean section. The cow recovered with a reducible hernial sac, which was decided not to correct surgically due to its large size. After 7 days, the cow showed no further complications and was discharged. In conclusion, although rare, a perineal hernia involving the uterus should be considered in the differential diagnosis of perineal swellings in pregnant cows.

Experience in the treatment of a patient with postoperative perineal hernia after extended combined abdominal-perineal extirpation of the rectum

Experience in the treatment of a patient with postoperative perineal hernia after extended combined abdominal-perineal extirpation of the rectum

Evisceration of the small bowel through the perineal hernia

Evisceration of the small bowel through the perineal hernia

Incidence and risk factors for perineal hernia after robotic abdominoperineal resection: a single-center, retrospective cohort study.

Perineal hernia (PH) is a late complication of abdominoperineal resection (APR) that may compromise a patient's quality of life. The frequency and risk factors for PH after robotic APR adopting recent rectal cancer treatment strategies remain unclear. Patients who underwent robotic APR for rectal cancer between December 2011 and June 2022 were retrospectively examined. From July 2020, pelvic reinforcement procedures, such as robotic closure of the pelvic peritoneum and levator ani muscles, were performed as prophylactic procedures for PH whenever feasible. PH was diagnosed in patients with or without symptoms using computed tomography 1 year after surgery. We examined the frequency of PH, compared characteristics between patients with PH (PH+) and without PH (PH-), and identified risk factors for PH. We evaluated 142 patients, including 53 PH+ (37.3%) and 89 PH- (62.6%). PH+ had a significantly higher rate of preoperative chemoradiotherapy (26.4% versus 10.1%, p = 0.017) and a significantly lower rate of undergoing pelvic reinforcement procedures (1.9% versus 14.0%, p = 0.017). PH+ had a lower rate of lateral lymph node dissection (47.2% versus 61.8%, p = 0.115) and a shorter operative time (340min versus 394min, p = 0.110). According to multivariate analysis, the independent risk factors for PH were preoperative chemoradiotherapy, not undergoing lateral lymph node dissection, and not undergoing a pelvic reinforcement procedure. PH after robotic APR for rectal cancer is not a rare complication under the recent treatment strategies for rectal cancer, and performing prophylactic procedures for PH should be considered.

Overview of perineal hernia in dogs

Overview of perineal hernia in dogs

Personalized Decisional Algorithms for Soft Tissue Defect Reconstruction after Abdominoperineal Resection for Low-Lying Rectal Cancers.

Abdominoperineal resection (APR)-the standard surgical procedure for low-lying rectal cancer (LRC)-leads to significant perineal defects, posing considerable reconstruction challenges that, in selected cases, necessitate the use of plastic surgery techniques (flaps). To develop valuable decision algorithms for choosing the appropriate surgical plan for the reconstruction of perineal defects. Our study included 245 LRC cases treated using APR. Guided by the few available publications in the field, we have designed several personalized decisional algorithms for managing perineal defects considering the following factors: preoperative radiotherapy, intraoperative position, surgical technique, perineal defect volume, and quality of tissues and perforators. The algorithms have been improved continuously during the entire period of our study based on the immediate and remote outcomes. In 239 patients following APR, the direct closing procedure was performed versus 6 cases in which we used various types of flaps for perineal reconstruction. Perineal incisional hernia occurred in 12 patients (5.02%) with direct perineal wound closure versus in none of those reconstructed using flaps. The reduced rate of postoperative complications suggests the efficiency of the proposed decisional algorithms; however, more extended studies are required to categorize them as evidence-based management guide tools.

Treatment of canine perineal hernia with a fascia lata graft is noninferior to the elevation of the internal obturator muscle: a prospective randomized trial of 66 dogs.

To compare the recurrence rate after herniorrhaphy of canine perineal hernia (PH) using elevation of the internal obturator muscle (EIOM) or fascia lata graft (FLG) and assess how clinical signs related to defecation evolve during 12 months postoperatively. 66 client-owned male dogs undergoing PH surgery between March 1, 2017, and December 31, 2020. Dogs were randomized into 2 groups (EIOM = 36; FLG = 30) applying 2 stratification factors: preoperative bladder location and the defecation signs score (DSS). Follow-up visits were at 2 weeks and 3, 6, and 12 months postoperatively. The main outcome, the recurrence of PH was evaluated by rectal examination. We evaluated the noninferiority of FLG to EIOM from the difference in recurrence proportions between the techniques (95% CI), comparing the CI with a pre-defined noninferiority margin (15%). To evaluate defecation signs, the DSS was calculated from the owner questionnaire and assessed with a linear mixed model (P < .05 significant). In 63 dogs attending the 12-month follow-up, the recurrence rate was 8.8% (3/34) in the EIOM and 10.3% (3/29) in the FLG group. The CI (-11.94% to 14.99%) was below the pre-defined margin, indicating the noninferiority of FLG. After surgery, the DSS decreased (P < .001), remaining low during the follow-up. FLG was non-inferior to EIOM when considering recurrence. The DSS decreased postoperatively and complications were uncommon. FLG is a useful alternative for the treatment of canine PH.

Spermatic cord torsion associated with perineal hernia in a cryptorchid dog

AbstractAn 8‐year‐old male German Shepherd dog with a history of dyschezia, tenesmus and perineal swelling for 1 month was referred. The dog was known to be unilaterally abdominal cryptorchid. The normally descended testis had been surgically removed a few years ago. On physical examination, a firm, non‐painful, irreducible mass was palpable in the left perineal region. Digital rectal examination revealed rectal deviation, and the pelvic diaphragm was absent on the left. The prostate gland was normal upon palpation. Abdominal radiography revealed that the urinary bladder was present in the caudal abdomen. Based on clinical, laboratory and imaging findings, a diagnosis of perineal hernia was made. Surgical exploration revealed the presence of left spermatic cord torsion in the perineal hernia. The testis was removed, and internal obturator muscle transposition was performed for herniorrhaphy. The dog had an uneventful recovery, and the results of re‐examinations 10 days, 6 months and 12 months later were normal.

Short- and long-term morbidity after Taylor flap (oblique rectus abdominis flap) for perineal reconstruction after abdominoperineal resection: A single-center series of 140 patients

BackgroundAbdominoperineal resection (APR) leads to a substantial loss of tissue and a high rate of complications. The Taylor flap is a musculocutaneous flap used in reconstruction after APR. ObjectivesWe aimed to analyze the short and long-term morbidity of reconstruction with a Taylor flap (oblique rectus abdominis flap) after APR and to identify the risk factors for postoperative complications. MethodsWe retrospectively included all patients who had undergone APR with immediate reconstruction with a Taylor flap in our department between July 2000 and June 2018. Demographics, oncological data, treatment, and short- and long-term morbidity were reviewed. ResultsAmong the 140 patients included, we identified early minor complications in 42 patients (30%) and 14 early major complications (10%). Total necrosis of the flap requiring its removal occurred in four patients (2.8%). Eleven patients (7.9%) presented with a midline incision hernia, and seven (5%) presented with a subcostal incision hernia. No perineal hernia was found. No risk factors for the complications were identified. ConclusionThe Taylor flap is a safe procedure with few complications and limited donor site morbidity. Moreover, it prevents perineal hernias. These results confirm that the Taylor flap is a well-suited procedure for reconstruction after APR.

Modified semitendinosus muscle transposition to repair bilateral perineal hernias in dogs

Perineal hernia (PH) resulting from a weakness and tear of the pelvic muscles of the diaphragm. Repair of the pelvic muscles by surgical repositioning is the curative treatment. To report a modified technique of semitendinosus muscle transposition for perineal hernias treatment. Eleven male dogs were prospectively enrolled to repair perineal hernias incorporating contralateral semitendinosus muscle transposition. The transected muscle was rotated medially through the subcutaneous tunnel ventral to the anus up to the opposite lateral perineum. Ten dogs were neutered and 01 was intact. The mean age was 10.45 years and the mean body weight was 18.52 kg. Five dogs had been previously submitted to perineal herniorrhaphy. Partial wound dehiscence occurred in two dogs. Postoperative complications related to the technique were presented in 7 of 11 dogs. Unilateral recurrence was detected in 8 of 11 dogs. The small number of samples, the absence of a control group and the heterogeneity of breeds make it difficult to reach significant conclusions. The transposition of the semitendinosus muscle through the subcutaneous tunnel is feasible to repair perineal hernias. The technique was unable to reduce complications and recurrence rates. However, provides evidence that can be used to repair cases of bilateral and ventral perineal hernias in dogs.

Surgical management of urethral obstruction secondary to perineal liposarcoma in a dog: a case report

BackgroundSwelling of the perineal region in male dogs is most commonly caused by a perineal hernia. Clinical signs associated with perineal hernia are constipation, tenesmus or stranguria. This case report documents a rare cause of perineal swelling created by the growth of a malignant tumour leading to urethral obstruction and subsequent stranguria.Case presentationAn 11-year-old neutered male German Shepherd was presented for swelling in the perineal region and stranguria for three days. Complete blood count and serum biochemistry were unremarkable. Ultrasound revealed a heterogeneous mass in the perineal region. Retrograde urethrography showed a severe narrowing of the urethra caudal to the pelvis. A fine-needle aspirate of the mass was highly suspicious for liposarcoma. Staging was performed by computed tomography (CT) of the thorax and abdomen. Total penile amputation in combination with pubic-ischial pelvic osteotomy, transposition of the remaining urethra through the inguinal canal, V-Y-plasty cranial to the prepuce and preputial urethrostomy were performed to remove the tumour. Histopathology confirmed a well-differentiated liposarcoma with complete histological margins. Six months after the surgery the dog was doing well and there were no signs indicating local tumour recurrence.ConclusionsWide surgical excision is generally recommended for soft tissue sarcomas, however this is sometimes not feasible for large tumours. In the case reported here, tumour resection was achieved by a combination of several surgical techniques with a good clinical outcome.

Perineal hernia repair following tailgut cyst excision: A case report and literature review of optimal management strategies

Perineal hernias, categorised as primary or secondary, pose a clinical challenge necessitating surgical intervention. Herein we present the surgical management of a postoperative perineal hernia of the retrorectal space. A 42-year-old female patient presented to the clinic with symptoms such as perineal discomfort, bulging, and constipation after previous surgical tailgut cyst excision. Diagnosis involved MRI, confirming rectal herniation into the retrorectal space. The surgical approach featured a perineal intervention using a unilateral inferior gluteal flap to reinforce the posterior rectal space, avoiding mesh complications. The patient experienced a successful recovery, highlighting the importance of tailored interventions based on symptoms and complications. Secondary perineal hernias, often postoperative, present diverse challenges influenced by multiple factors such as pelvic surgeries. Surgical repair options include perineal and abdominal approaches, mesh usage, and flap methods, each with variable outcomes. This case study contributes to the evolving understanding of perineal hernias, emphasising the need for multidisciplinary approaches and ongoing research to enhance management strategies in this complex clinical scenario.

Dimensional and spatial computed tomographic abnormalities of the rectum and prostate are only partly reversible after surgical repair of perineal hernia in dogs.

Caudal protrusion of pelvic organs and dilatation and deviation of the rectum with perineal hernia (PH) have not previously been studied using CT, and it is not known how completely the changes normalize after PH repair. Objectives of this prospective experimental case series were to evaluate the dimensions and shape of the rectum and the volume, location, and other features (enhancement pattern, presence of cysts, and mineralizations) of the prostate of 66 dogs on CT before and 3 months after PH repair. The rectal cross-sectional areas were measured at intrapelvic and caudal locations, and the shape was categorized as straight, deviated, flexure, or caudal fold on dorsal images. According to paired samples t-tests, the caudal rectal dimensions were significantly larger (P<.001) than the intrapelvic dimensions both before and 3 months after PH repair, and according to linear mixed models, the intrapelvic dimensions increased significantly (P<.001) after repair. Before PH repair, the most common rectal shape was flexure (69.2%); after repair, the number of dogs having a straight rectum increased significantly (P<.001) according to the McNemar paired-samples proportion test. We were also able to show that rectal dimensions increased after PH repair despite straightening in most dogs. According to the linear mixed model, prostate ratio volume, and according to Wilcoxon signed ranks test, the number of prostates with intraprostatic cysts decreased significantly (both P<.001) after PH repair, but the proportion of prostates located in the caudal or perineal area did not. Small mineralizations remained in some dogs.

Bloqueio epidural para herniorrafia perineal bilateral em cão

In this case report, we describe the technique of epidural block with bupivacaine associated with morphine using the lumbosacral approach to correct a bilateral perineal hernia in a canine patient, 8 years old, mixed breed, not castrated. The combination of general inhalation anesthesia and epidural block was used for multimodal analgesia, reducing the doses of medication necessary to maintain the patient in the anesthetic state, thus minimizing the associated risks. The patient was carefully monitored throughout the procedure, and recovered calmly with no pain in the surgical wound.

Recurrent Perineal Hernia in a Female Cat Diagnosed by Positive-Contrast Vaginourethrocystogram.

A 9 yr old female spayed domestic shorthair was presented with a 12-day history of stranguria. Six years previously, the cat had a bilateral perineal herniorrhaphy with cystopexy and pubic osteotomy. At presentation, survey radiographs and a positive-contrast vaginourethrocystogram were performed, which revealed cystolithiasis and recurrent bilateral perineal hernias with bladder retroflexion. A cystopexy was repeated, followed by bilateral perineal repairs using the internal obturator muscle flap transposition. To the authors' knowledge, this is the first reported case of a perineal hernia with recurrent bladder retroflexion after cystopexy diagnosed with positive-contrast vaginourethrocystogram in a female cat.

Retrospective analysis of perineal herniorrhaphy with cone-shaped polypropylene mesh in dogs: technique description and outcome.

This study aimed to describe the technique for the surgical repair of perineal hernia (PH) in dogs using a polypropylene mesh (PM) and to evaluate its outcomes. All dogs were placed in the Trendelenburg position. Castration and caudal celiotomy for cystopexy and colopexy were performed as needed. Ipsilateral perianal incision was performed in the affected hernia side. A PM was formed a cone-shape with suturing and placed in hernial foramen. The PH was repaired with suturing between PH and pelvic diaphragm including the sacrotuberous ligament, internal obturator muscle, and external anal sphincter muscle. The medical records of all dogs were reviewed to evaluate signalment, perioperative findings, postoperative complications, and prognosis. Of the 22 dogs, 15 were intact, and 7 were previously neutered. The median age and body weight were 10 years and 6.8 kg, respectively. The PH reconstruction using a cone-shaped PM was feasible in all dogs. The median operative time was 60.5 min for unilateral PH and 109 min for bilateral PH. Major postoperative complications occurred in seven dogs (32%), and three dogs (14%) had a recurrence of PH. In the long-term (> 2 weeks) follow-up period, 16 dogs (73%) had an excellent prognosis. Our study suggests that PH reconstruction surgery using a cone-shaped PM may be a viable treatment method for PH in dogs. Therefore, a cone-shaped PM could serve as an alternative treatment option for canine PH reconstruction.

Transperineal Repair of Secondary Perineal Hernia Using a Mesh with a Memory-recoil Ring.

The aim of this study was to evaluate the effectiveness of transperineal repair of secondary perineal hernia (SPH) using a mesh with a memory-recoil ring. Seven patients with SPH who underwent transperineal repair (TPR) between July 2010 and May 2022 were retrospectively analyzed. TPR was performed using a mesh with a memory-recoil ring. All SPHs developed after abdominoperineal resections in patients with anorectal malignancies. The median longitudinal and transverse diameters of the hernia orifice were 8 (7-10) cm and 6 (5-7) cm, respectively. In all cases, the mesh was fixed to the ischial tuberosity, residual levator muscle, coccygeus muscle, and coccyx after thorough dissection of the sac. The median operation time was 154 (142-280) min. Perioperative complications occurred in 2 cases (29%). One was enterotomy, which caused postoperative mesh infection requiring extraction of the mesh. The other was vaginal injury, which resulted in vaginal fistula but closed spontaneously. The median postoperative length of stay was 9 (5-14) days. No recurrence was observed during a median follow-up of 35 (9-151) months. TPR using a mesh with a memory-recoil ring is safe, feasible and promising technique for SPH repairs.

A comparison of surgical techniques for perineal wound closure following perineal excision: a systematic review and network meta-analysis.

To mitigate pelvic wound issues following perineal excision of rectal or anal cancer, a number of techniques have been suggested as an alternative to primary closure. These methods include the use of a biological/dual mesh, omentoplasty, muscle flap, and/or pelvic peritoneum closure. The aim of this network analysis was to compare all the available surgical techniques used in the attempt tomitigate issues associated with an empty pelvis. An electronic systematic search using MEDLINE databases (PubMed), EMBASE, and Web of Science was performed (Last date of research was March 15th, 2023). Studies comparing at least two of the aforementioned surgical techniques for perineal wound reconstruction during abdominoperineal resection, pelvic exenteration, or extra levator abdominoperineal excision were included. The incidence of primary healing, complication, and/or reintervention for perineal wound were evaluated. In addition, the overall incidence of perineal hernia was assessed. Forty-five observational studies and five randomized controlled trials were eligible for inclusion reporting on 146,398 patients. All the surgical techniques had a comparable risk ratio (RR) in terms of primary outcomes. The pooled network analysis showed a lower RR for perineal wound infection when comparing primary closure (RR 0.53; Crl 0.33, 0.89) to muscle flap. The perineal wound dehiscence RR was lower when comparing both omentoplasty (RR 0.59; Crl 0.38, 0.95) and primary closure (RR 0.58; Crl 0.46, 0.77) to muscle flap. Surgical options for perineal wound closure have evolved significantly over the last few decades. There remains no clear consensus on the "best" option, and tailoring to the individual remains a critical factor.

Quality of life in patients with a perineal hernia

IntroductionPatients who develop a perineal hernia after abdominoperineal resection may experience discomfort during daily activities and urogenital dysfunction, but the impact on quality of life has never been formally assessed. Materials and methodsPatients who underwent abdominoperineal resection for rectal cancer between 2014 and 2022 in two prospective multicenter trials were included. Primary outcome was defined as median overall scores or scores on functional and symptom scales of the following quality of life questionnaires: 5-level version of the 5-dimensional EuroQol, Short Form-36, and European Organization for Research and Treatment of Cancer QoL Questionnaire Colorectal cancer 29 and 30, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7. ResultsQuestionnaires were available in 27 patients with a perineal hernia and 62 patients without a perineal hernia. The 5-dimensional EuroQol score was significantly lower in patients with a perineal hernia (83 vs 87, p = 0.048), which implies a reduced level of functioning. The median scores of pain-specific domains were significantly worse in patients with a perineal hernia as measured by the SF-36 (78 vs. 90, p = 0.006), the EORTC-CR29 (17 vs. 11, p=<0.001) and EORTC-C30 (17 vs. 0, p = 0.019). Also, significantly worse physical (73 vs. 100, p = 0.049) and emotional (83 vs. 100, p = 0.048) functioning based on EORTC-C30 was observed among those patients. Minimally important differences were found for role, physical and social functioning of the SF-36 and EORTC-C30. The urological function did not differ between the groups. ConclusionA symptomatic perineal hernia can significantly worsen quality of life on several domains, indicating the severity of this complication.

Perineal Hernia Mesh Repair Using Only the Perineal Approach: How We Do It.

Perineal hernia is a rare complication of rectal surgery. Different types of surgical approach have been described, but none of them have proven their superiority. Although there are many methods of closing the defect, we selected two cases to present from a series of five cases, in which the perineal hernia was successfully resolved surgically using only the perineal approach. The reconstruction of the perineal floor and closure of the defect were performed using a synthetic polypropylene mesh. The significance of this Technical Note article lies in the fact that we describe, step by step, a surgical technique for perineal hernia using just a perineal approach.